Knowledge, perceptions, and communication about colorectal cancer screening among Chinese American primary care physicians

Background. Colorectal cancer (CRC) is one of the most commonly diagnosed cancers and the third leading cause of cancer death among Chinese Americans. Physician recommendation is the most important determinant of CRC screening. Little is known about Chinese primary care physicians' knowledge, skills, or attitudes toward recommending CRC screening. Methods. Chinese American primary care physicians serving Chinese American patients in two metropolitan areas were invited to complete a mailed survey between July and August 2006. Survey questionnaire included background and practice characteristics, CRC and screening knowledge, preference for shared decision making, attitudes toward CRC screening, and CRC screening recommendation patterns. Results. About half of the 56 respondents did not know the CRC prevalence and mortality figures among Chinese Americans. Those aged 50 and younger, graduating from U.S. medical schools, or working in non-private settings had higher knowledge scores (p<0.01). Physicians graduated from U.S. medical schools perceived more favorably toward sharing medical decisions with their patients (p<0.01). Patient's lack of health insurance, inconsistent guidelines, and insufficient time were the most frequently cited CRC screening recommendation barriers. Most physicians did not share Chinese patients' cultural views on health and cancer. About half recommended shorter colonoscopy intervals or used home-based blood stool tests. Conclusions. Most Chinese American physicians had inadequate knowledge about CRC in Chinese Americans, experienced CRC screening recommendation barriers, and made suboptimal recommendations. Educational programs focusing on Chinese American CRC risks, CRC screening guidelines, and identifying patient cultural barriers are likely to improve CRC screening recommendations among Chinese American physicians.