Unraveling the Determinants to Colorectal Cancer Screening Among Asian Americans: A Systematic Literature Review

Background/Purpose: Colorectal cancer (CRC) is one of the top three cancers experienced among Asian Americans (AA). Examination of CRC screening and determinants to screening among AA subgroups is fairly recent; and there appears to be no published papers that systematically synthesized this information among subgroups except for Korean Americans. As such, the aim of this study is to expand current knowledge and examine determinants to screening organized as facilitators (i.e., factors that positively affect screening uptake) and barriers (i.e., factors that negatively affect screening uptake) among multiple subgroups: Chinese Americans (CA), Filipino Americans (FA), Korean Americans (KA), and Japanese Americans (JA). Findings from this study can help inform targeted areas when developing interventions to promote screening uptake for AA ethnic subgroups.

Methods: A systematic literature review was conducted in August 2016 using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Five academic databases were examined using the search string “colorectal cancer AND screening AND [Chinese, Filipino, Korean, and Japanese] American.” Each subgroup was independently entered. Inclusion criteria included: studies conducted in the U.S., studies must evaluate factors associated with CRC screenings as their outcome measure, the subgroups as a disaggregated measure must be included in the studies, and no publication date restriction was imposed. This study coded and organized the facilitators and barriers by three primary categories: predisposing characteristics, psychological constructs, and cues to action. In total, 22 articles were included for analyses and synthesis. The 22 articles yielded 29 separate examinations of the subgroups: CA (9), FA (7), KA (8), and JA (5).

Results: Across all subgroups physician recommendation was a facilitator and not having health problems and unawareness of screening tests were barriers to screening. For CA, higher acculturation level to U.S. was a facilitator and emotional responses to screening (i.e., embarrassment of undergoing specific screening tool and fearing the screening outcomes) were barriers. For FA, quality patient-provider relation was a facilitator. For KA, access to healthcare was a facilitator and low socioeconomic status was a barrier. For JA, quality patient-provider relations, social support from family and friends, and positive behavioral norm of CRC screening were facilitators.

Conclusion and Implications: External cues to action and personal health factors were notable determinants of CRC screening across all subgroups. This study showcased distinct determinants that influenced CRC screening for each of the subgroups. Future intervention efforts should consider increasing education on CRC disease process and screening options in fostering patient’s knowledge base and advancing informed and shared decision-making across all the subgroups. In particular, Chinese may benefit from supportive services to address specific psychological barriers throughout the entire spectrum of the screening process. Filipino may benefit from enhanced patient-provider communication. Koreans may benefit if barriers are reduced to accessing the healthcare system. Finally, Japanese may also benefit from enhanced patient-provider communication, in addition to inclusion of their family and/or friends when discussing and counseling patients on screening.