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

简介(申请人提供)：结直肠癌(CRC)是华裔美国人中最常见的癌症之一，也是导致癌症死亡的第三大原因。华裔美国人是亚裔美国人和太平洋岛民中最大的亚裔群体。年长的华裔美国人大多是移民，他们在筛查方面面临着独特的文化障碍，是美国结直肠癌筛查率最低的人群之一。医生推荐是中国老年人ZRC筛查最重要的决定因素。不幸的是，向说中文的医生寻求治疗的中国人收到结直肠癌筛查建议的频率低于那些看英语医生的人。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，与华盛顿特区和费城地区的中国医生及其中国患者开展基于社区初级保健的研究。具体目的是开发一种干预措施，通过观察收入来提高中国医生在与结直肠癌相关的文化沟通方面的技能，并进行一项随机对照试验，以评估这种基于医生的干预对50岁及以上不坚持筛查的无症状华裔美国患者结直肠癌筛查率的影响。我们地区有110多名中国医生。我们对54名华裔美国初级保健医生(PCP‘s)进行了形成性工作，以了解他们对结直肠癌筛查的障碍。这项形成性工作的结果已被用来为干预提供信息。将30例中国PCP患者随机分为干预组和常规护理组。干预组的医生将收到(1)邮寄的关于结直肠癌筛查和沟通技能的文化合适的教育材料，用于识别患者障碍的工具包，以及筛查跟踪系统的示例，以及(2)与标准化的中国患者一起进行的两次办公室培训，以提高提出筛查建议的技能和自我效能。我们还将录制一段会面的样本，以了解有关CRC筛查的实际沟通。自上次提交以来，由NCI资助的一项试点研究的初步结果表明，邮寄的材料和在职培训是可行的，中国医生可以接受。主要结果将是干预一年后600名50岁及以上(每个医生20名)的非粘附性华裔美国患者的CRC筛查率。这项研究与NCI通过新的干预研究来确定并成功克服癌症筛查的社会文化和卫生系统障碍来减少少数群体癌症健康差距的计划是一致的。这项拟议的研究将是第一项使用文化上合适的、理论上有根据的医生干预来提高华裔美国人结直肠癌筛查率的研究。如果有效，这种干预措施将具有很高的可移动性，可以广泛接触到医生受众，并在不断增长的中国人口中增加筛查。这种方法也应该广泛可移植到在其他少数群体中制定文化上合适的初级保健癌症控制干预措施。

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.