Journal of Immigrant and Minority Health

, Volume 11, Issue 4, pp 302–309 | Cite as

Why are Korean American Physicians Reluctant to Recommend Colorectal Cancer Screening to Korean American Patients? Exploratory Interview Findings

  • Angela M. Jo
  • Annette E. Maxwell
  • Albert J. Rick
  • Jennifer Cha
  • Roshan Bastani
Original Paper


Background Korean Americans have one of the lowest screening rates for colorectal cancer. Although physician recommendation is one of the most important predictors of cancer screening across populations, only few Korean American patients receive such a recommendation. Methods We interviewed 14 Korean American physicians in Los Angeles area who primarily serve Korean Americans to explore why they are reluctant to recommend colorectal cancer screening to their Korean patients. Results Physicians identified barriers attributable to themselves (i.e., lack of knowledge, fear of medicolegal liability), their patients (i.e., patient’s unfamiliarity with the concept of screening), and the health care system (i.e., lack of referral network, poor reimbursement). Discussion Our results suggest the need for multi-faceted interventions directed at the physicians, their patients, and the health care system. Further research is needed to validate our results and to assess the extent to which they apply to physicians from other racial/ethnic groups.


Colorectal cancer Cancer screening Korean Americans Physician barriers Physician recommendation 



Sources of support for this research: grant number U01CA114640 from the Center to Reduce Cancer Health Disparities/National Cancer Institute; UCA Jonsson Comprehensive Cancer Foundation Research Fellowship grant; training grant R25 CA 87949 from the National Cancer Institute. The contents of this paper are solely the responsibility of the authors and do not necessarily represent the official views of the National Cancer Institute.


  1. 1.
  2. 2.
    U.S. Department of Commerce Bureau of Census. Statistical Brief. United States, November 2000.Google Scholar
  3. 3.
    Maxwell AE, Song H. Cancer screening of Korean Americans in Los Angeles County: adding pieces to the puzzle. Korean Korean-Am Stud Bull. 2003;13:59–70.PubMedGoogle Scholar
  4. 4.
    Chen MS Jr. A 1993 Status report on the Health Status of Asian Pacific Islander Americans: comparisons with healthy people 2000 objectives. Asian Am Pac Isl J Health. 1993;1(1):37–55.PubMedGoogle Scholar
  5. 5.
    Koh HK, Koh HC. Health issues in Korean Americans. Asian Am Pac Isl J Health. 1993;1(2):176–93.PubMedGoogle Scholar
  6. 6.
    Lin-Fu JS. Asian and Pacific Islander Americans: an overview of demographic characteristics and health care issues. Asian Am Pac Isl J Health. 1993;1(1):20–36.PubMedGoogle Scholar
  7. 7.
    California Cancer Facts & Figures. American Cancer Society; 2002.Google Scholar
  8. 8.
    California Cancer Facts and Figures. American Cancer Society; 2005.Google Scholar
  9. 9.
    California Cancer Facts and Figures. American Cancer Society; 2007.Google Scholar
  10. 10.
    U.S. Preventive Services Task Force, Agency for Healthcare Research and Quality. U.S. Preventive Services Task Force (USPSTF) recommendations; 2007.Google Scholar
  11. 11.
    Juon HS, Han W, Shin H, Kim KB, Kim MT. Predictors of older Korean Americans’ participation in colorectal cancer screening. J Cancer Educ. 2003;18(1):37–42. doi: 10.1207/S15430154JCE1801_13.PubMedCrossRefGoogle Scholar
  12. 12.
    Kim K, Yu ES, Chen EH, Kim J, Brintnall RA. Colorectal cancer screening. Knowledge and practices among Korean Americans. Cancer Pract. 1998;6(3):167–75. doi: 10.1046/j.1523–5394.1998.006003167.x.PubMedCrossRefGoogle Scholar
  13. 13.
    Maxwell AE, Bastani R, Warda US. Demographic predictors of cancer screening among Filipino and Korean immigrants in the United States. Am J Prev Med. 2000;18(1):62–8. doi: 10.1016/S0749-3797(99)00110-5.PubMedCrossRefGoogle Scholar
  14. 14.
    Sarna L, Tae YS, Kim YH, Brecht ML, Maxwell AE. Cancer screening among Korean Americans. Cancer Pract. 2001;9(3):134–40. doi: 10.1046/j.1523-5394.2001.009003134.x.PubMedCrossRefGoogle Scholar
  15. 15.
    Ask CHIS. California Health Interview Survey. (2005). Accessed in March 2008.
  16. 16.
    Bastani R, Marcus AC, Maxwell AE, Das IP, Yan KX. Evaluation of an intervention to increase mammography screening in Los Angeles. Prev Med. 1994;23(1):83–90. doi: 10.1006/pmed.1994.1012.PubMedCrossRefGoogle Scholar
  17. 17.
    Hay JL, Ford JS, Klein D, Primavera LH, Buckley TR, Stein TR, et al. Adherence to colorectal cancer screening in mammography-adherent older women. J Behav Med. 2003;26(6):553–76. doi: 10.1023/A:1026253802962.PubMedCrossRefGoogle Scholar
  18. 18.
    Honda K. Factors associated with colorectal cancer screening among the US urban Japanese population. Am J Public Health. 2004;94(5):815–22.PubMedCrossRefGoogle Scholar
  19. 19.
    Klabunde CN, Vernon SW, Nadel MR, Breen N, Seeff LC, Brown ML. Barriers to colorectal cancer screening: a comparison of reports from primary care physicians and average-risk adults. Med Care. 2005;43(9):939–44. doi: 10.1097/ Scholar
  20. 20.
    Maxwell AE, Bastani R, Warda US. Misconceptions and mammography use among Filipino-and Korean-American women. Ethn Dis. 1998;8(3):377–84.PubMedGoogle Scholar
  21. 21.
    Maxwell AE, Bastani R, Warda US. Mammography utilization and related attitudes among Korean-American women. Women Health. 1998;27(3):89–107. doi: 10.1300/J013v27n03_07.PubMedCrossRefGoogle Scholar
  22. 22.
    Seeff LC, Nadel MR, Klabunde CN, Thompson T, Shapiro JA, Vernon SW, et al. Patterns and predictors of colorectal cancer test use in the adult U.S. population. Cancer. 2004;100(10):2093–103. doi: 10.1002/cncr.20276.PubMedCrossRefGoogle Scholar
  23. 23.
    Tang TS, Solomon LJ, McCracken LM. Barriers to fecal occult blood testing and sigmoidoscopy among older Chinese-American women. Cancer Pract. 2001;9(6):277–82. doi: 10.1046/j.1523-5394.2001.96008.x.PubMedCrossRefGoogle Scholar
  24. 24.
    McGregor SE, Hilsden RJ, Murray A, Bryant HE. Colorectal cancer screening: practices and opinions of primary care physicians. Prev Med. 2004;39(2):279–85. doi: 10.1016/j.ypmed.2004.03.037.PubMedCrossRefGoogle Scholar
  25. 25.
    Schroy PC 3rd, Barrison AF, Ling BS, Wilson S, Geller AC. Family history and colorectal cancer screening: a survey of physician knowledge and practice patterns. Am J Gastroenterol. 2002;97(4):1031–6. doi: 10.1111/j.1572-0241.2002.05624.x.PubMedCrossRefGoogle Scholar
  26. 26.
    Sharma VK, Corder FA, Raufman JP, Sharma P, Fennerty MB, Howden CW. Survey of internal medicine residents’ use of the fecal occult blood test and their understanding of colorectal cancer screening and surveillance. Am J Gastroenterol. 2000;95(8):2068–73. doi: 10.1111/j.1572-0241.2000.02229.x.PubMedCrossRefGoogle Scholar
  27. 27.
    Bodle EE, Islam N, Kwon SC, Zojwalla N, Ahsan H, Senie RT. Cancer screening practices of Asian American physicians in new york city. J Immigr Minor Health. 2008;10(3):239–46. doi: 10.1007/s10903-007-9077-3.CrossRefGoogle Scholar
  28. 28.
    Cornuz J, Ghali WA, Di Carlantonio D, Pecoud A, Paccaud F. Physicians’ attitudes towards prevention: importance of intervention-specific barriers and physicians’ health habits. Fam Pract. 2000;17(6):535–40. doi: 10.1093/fampra/17.6.535.PubMedCrossRefGoogle Scholar
  29. 29.
    Fairfield KM, Chen WY, Colditz GA, Emmons KM, Fletcher SW. Colon cancer risk counseling by health-care providers: perceived barriers and response to an internet-based cancer risk appraisal instrument. J Cancer Educ. 2004;19(2):95–7. doi: 10.1207/s15430154jce1902_9.PubMedCrossRefGoogle Scholar
  30. 30.
    Gennarelli M, Jandorf L, Cromwell C, Valdimarsdottir H, Redd W, Itzkowitz S. Barriers to colorectal cancer screening: inadequate knowledge by physicians. Mt Sinai J Med. 2005;72(1):36–44.PubMedGoogle Scholar
  31. 31.
    Katz ML, James AS, Pignone MP, Hudson MA, Jackson E, Oates V, et al. Colorectal cancer screening among African American church members: a qualitative and quantitative study of patient–provider communication. BMC Public Health. 2004;4:62. doi: 10.1186/1471-2458-4-62.PubMedCrossRefGoogle Scholar
  32. 32.
    Jo AM, Maxwell AE, Wong WK, Bastani R. Colorectal cancer screening among underserved Korean Americans in Los Angeles County. J Immigr Minor Health. 2008;10(2):119–26. doi: 10.1007/s10903-007-9066-6.CrossRefGoogle Scholar
  33. 33.
    Crabtree BF, Miller WL. A qualitative approach to primary care research: the long interview. Fam Med. 1991;23(2):145–51.PubMedGoogle Scholar
  34. 34.
    Miller WL, Crabtree BF. Qualitative analysis: how to begin making sense. Fam Pract Res J. 1994;14(3):289–97.PubMedGoogle Scholar
  35. 35.
    McCracken M, Olsen M, Chen MS Jr, Jemal A, Thun M, Cokkinides V, et al. Cancer incidence, mortality, and associated risk factors among Asian Americans of Chinese, Filipino, Vietnamese, Korean, and Japanese ethnicities. CA Cancer J Clin. 2007;57(4):190–205.PubMedCrossRefGoogle Scholar
  36. 36.
    Jenkins CN, McPhee SJ, Bird JA, Pham GQ, Nguyen BH, Nguyen T, et al. Effect of a media-led education campaign on breast and cervical cancer screening among Vietnamese-American women. Prev Med. 1999;28(4):395–406. doi: 10.1006/pmed.1998.0444.PubMedCrossRefGoogle Scholar
  37. 37.
    Lew AA, Moskowitz JM, Ngo L, Wismer BA, Wong JM, Ahn Y, et al. Effect of provider status on preventive screening among Korean American women in Alameda County, California. Prev Med. 2003;36(2):141–9. doi: 10.1016/S0091-7435(02)00039-7.PubMedCrossRefGoogle Scholar
  38. 38.
    Cauffman JG, Forsyth RA, Clark VA, Foster JP, Martin KJ, Lapsys FX, et al. Randomized controlled trials of continuing medical education: what makes them most effective? J Contin Educ Health Prof. 2002;22(4):214–21. doi: 10.1002/chp. 1340220405.PubMedCrossRefGoogle Scholar
  39. 39.
    Daly MB, Balshem M, Sands C, James J, Workman S, Engstrom PF. Academic detailing: a model for in-office CME. J Cancer Educ. 1993;8(4):273–80.PubMedCrossRefGoogle Scholar
  40. 40.
    Davis D. Does CME work? An analysis of the effect of educational activities on physician performance or health care outcomes. Int J Psychiatry Med. 1998;28(1):21–39. doi: 10.2190/UA3R-JX9W-MHR5-RC81.PubMedCrossRefGoogle Scholar
  41. 41.
    Davis DA, Thomson MA, Oxman AD, Haynes RB. Changing physician performance. A systematic review of the effect of continuing medical education strategies. J Am Med Assoc. 1995;274(9):700–5. doi: 10.1001/jama.274.9.700.PubMedCrossRefGoogle Scholar
  42. 42.
    Keys PW, Goetz CM, Keys PA, Sterchele JA, Snedden TM, Livengood BH. Computer-guided academic detailing as part of a drug benefit program. Am J Health Syst Pharm. 1995;52(20):2199–203. discussion 2203–4.PubMedGoogle Scholar
  43. 43.
    Sheinfeld Gorin S, Gemson D, Ashford A, Bloch S, Lantigua R, Ahsan H, et al. Cancer education among primary care physicians in an underserved community. Am J Prev Med. 2000;19(1):53–8. doi: 10.1016/S0749-3797(00)00153-7.PubMedCrossRefGoogle Scholar
  44. 44.
    Brown EJ, Ojeda VD, Wyn R, Levan, R. Racial and ethnic disparities in access to health insurance and health care. Los Angeles: UCLA Center for Health Policy Research and the Henry J. Kaiser Family Foundation; 2000.Google Scholar

Copyright information

© Springer Science+Business Media, LLC 2008

Authors and Affiliations

  • Angela M. Jo
    • 1
  • Annette E. Maxwell
    • 2
  • Albert J. Rick
    • 3
  • Jennifer Cha
    • 2
  • Roshan Bastani
    • 2
  1. 1.Department of Family Medicine, David Geffen School of MedicineUniversity of CaliforniaLos AngelesUSA
  2. 2.Division of Cancer Prevention & Control Research, School of Public Health/Jonsson Comprehensive Cancer CenterUniversity of CaliforniaLos AngelesUSA
  3. 3.School of MedicineLoma Linda UniversityLoma LindaUSA

Personalised recommendations