A Mixed Method Study of Physician-Patient Communication on Colorectal Cancer Screening among Older Chinese and Korean Americans

Background/Objective: Chinese and Korean Americans have one of the lowest colorectal cancer screening (CRCS) rates among all racial/ethnic groups. This study aims to examine the role of physician-patient communication on CRCS by utilizing quantitative and qualitative methods.

Method: 120 Chinese and Korean Americans aged 50-75 recruited from Washington D.C. metropolitan area participated in 12 focus groups and surveys.  Age, education, income, health insurance, and regular doctor were adjusted in multivariate-adjusted analyses.

Results: Participants who received physician recommendation were 9 times more likely to get CRCS. This association was stronger among those well-educated, high-income, and more acculturated participants. For those who received physician recommendation, married people tended to be more likely to follow the instruction. Participants who brought up CRCS with a physician were 2.8 times more likely to get CRCS. Qualitative findings showed that if physicians did not bring up CRCS or their family/friends had CRCS, the participants were more likely to initiate the conversation. Family and friend recommendations doubled the likelihood of getting CRCS. Focus group findings suggested that if family/friends had positive CRCS experience or if participants knew someone with CRC, they were more likely to get CRCS. Having a primary care physician raised the probability of getting CRCS by 3.5 times. Qualitative data revealed that linguistic concordance and cultural competence enhanced effective communication between physicians and patients and ultimately built stronger trust.

Conclusions: Findings suggest that physician-patient communication is crucial in increasing CRCS. Future interventions should include culturally appropriate education on effective patient-physician communication.