Abstract A37: Colorectal cancer screening: Does racial/ethnic and language concordance matter?

Abstract

Objectives: Asian Americans are the only racial/ethnic population to experience cancer as the leading cause of death. Barriers to cancer screening among Asian Americans have been widely studied; however, the importance of concordance that may link to health care disparities has yet to be studied in the Asian-American population. Racial/ethnic and language concordance is found to foster trust, communication and better patient-provider interaction, but whether it can also improve compliance of cancer screening guidelines remain unknown. The purpose of this study was to examine how physician racial/ethnic and language concordance may motivate colorectal cancer screening (CRS) using Fecal Occult Blood Test (FOBT) among Chinese Americans.

Methods: This study used a prospective, quasi-experimental design. Participants in this study were recruited through a Chinese American community-based organization's homemaker program. The homemaker program has six teams, about 40 homemakers per team, to provide basic care to local elderly clients. The six teams were randomly assigned to one of the three CRS education sessions. Presenters of the educational sessions were all male physicians and different in their race/ethnicity and language capacity: 1) Chinese and Chinese-speaking presenter, 2) Chinese and English-speaking presenter with interpreter; and 3) White and English-speaking presenter with interpreter. A culturally tailored presentation was given during the sessions. Participants who agreed to participate in the study were asked to fill out a bilingual pre- and post-survey. Each participant was offered a no-cost FOBT kit at the end of the session, and had four weeks to mail back the FOBT kit. The two main independent variables were racial/ethnic and language concordances. Racial/ethnic concordance was determined by the presenter's race/ethnicity, while language concordance was determined by the use of an interpreter. The main dependent variable of interest was the return of FOBT kit.

Results: A total of 337 homemakers participated in the education sessions. Following the recommendation guideline for CRS, only participants who were older than 49 years old were included in the final data analysis. A total of 224 participants met the age criterion. There were only 21 male participants. 99% of the participants were foreign-born and 59% had no high school education. Only 13% reported their English speaking skill fair to fluent. About half the participants had a primary care physician and only 27% have ever had CRS. 61% of the participants returned their FOBT within 4 weeks. The Chinese and Chinese-speaking presenter group had the lowest return rate, 49%, compared to 61% for the White and English-speaking presenter group and 72% for the Chinese and English-speaking presenter group (p = .019). For race/ethnic concordance only, the return rate was 60.7% for Chinese presenters and 60.5% for the White presenter; while for language concordance only, the return rate was 49.3 for Chinese-speaking presenter and 66.2% for the English-speaking presenters with interpreters (p =.016).

Conclusion: This preliminary study provides important information on how race/ethnic and language concordance might influence CRS behaviors. Our findings, which were congruent with other studies, showed that interpreter use could overcome language barrier. Although we couldn't find significant differences in race/ethnic concordance, Chinese and English-speaking presenter group had the highest return rate. Whether a Chinese and English-speaking physician is more trustworthy than a Chinese and Chinese-speaking physician among Chinese immigrants, further study is warranted to explore this phenomenon.

Citation Format: Karen Kim, Edwin Chandraskar, Helen Lam. Colorectal cancer screening: Does racial/ethnic and language concordance matter? [abstract]. In: Proceedings of the Seventh AACR Conference on The Science of Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; Nov 9-12, 2014; San Antonio, TX. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2015;24(10 Suppl):Abstract nr A37.