A Physician-Based Trial to Increase Colorectal Cancer Screening in Chinese

描述（由申请人提供）：结直肠癌（CRC）是最常见的诊断癌症之一，也是华裔美国人（亚裔美国人和太平洋岛民中最大的亚组）癌症死亡的第三大原因。老年华裔美国人大多是移民，面临着独特的文化障碍，在美国CRC筛查率最低。医生的推荐是老年人ZRC筛查的最重要决定因素。不幸的是，中国人从讲中文的医生那里寻求治疗的人比那些看讲英语的医生的人更少接受CRC筛查建议。我们组建了一支经验丰富的跨学科、多文化、双语团队，在社会认知理论的指导下，与华盛顿和费城地区的中国医生和他们的中国患者进行社区基层医疗研究。具体目标是通过观察收入开发一种干预措施，以提高中国医生在文化上适当沟通CRC的技能，并进行一项随机对照试验，以评估这种基于医生的干预措施对年龄在50岁及以上不遵守筛查的无症状美籍华人患者的CRC筛查率的影响。我们地区有110多名中国医生。我们与54位华裔美国初级保健医生（PCP）进行了形成性工作，以了解他们对CRC筛查的障碍。这项形成性工作的结果已被用于为干预提供信息。30名中国PCP将被随机分配到干预组或常规护理组。干预组的医生将收到（1）邮寄的关于CRC筛查和沟通技巧的文化上适当的教育材料，用于识别患者障碍的工具包，以及筛查跟踪系统的示例;（2）两次标准化中国患者的在职培训，以提高制定筛查建议的技能和自我效能。我们还将录音样本的遭遇，以了解有关CRC筛查的实际沟通。自上次提交以来，一项由NCI资助的试点研究的初步结果表明，邮寄材料和在职培训是可行的，并为中国医生所接受。主要结果将是600例年龄在50岁及以上的非依从性美籍华人患者（每位医生20例）干预后1年的CRC筛查率。这项研究符合NCI的计划，即通过新的干预研究来减少少数群体的癌症健康差异，以确定并成功克服癌症筛查的社会文化和卫生系统障碍。这项拟议的研究将是第一项使用文化上适当的、有理论基础的医生干预来提高华裔美国人CRC筛查率的研究。如果有效，这种干预措施将具有高度的可移植性，并广泛覆盖医生受众，并在不断增长的中国人口中增加筛查。这种方法也应该是广泛便携式发展文化上适当的初级保健癌症控制干预措施，在其他少数群体。

DESCRIPTION (provided by applicant): Colorectal cancer (CRC) is one of the most commonly diagnosed cancers and the third leading cause of cancer death among Chinese Americans, the largest sub-group of Asian American and Pacific Islanders. Older Chinese Americans, who are mostly immigrants, face unique cultural barriers to screening and have among the lowest CRC screening rates in the US. Physician recommendation is the most important determinant of ZRC screening in older Chinese. Unfortunately, Chinese seeking care from Chinese-speaking physicians eceive CRC screening recommendations less often than those seeing English-speaking providers. We have assembled an experienced interdisciplinary, multi-cultural, bilingual team to conduct community primary care-based research guided by the Social Cognitive Theory with Chinese physicians and their Chinese patients in the Washington DC and the Philadelphia areas. The specific aims are to develop an intervention to mprove Chinese physicians' skills in culturally appropriate communication about CRC through observational earning, and conduct a randomized controlled trial to evaluate the impact of this physician-based intervention on CRC screening rates among their asymptomatic Chinese-American patients ages 50 and older who are non-adherent to screening. There are more than 110 Chinese physicians in our area. We have conducted formative work with 54 Chinese American primary care physicians (PCP's) to understand their barriers to CRC screening. Results from this formative work have been used to inform the intervention. Thirty Chinese PCP's will be randomized to the intervention or the usual care group. Physicians in the intervention group will receive (1) mailed culturally appropriate educational materials on CRC screening and communication skills, tool kits for identifying patient barriers, and examples of tracking systems for screening and (2) two sessions of in-office training with standardized Chinese patients to increase skills and self-efficacy for making screening recommendations. We will also audio-tape a sample of encounters to understand actual communication about CRC screening. Preliminary results from an NCI-funded pilot study awarded since the last submission show that the mailed materials and in-office training are feasible and acceptable to Chinese physicians. The main outcome will be CRC screening rates of 600 non-adherent Chinese American patients aged 50 and older (20 per physician) one year post-intervention. This research is consistent with the NCI's plan to reduce cancer health disparities in minority groups via new intervention research to identify and successfully overcome sociocultural and health system barriers to cancer screening. The proposed research will be the first study to use a culturally appropriate, theoretically-grounded physician intervention to improve CRC screening rates in Chinese Americans. If effective, this intervention will be highly transportable and have broad reach to physician audiences and increase screening in the growing Chinese population. This approach should also be broadly portable to developing culturally appropriate primary care cancer control interventions in other minority groups.