Abstract PR7: Patient-provider communication and colorectal cancer screening in three Asian communities

Abstract

Objectives: Unlike other cancer screening tests, which rely on early detection, colorectal cancer screening (CRS) provides an opportunity for prevention since most colorectal cancer (CRC) begin as a benign polyp. However, over 20 million people age 50 to 75 in the U.S. have never undergone CRS. Furthermore, lower screening rates were observed among minority groups, especially immigrants with low English proficiency (LEP). The purpose of this study was to explore patient-provider communication on CRS among three LEP Asian immigrant subgroups (Chinese, Vietnamese and Cambodian).

Methods: This was a cross-sectional study using data collected from the Chicago Asian Community Survey (CACS). Participants were recruited from three Asian communities, Chinese, Cambodian and Vietnamese, using a three-stage random sampling of the Chinese community and Respondent Driven Sampling (RDS) of the Cambodian and Vietnamese communities. The CACS consisted of face-to-face interviews and was conducted following cultural and language-specific survey guidelines. The survey questionnaire was developed from several validated national health surveys, including the Centers for Disease Control and Prevention's Behavioral Risk Factor Surveillance System (BRFSS), National Health and Nutrition Examination Survey (NHANES), and the National Health Interview Survey (NHIS). Patient-provider communication was measured by the language the doctor spoke and self-reported understanding information given by health providers.

Results: A total of 783 participants completed the survey and 465 of them aged 50 or older. The proportion of adults aged 50 or older who reported ever having a sigmoidoscopy or a colonoscopy was 27% Chinese, 31% Vietnamese, and 36% Cambodian. Only 14% Chinese, 5% Vietnamese and 9% Cambodian reported speaking well to very well English; however, 23% Chinese, 44% Vietnamese and 100% Cambodian had English-speaking doctors. More than half of Cambodian participants (56%) had difficulty understanding information given by their health providers, compared to 16% and 13% Chinese and Vietnamese participants respectively. Interestingly, among the Cambodian cohort who reported understanding their physician (44%), only 17% of this group reported having CRS. In contrast, among those who reported difficulty with physician communication, 51% reported past CRS. This paradox was not found among the Chinese and Vietnamese subgroups. For Cambodian participants, understanding information given by their health providers alone accounted for 16% to 22% of the variance, and Cambodian participants who reported understanding information given by their health providers were less likely to have screened before (OR = .148, 95%CI .042-.519). Even after adjusting for socio-economic characteristics (having insurance coverage, having a regular place for health care, age, years in the U.S, employment status and education levels), the significance remained (OR = .126, 95%CI .028-.585).

Conclusion: The CRS rates remain suboptimal across the three Asian subgroups. Studies have shown that provider prescription of certain health services can vary by race/ethnicity of the patient. In addition, disparate communication between patient and provider, which can stem from language proficiency and cultural differences, may further hinder CRS uptake among Asian immigrants. Our finding suggests that there is a need for cultural competent and linguistic appropriate care to improve CRS uptake in LEP, underserved Asian immigrants. Our study also highlights the need for further research on disaggregated Asian subgroups in order to better understand the role of patient-provider communication on CRS uptake.

This abstract is also presented as Poster A13.

Citation Format: Karen Kim, Edwin Chandraskar, Helen Lam. Patient-provider communication and colorectal cancer screening in three Asian communities. [abstract]. In: Proceedings of the Sixth AACR Conference: The Science of Cancer Health Disparities; Dec 6–9, 2013; Atlanta, GA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2014;23(11 Suppl):Abstract nr PR7. doi:10.1158/1538-7755.DISP13-PR7