Strong Carol, Ji Cheng Shuang, Liang Wenchi, Ma Grace, Brown Roger, Wang Judy Huei-yu
Author Affiliations: Department of Health, Behavior & Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland (Dr Strong); Cancer Control Program, Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, DC (Drs Ji, Liang, and Wang); Department of Public Health and Center for Asian Health, Temple University, Philadelphia, Pennsylvania (Dr Ma); and School of Nursing, University of Wisconsin-Madison (Dr Brown).
Cancer Nurs. 2014 Mar-Apr;37(2):106-13. doi: 10.1097/NCC.0b013e3182888b5b.
Colorectal cancer (CRC) is one of the leading causes of cancer death in Chinese Americans, but their CRC screening rates remain low.
We examined subgroups of Chinese American patients nonadherent to CRC screening guidelines to better inform clinical practices to effectively promote screening.
Using latent class analysis of data from 327 participants recruited from 18 primary care clinics, we classified nonadherent patients based on sociodemographics, screening barriers, and attitudinal and clinical factors for CRC screening.
The best-fitting latent class analysis model described 3 distinctive classes: Western healthcare class (36%), Eastern healthcare class (18%), and mixed healthcare class (46%). Western healthcare class patients were highly educated, with average US residency of 20 years, a high level of English proficiency, the least Eastern cultural views of care, and the greatest exposure to physician recommendations, but reported having no time for screenings. Eastern healthcare class patients were highly educated seniors and recent immigrants with the least CRC knowledge and the most Eastern cultural views. Mixed healthcare class patients had low level of education, resided in the United States for 20 years, and half had sought services of their physicians for at least 3 years, but their knowledge and cultural views were similar to those of Eastern healthcare class patients.
Nonadherent Chinese American patients are heterogeneous. It is essential to have future intervention programs tailored to address specific screening beliefs and barriers for subtypes of nonadherent patients.
Training primary care physicians to recognize patients' different demographic characteristics and healthcare beliefs may facilitate physicians' communication with patients to overcome their barriers and improve screening behaviors.
结直肠癌（CRC）是美籍华人癌症死亡的主要原因之一，但他们的CRC筛查率仍然很低。
我们研究了不遵守CRC筛查指南的美籍华人患者亚组，以便更好地为有效促进筛查的临床实践提供信息。
通过对从18家初级保健诊所招募的327名参与者的数据进行潜在类别分析，我们根据社会人口统计学、筛查障碍以及CRC筛查的态度和临床因素对不遵守筛查的患者进行分类。
拟合度最佳的潜在类别分析模型描述了3个不同的类别：西方医疗保健类别（36%）、东方医疗保健类别（18%）和混合医疗保健类别（46%）。西方医疗保健类别患者受教育程度高，在美国平均居住20年，英语水平高，对东方护理文化观点最少，接触医生建议最多，但报告没有时间进行筛查。东方医疗保健类别患者是受教育程度高的老年人和新移民，对CRC知识最少，对东方文化观点最多。混合医疗保健类别患者教育程度低，在美国居住20年，一半人寻求医生服务至少3年，但他们的知识和文化观点与东方医疗保健类别患者相似。
不遵守筛查的美籍华人患者是异质的。未来必须制定有针对性的干预计划，以解决不遵守筛查患者亚型的特定筛查信念和障碍。
培训初级保健医生认识患者不同的人口统计学特征和医疗保健信念，可能有助于医生与患者沟通，克服他们的障碍，改善筛查行为。
