Breaking Barriers

Moonju Lee, Ph.D., RN, is conducting research to benefit Koreans Americans who have some of the highest incidences of colorectal cancer but also some of the lowest rates of colorectal cancer screening.
Moonju Lee, Ph.D., RN, is conducting research to benefit South Koreans in the U.S. who have some of the highest incidences of colorectal cancer but also some of the lowest rates of colorectal cancer screening.

Research Dedicated to Preventing Cancer in Korean Americans

By Teri Speece
Imagine you knew you were predisposed to certain types of cancers—but you found it so hard to find a physician, communicate your symptoms, understand medical advice and pay the costs of screening that you ended up doing nothing about it.

Moonju Lee, Ph.D., M.S.N, RN, assistant professor in the School of Nursing, is tackling this issue. Her research addresses emigrants from the Republic of Korea, a rapidly growing U.S. population with some of the highest incidences of colorectal cancer worldwide, yet some of the lowest rates of colorectal cancer screening.

“According to the American Cancer Society, colorectal cancer is the most commonly diagnosed cancer among Korean-American men and the second most common cancer in Korean-American women,” Dr. Lee said. “But, their cancer screening rates are extremely low compared to other Asian American ethnic groups and the overall U.S. population.”

“It’s very hard to find Korean-American data, because most national statistics represent Asian Americans or Asian Americans/Pacific Islanders in aggregate, except in California and Hawaii, where they do break them out,” she said. “But individual Asian groups have different health issues, languages, immigration histories and demographic profiles.”

Dr. Lee’s research into Korean-American health behaviors arose from 17 years’ experience in critical care oncology nursing, six years of research and clinical work in community health and her personal experience emigrating from Korea 20 years ago.

For her Ph.D. from the University of Arizona, she completed her dissertation on barriers to and facilitators of colorectal cancer screening among Korean Americans aged 50 and older. That study involved conducting a survey in the Greater Los Angeles area, mainly Los Angeles and Orange counties, which contain the highest number of Korean Americans in the United States.

Her current study builds on that data using surveys and individual interviews to confirm the previous results and also explore sociocultural beliefs about cancer screening and the experiences of U.S. health care services utilization among Korean Americans in Dallas, Houston, Austin and San Antonio. Dr. Lee conducted 500 surveys and 18 in-depth interviews.

Dr. Lee is currently analyzing survey data but has found important themes from her analysis of the interview study:

Health care providers aren’t recommending screenings. This finding is prevalent in both California and Texas, with every one of the 18 Texas participants citing they had never received colorectal cancer screening recommendations from their doctors. While data indicates the lack of insurance coverage to be a factor, even the participants who had insurance coverage said they did not receive a recommendation—a finding Dr. Lee hopes to explore further in future research.

She suspects a significant difference in communication styles between American doctors and Korean doctors may contribute to this result.
“A Korean physician’s communication style is to force by telling their patients, ‘You have to do your cancer screening.’ In Korean culture, doctors are an authority, and when the doctor tells them to do something, they say, ‘No matter whether I can afford it or not, I have to do it,’ ” she said.

“In the United States, many physicians present it as a choice:

‘If you want, you can have your cancer screening done.’ They leave the decision-making to the patient,” said Dr. Lee. “This difference in communication styles is an important factor contributing to patients’ decision-making. So the patient says, ‘If I don’t have any symptoms, why do I need to be tested?’ ”

The U.S. health care system is costly and difficult to navigate. Most Korean Americans work for small businesses, which do not provide health insurance. Those who have insurance privately or through the U.S. Patient Protection and Affordable Care Act rarely used it for several reasons, including difficulty navigating the U.S. health care system and language barriers.

“Basic communication is possible, but Korean patients often don’t fully express their feelings or their symptoms, and they don’t fully understand what the doctor is talking about,” Dr. Lee said.

Interview subjects also said they are intimidated by the unfamiliarity of the U.S. health care systems, have difficulty finding health care providers in their network, or find it hard to go to multiple places for services such as checkups, radiology and blood work.

“The system is very different from Korea’s, where it is one stop for many services. They can do radiology, blood work, pharmacy, specialists—everything in one building on the same day. They are very complete and speedy,” she said.

Other participants cited the unavailability of specialists when they needed them.

Dr. Lee interviews Korean Americans for her research with the goal of developing robust health promotion programs to reduce health disparities.

“One of the saddest stories I heard was from a lady who fell and had a fracture. She went to the ER, but they said she had to wait a few weeks or months for an orthopedic specialist. She didn’t go to the doctor for six months,” said Dr. Lee. “She finally went to Korea to get treated.”

It’s easier to go home for health care. Dr. Lee’s research also revealed many Koreans prefer to travel back to Korea for routine checkups, screenings and even medication over trying to navigate the U.S. system.

Korean travel agencies advertise medical tour packages offering a cafeteria-style list of services, including health examination, blood work, radiology, and various screenings for $500 to $1,500. “The packages include many options such as dementia checkup, brain MRI, and many cancer screenings,” she said.

Some participants also said they used Korea’s national health insurance program as an alternative to U.S. health care. “It’s much cheaper and easier to get health care services in Korea compared to the U.S.,” Dr. Lee said. “Even if they don’t have Korea’s National Health Insurance plan, they can pay cash to get services.”

In addition to furthering her research, Dr. Lee’s goal is to develop robust health promotion programs to reduce health disparities in this group and build a healthy Korean-American community using community-based participatory research.

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In the 2017 issue of Tribute

Tribute is the official magazine for the alumni and friends of the School of Nursing at The University of Texas Health Science Center at San Antonio. Read and share inspiring stories highlighting our alumni, faculty and students who are revolutionizing education, research, patient care and critical services in the communities they serve.

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