Abstract A105: Participants with lower socioeconomic status or lacking access to health care benefited more from a decision support navigation trial to increase colorectal cancer screening: Study of Chinese and Korean American primary care patients
Authors: Lee Sunmin , Ryu Soomin , Kwan Carissa , Myers Ronald E. , Shi Yuxi , Jiang Luohua , Morey Brittany N. 
Published: January 2023

Background: Although colorectal cancer (CRC) is the second most common cancer among Asian Americans, cancer screening rates among Chinese- and Korean Americans are lower than in other racial/ethnic groups in the United States. To address this disparity, we designed, implemented, and evaluated the effectiveness of a culturally adapted decision support navigation trial. Methods: Twenty-four Chinese and Korean primary care physicians (PCPs) from Maryland and northern Virginia were recruited to the STOP CRC (Screening TO Prevent CRC) program, a cluster randomized controlled trial. The PCPs’ clinics were randomized into intervention or control group. Then, 400 Chinese and Korean Americans were recruited through the PCPs’ clinics. Participants randomized to a decision support navigation intervention group (n=200) received an informational booklet, instructions to access colonoscopy screening, and a free fecal immunochemical test (FIT) kit at baseline. A bilingual patient navigator also guided them through an exercise to facilitate screening test choices. Six months after enrollment, participants randomized to the control group (n=200) received the informational booklet, colonoscopy instructions, and a FIT kit. Participants were offered a choice to select between the FIT or colonoscopy. Screening (completion of FIT or colonoscopy) was measured at 6 and 12 months after enrollment by medical record review and self-report. Generalized estimating equations (GEE) models with an exchangeable working correlation matrix to account for clustering effects at the PCP level were employed to examine intervention effects on CRC screening outcomes. Results: Intervention and control participants were comparable in their socio-demographic background and access to healthcare at baseline. At 12 months, screening adherence in the intervention group was (93%) substantially higher than in the control group (63%) (Prevalence Ratio: 1.51, 95% confidence interval: 1.37-1.66). Interestingly, the effect of the intervention on CRC screening was significantly higher among those with less than or equal to high school education (PR=1.95; 95% CI: 1.89-2.02) compared to those with higher than high school education (PR=1.37; 95% CI: 1.37; 95% CI: 1.22-1.54). Moreover, the impact of the intervention on CRC screening was higher among participants with lower income (&lt;$100,000: PR=1.60; 95% CI: 1.56-1.65) than the participants with higher income (≥$100,000: PR=1.18; 96% CI: 0.85-1.64). The same impact was higher among those without health insurance (PR=1.70; 95% CI: 1.28-2.25) and those with Medicare/Medicaid (PR=1.80, 95% CI: 1.29-2.52) compared to those who have private health insurance (PR=1.35, 95% CI: 1.19-1.53). Conclusions: The STOP CRC program, a culturally and linguistically adapted decision support navigation intervention, is effective in increasing CRC screening among Chinese and Korean American primary care patients who are not up-to-date with the screening. This impact is more pronounced among participants with lower socioeconomic status or lacking access to health care.

Citation Format: Sunmin Lee, Soomin Ryu, Carissa Kwan, Ronald E. Myers, Yuxi Shi, Luohua Jiang, Brittany N. Morey. Participants with lower socioeconomic status or lacking access to health care benefited more from a decision support navigation trial to increase colorectal cancer screening: Study of Chinese and Korean American primary care patients [abstract]. In: Proceedings of the 15th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2022 Sep 16-19; Philadelphia, PA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2022;31(1 Suppl):Abstract nr A105.