Developing and evaluating a culturally appropriate intervention to improve colorectal cancer screening recommendation by Chinese primary care physicians

Background: Chinese Americans are more likely to be diagnosed with late-stage colorectal cancer (CRC) than other Asian groups or Whites. Physician recommendation is a key factor for screening adherence, but Chinese-speaking physicians recommend CRC screening less often than English-speaking physicians.

Objective: To design and evaluate a physician-based intervention to improve Chinese primary care physicians' (PCPs) communication.

Methods: Four Chinese PCPs were recruited from Washington DC and Philadelphia, PA and randomized to intervention or control (usual care). Interventions included printed materials and two subsequent interactive in-office trainings with standardized patients, played by trained Chinese American elderly. Physician performance in the in-office training was observed independently by two trained researchers and discussed at the end of the training. Twenty-five Chinese patients aged 50 and older who did not have colorectal cancer screening in the past year participated in the study from each physician and completed an assessment about CRC communication with physicians and intention for future CRC screening.

Results: Physicians considered the intervention to be very helpful, especially for its inclusion of culturally appropriate communication examples. Physicians also cited that the cultural barriers played by standardized patients helped them practice communication skills. Preliminary patient data indicate that physicians might not discuss screening in a busy practice or with patients if visit for specific health problems.

Conclusions: Physician-based printed materials and in-office training are feasible and acceptable by Chinese PCPs. However, high doses of interventions, such as using screening reminders or CRC communication toolkits, are needed to help physician initiate CRC communication.