Carmen WH Chan
ORCID: http://orcid.org/0000-0003-0696-2369
Prof. Carmen Chan has demonstrated integrated scholarship in pediatric, cancer and palliative care research which has had broad impact on the profession, patients, families, community, and nursing education. Her main fields of research specialization are on symptom management, psychosocial care, sexuality, advance care planning, and cancer screening.
As ‘symptom cluster’ has been acknowledged to be at the cutting edge science in symptom management, her early PhD work on the identification and management of ‘symptom cluster’ in patients with cancer was novel and contributed to the international body of nursing knowledge. It also laid a foundation for her subsequent studies on symptom management including the treatment of oral mucositis, skin rash, breathlessness, fatigue, nausea and vomiting, pain, anxiety and sexual function.
Her palliative care research focuses on the promotion of advance care planning and advance directives, and targets on cancer patients, pediatric patients, elderly and the general public. Her research initiatives on this area have demonstrated an excellent design, innovation, and great impact to the health care profession and the society. She has conducted several community roadshows and surveys to promote advance care planning /advance directives in Hong Kong. Subsequently, Carmen and her team has published a health manual for advance care planning, which has been widely distributed in community road shows, elderly centers, and hospitals. In 2016, Carmen will lounge another GRF projects on a large scale population survey on the acceptance and completion of advance directive in general public.
Esteem factors:
Excellence in Research Award, Sigma Theta Tau International Honor Society of Nursing, 2014.
Honorable advisor for the Association of Palliative Nursing in Hong Kong to promote research and evidenced-based practice in palliative nursing.
Founding member and council member of the Hong Kong College of Education and Research under the Hong Kong Academy of Nursing to advancing nursing scholarship in Hong Kong.
Fellow of Hong Kong Academy of Nursing
Prof. Carmen Chan has demonstrated integrated scholarship in pediatric, cancer and palliative care research which has had broad impact on the profession, patients, families, community, and nursing education. Her main fields of research specialization are on symptom management, psychosocial care, sexuality, advance care planning, and cancer screening.
As ‘symptom cluster’ has been acknowledged to be at the cutting edge science in symptom management, her early PhD work on the identification and management of ‘symptom cluster’ in patients with cancer was novel and contributed to the international body of nursing knowledge. It also laid a foundation for her subsequent studies on symptom management including the treatment of oral mucositis, skin rash, breathlessness, fatigue, nausea and vomiting, pain, anxiety and sexual function.
Her palliative care research focuses on the promotion of advance care planning and advance directives, and targets on cancer patients, pediatric patients, elderly and the general public. Her research initiatives on this area have demonstrated an excellent design, innovation, and great impact to the health care profession and the society. She has conducted several community roadshows and surveys to promote advance care planning /advance directives in Hong Kong. Subsequently, Carmen and her team has published a health manual for advance care planning, which has been widely distributed in community road shows, elderly centers, and hospitals. In 2016, Carmen will lounge another GRF projects on a large scale population survey on the acceptance and completion of advance directive in general public.
Esteem factors:
Excellence in Research Award, Sigma Theta Tau International Honor Society of Nursing, 2014.
Honorable advisor for the Association of Palliative Nursing in Hong Kong to promote research and evidenced-based practice in palliative nursing.
Founding member and council member of the Hong Kong College of Education and Research under the Hong Kong Academy of Nursing to advancing nursing scholarship in Hong Kong.
Fellow of Hong Kong Academy of Nursing
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Papers by Carmen WH Chan
The review aims to identify available evidence related to the effects of dignity therapy on dignity, psychological well‐being, and quality of life (QoL) among patients with cancer under palliative care.
Methods
Thirteen electronic databases were searched for published articles in English or Chinese from inception to May 2018. Methodological rigour was assessed through the Joanna Briggs Institute (JBI) checklist for randomised controlled trials and quasi‐experimental studies. Sufficient data from four trials were statistically pooled with Review Manager; otherwise, a narrative summary was used.
Results
Ten articles describing eight studies met the selection criteria and were included in the review. None of the studies met all JBI checklist criteria. Meta‐analysis results revealed that dignity therapy significantly improved dignity‐related distress in existential distress domain (mean differences [MD]: −0.26, 95% CI, −0.50 to −0.02, .03) and social support domain (MD: −0.23, 95% CI, −0.39 to −0.07, .004), but nonsignificant improved depression and anxiety. Narrative summaries indicated that dignity therapy exerted positive effects on patients' dignity, psychological well‐being, and QoL.
Conclusions
Dignity therapy is a promising approach to improve psychological well‐being among patients with cancer under palliative care. However, the effects of dignity therapy on dignity and QoL are inconsistent. Further extensive studies should measure the impact of dignity therapy through qualitative and quantitative approaches to establish outcomes in psychological well‐being. Studies with sensitivity to the cultural context within which dignity therapy applied should be conducted to explore its effects on patients with cancer at the early stages of illness trajectory.
A life review is a promising intervention to enhance spiritual well-being in older people. Conventional life review interventions are lengthy and often led by psychologists.
Objectives
This is the first randomised controlled trial study to examine the effectiveness and applicability of a nurse-led short term life-review intervention in people with life limiting diseases, the purpose being to enhance their spiritual well-being and lower their anxiety and depression.
Design
A sequential mixed method approach, randomised controlled trial and qualitative evaluation, was adopted. The intervention group received the short version life review, and the control group attention placebo. Participants were randomly assigned to either intervention or control groups by computerised randomisation. Both participants and outcome assessors were blinded to the group assignment.
Settings
The study was conducted in three publicly funded regional hospitals in Hong Kong.
Participants
The target population were people suffering from life-limiting diseases, and receiving hospitalised, day hospice or outreach home care from the palliative care team.
Methods
Two sets of questionnaires were used: the spiritual sub-scale of the McGill Quality of Life Questionnaire, Hong Kong version and the Hospital Anxiety and Depression Scale, Chinese version. The intervention process was assessed by means of observation log sheets and semi-structured interviews of 12 participants.
Results
A total of 109 participants were recruited (54 in the intervention group, 55 in the control group). The intervention group showed significantly more improvement in spiritual well-being than the control group, with a Cohen’s d-effect size of 0.65. Although there were improvements in both anxiety and depression levels in the intervention group, statistical significance in between-group comparisons was not reached. The process evaluation found that most participants were highly involved (92.6%), interested (77.8 %) and participated in the intervention (79.6%). The participants described the intervention process as ‘comfortable’, ‘relaxing’ and ‘interesting’, and felt enlightened, with raised self-awareness, after it.
Conclusion
The nurse-led short term life-review intervention demonstrated significant improvement effects in spiritual well-being. Participant feedback on nurses’ performance was positive, finding the intervention acceptable and useful. The setting of the intervention has now been extended from bedside to home. It is recommended to incorporate life review into palliative nursing specialty training, empowering more nurses to deliver the intervention in their daily practice.
Purpose: To examine the effects of the empowerment intervention on stroke patients’ self-efficacy, self-management behavior, and functional recovery.
Methods: This is a single-blind randomized controlled trial with stroke survivors assigned to either a control group (CG) receiving usual ambulatory rehabilitation care or the HEISS in addition to usual care (intervention group [IG]). Outcome data were collected at baseline (T0), 1 week (T1), 3 months (T2), and 6 months (T3) postintervention. Data were analyzed on the intention-to-treat principle. The generalized estimating equation model was used to assess the differential change of self-efficacy in illness management, self-management behaviors (cognitive symptom management, communication with physician, medication adherence, and self-blood pressure monitoring), and functional recovery (Barthel and Lawton indices) across time points (baseline = T0, 1 week = T1, 3 months = T2, and 6 months = T3 postintervention) between the two groups.
Results: A total of 210 (CG =105, IG =105) Hong Kong Chinese stroke survivors (mean age =69 years, 49% women, 72% ischemic stroke, 89% hemiparesis, and 63% tactile sensory deficit) were enrolled in the study. Those in IG reported better self-efficacy in illness management 3-month (P=0.011) and 6-month (P=0.012) postintervention, along with better self-management behaviors at all follow-up time points (all P<0.05), apart from medication adherence (P>0.05). Those in IG had significantly better functional recovery (Barthel, all P<0.05; Lawton, all P<0.001), compared to CG. The overall dropout rate was 16.7%.
Conclusion: Patient empowerment intervention (HEISS) may influence self-efficacy in illness management and improve self-management behavior and functional recovery of stroke survivors. Furthermore, the HEISS can be conducted in parallel with existing ambulatory stroke rehabilitation services and provide added value in sustaining stroke self-management and functional improvement in the long term.
Objective: The aim of this study is to understand cervical cancer risk perception and the role of personal risk factors as they influence screening behavior among Chinese women.
Method: An exploratory qualitative research design was used. We conducted semistructured, in-depth interviews of 27 women in Changsha, a medium-size city in Hunan province, China.
Results: Participants identified that cervical cancer had serious consequences, but they distanced themselves psychologically from the disease because they felt that “cervical cancer is a shameful and deadly disease.” Although women identified some of the risk factors for the disease, they had little specific knowledge of human papillomavirus infection, its association with cervical cancer, and the importance of cervical screening.
Conclusion: This study contributes new knowledge to the understanding of cervical screening behavior within a specific social and cultural context. Better efforts should be made to educate Chinese women on the risk of cervical cancer and emphasize that effective cancer treatments are available and that there is a good chance of survival.
Implications for Practice: Nurses working with Chinese women should ensure that the information they provide is culturally sensitive, particularly by acknowledging the normative beliefs of this population group.
The prevalence of colorectal cancer (CRC) among older people is high. Screening for CRC presents a cost-effective secondary prevention and control strategy which results in a significant reduction in mortality. This study aims to describe the prevalence of CRC screening and examine its risk factors among Chinese community-dwelling older people guided by a comprehensive model combining Health Belief Model and Extended Parallel Processing Model.
Methods
A descriptive correlational study was conducted. A convenience sample of 240 community-dwelling adults aged ≥60 was recruited in May–July in 2012 in Hong Kong. Participants were asked to complete a questionnaire which collected information on demographic variables, CRC-related psychosocial variables and whether they had a CRC screening in the past 10 years.
Results
Among the participants, 25.4% reported having a CRC screening test. Results of logistic regression analyses indicated that participants with a higher level in cue to action, and lower perceived knowledge barriers and severity-fear were significantly associated with participation in CRC screening. But there were no significant associations between fatalism and cancer fear with screening.
Conclusions
The prevalence of CRC screening was low in Hong Kong Chinese community-dwelling elders. A number of modifiable factors associated with CRC screening were identified which provides specific targets for interventions. This study also adds to the knowledge regarding the associations between fatalism and fear with CRC screening behaviors among Chinese older people.
The purpose of the study was to translate the M.D. Anderson Symptom Inventory-Heart Failure (MDASI-HF), a specific instrument to assess symptoms in cancer patients with concurrent heart failure (HF), into Mandarin Chinese and to examine its psychometric properties in Chinese cancer patients.
Design
A translation and psychometric evaluation design was used.
Methods
The translation of the MDASI-HF into Mandarin Chinese followed Brislin's model with the four steps: translation, monolingual assessment, backward translation, and comparison. The Chinese version MDASI-HF was tested among 135 cancer patients with concurrent HF from a cancer hospital in Tianjin, China. Psychometric properties of content validity, internal consistency, test–retest reliability, concurrent validity, and sensitivity of the instrument were evaluated.
Findings
The Cronbach's α was .913 for the core items, .835 for the HF items, and .897 for the interference items. The test–retest reliability was satisfactory with intra-class coefficients >.9 and content validity index was .94. The Chinese version MDASI-HF was significantly correlated with the Eastern Cooperative Oncology Group performance grade (correlation coefficients .456–.600) and the New York Heart Association classification (correlation coefficients .477–.631), indicating the established concurrent validity of the translated instrument.
Conclusions
The Chinese version MDASI-HF is a valid and reliable instrument to assess the symptoms of Chinese cancer patients with concurrent HF.
Clinical Relevance
Symptom assessment and management play important roles in cancer rehabilitation. The Chinese version MDASI-HF can assist appropriate and timely symptom assessment in cancer patients with concurrent HF and can promote communication between health care professionals and patients. Based on the assessment, the rehabilitation team could provide effective symptom management, evaluate the effectiveness of interventions, and improve patients' quality of life.
Objective: The aim of this study was to evaluate the effectiveness of PEI on managing symptom clusters in patients with cancer.
Methods: Six databases were searched, together with hand searching, to identify eligible randomized controlled trials from the year 2001 to July 2014. Data selection, quality appraisal of studies, and data extraction were conducted independently by 2 reviewers. Data were synthesized by use of a systematic narrative approach, and meta-analysis was conducted when this was possible.
Results: Four eligible studies involving 343 cancer patients were included in the review. The methodological quality of the studies was generally fair. Symptom clusters seemed to improve with the provision of PEI. Meta-analysis shows significant improvement in functional performance.
Conclusions: The evidence that PEI could alleviate cancer symptom clusters is encouraging but inconclusive in this review. Future well-designed investigations testing some commonly used PEI such as progressive muscle relaxation and patient education on various types of cancer symptom clusters are warranted.
Implications for Practice: This review suggests a promising role of PEI in managing cancer symptom clusters. Healthcare providers should increase their awareness of managing symptom clusters using PEI to yield more effective and efficient cancer care.
Colorectal cancer (CRC) is one of the most common cancers. This study aimed to compare the uptake of CRC testing in the general public and in ethnic minorities in Hong Kong.
Materials and Methods:
This cross-sectional survey covered 2,327 South Asian and Chinese adults aged over 50, recruited from two separate studies. A structured questionnaires were administered by research staff over the telephone or in faceto-face interviews.
Results:
The uptake rate of CRC testing among South Asians was significantly lower than that of the general population in Hong Kong. Factors associated with the uptake rate were health professional’s recommendation, perception of regular visits to doctor, use of complementary therapy, ethnicity, perceived susceptibility to cancer, presence of chronic illness, and education level. In addition, a significant interaction (p<0.05) between ethnicity and health professionals’ recommendations was found, after adjustment for the main independent factors identified.
Conclusions:
Older people with lower educational attainment, without chronic illness and those have lower perceived susceptibility to cancer may be targeted for CRC testing promotion in the society. In addition, health professionals can play a highly influential role in promoting such testing, particularly among ethnic minorities.
The review aims to identify available evidence related to the effects of dignity therapy on dignity, psychological well‐being, and quality of life (QoL) among patients with cancer under palliative care.
Methods
Thirteen electronic databases were searched for published articles in English or Chinese from inception to May 2018. Methodological rigour was assessed through the Joanna Briggs Institute (JBI) checklist for randomised controlled trials and quasi‐experimental studies. Sufficient data from four trials were statistically pooled with Review Manager; otherwise, a narrative summary was used.
Results
Ten articles describing eight studies met the selection criteria and were included in the review. None of the studies met all JBI checklist criteria. Meta‐analysis results revealed that dignity therapy significantly improved dignity‐related distress in existential distress domain (mean differences [MD]: −0.26, 95% CI, −0.50 to −0.02, .03) and social support domain (MD: −0.23, 95% CI, −0.39 to −0.07, .004), but nonsignificant improved depression and anxiety. Narrative summaries indicated that dignity therapy exerted positive effects on patients' dignity, psychological well‐being, and QoL.
Conclusions
Dignity therapy is a promising approach to improve psychological well‐being among patients with cancer under palliative care. However, the effects of dignity therapy on dignity and QoL are inconsistent. Further extensive studies should measure the impact of dignity therapy through qualitative and quantitative approaches to establish outcomes in psychological well‐being. Studies with sensitivity to the cultural context within which dignity therapy applied should be conducted to explore its effects on patients with cancer at the early stages of illness trajectory.
A life review is a promising intervention to enhance spiritual well-being in older people. Conventional life review interventions are lengthy and often led by psychologists.
Objectives
This is the first randomised controlled trial study to examine the effectiveness and applicability of a nurse-led short term life-review intervention in people with life limiting diseases, the purpose being to enhance their spiritual well-being and lower their anxiety and depression.
Design
A sequential mixed method approach, randomised controlled trial and qualitative evaluation, was adopted. The intervention group received the short version life review, and the control group attention placebo. Participants were randomly assigned to either intervention or control groups by computerised randomisation. Both participants and outcome assessors were blinded to the group assignment.
Settings
The study was conducted in three publicly funded regional hospitals in Hong Kong.
Participants
The target population were people suffering from life-limiting diseases, and receiving hospitalised, day hospice or outreach home care from the palliative care team.
Methods
Two sets of questionnaires were used: the spiritual sub-scale of the McGill Quality of Life Questionnaire, Hong Kong version and the Hospital Anxiety and Depression Scale, Chinese version. The intervention process was assessed by means of observation log sheets and semi-structured interviews of 12 participants.
Results
A total of 109 participants were recruited (54 in the intervention group, 55 in the control group). The intervention group showed significantly more improvement in spiritual well-being than the control group, with a Cohen’s d-effect size of 0.65. Although there were improvements in both anxiety and depression levels in the intervention group, statistical significance in between-group comparisons was not reached. The process evaluation found that most participants were highly involved (92.6%), interested (77.8 %) and participated in the intervention (79.6%). The participants described the intervention process as ‘comfortable’, ‘relaxing’ and ‘interesting’, and felt enlightened, with raised self-awareness, after it.
Conclusion
The nurse-led short term life-review intervention demonstrated significant improvement effects in spiritual well-being. Participant feedback on nurses’ performance was positive, finding the intervention acceptable and useful. The setting of the intervention has now been extended from bedside to home. It is recommended to incorporate life review into palliative nursing specialty training, empowering more nurses to deliver the intervention in their daily practice.
Purpose: To examine the effects of the empowerment intervention on stroke patients’ self-efficacy, self-management behavior, and functional recovery.
Methods: This is a single-blind randomized controlled trial with stroke survivors assigned to either a control group (CG) receiving usual ambulatory rehabilitation care or the HEISS in addition to usual care (intervention group [IG]). Outcome data were collected at baseline (T0), 1 week (T1), 3 months (T2), and 6 months (T3) postintervention. Data were analyzed on the intention-to-treat principle. The generalized estimating equation model was used to assess the differential change of self-efficacy in illness management, self-management behaviors (cognitive symptom management, communication with physician, medication adherence, and self-blood pressure monitoring), and functional recovery (Barthel and Lawton indices) across time points (baseline = T0, 1 week = T1, 3 months = T2, and 6 months = T3 postintervention) between the two groups.
Results: A total of 210 (CG =105, IG =105) Hong Kong Chinese stroke survivors (mean age =69 years, 49% women, 72% ischemic stroke, 89% hemiparesis, and 63% tactile sensory deficit) were enrolled in the study. Those in IG reported better self-efficacy in illness management 3-month (P=0.011) and 6-month (P=0.012) postintervention, along with better self-management behaviors at all follow-up time points (all P<0.05), apart from medication adherence (P>0.05). Those in IG had significantly better functional recovery (Barthel, all P<0.05; Lawton, all P<0.001), compared to CG. The overall dropout rate was 16.7%.
Conclusion: Patient empowerment intervention (HEISS) may influence self-efficacy in illness management and improve self-management behavior and functional recovery of stroke survivors. Furthermore, the HEISS can be conducted in parallel with existing ambulatory stroke rehabilitation services and provide added value in sustaining stroke self-management and functional improvement in the long term.
Objective: The aim of this study is to understand cervical cancer risk perception and the role of personal risk factors as they influence screening behavior among Chinese women.
Method: An exploratory qualitative research design was used. We conducted semistructured, in-depth interviews of 27 women in Changsha, a medium-size city in Hunan province, China.
Results: Participants identified that cervical cancer had serious consequences, but they distanced themselves psychologically from the disease because they felt that “cervical cancer is a shameful and deadly disease.” Although women identified some of the risk factors for the disease, they had little specific knowledge of human papillomavirus infection, its association with cervical cancer, and the importance of cervical screening.
Conclusion: This study contributes new knowledge to the understanding of cervical screening behavior within a specific social and cultural context. Better efforts should be made to educate Chinese women on the risk of cervical cancer and emphasize that effective cancer treatments are available and that there is a good chance of survival.
Implications for Practice: Nurses working with Chinese women should ensure that the information they provide is culturally sensitive, particularly by acknowledging the normative beliefs of this population group.
The prevalence of colorectal cancer (CRC) among older people is high. Screening for CRC presents a cost-effective secondary prevention and control strategy which results in a significant reduction in mortality. This study aims to describe the prevalence of CRC screening and examine its risk factors among Chinese community-dwelling older people guided by a comprehensive model combining Health Belief Model and Extended Parallel Processing Model.
Methods
A descriptive correlational study was conducted. A convenience sample of 240 community-dwelling adults aged ≥60 was recruited in May–July in 2012 in Hong Kong. Participants were asked to complete a questionnaire which collected information on demographic variables, CRC-related psychosocial variables and whether they had a CRC screening in the past 10 years.
Results
Among the participants, 25.4% reported having a CRC screening test. Results of logistic regression analyses indicated that participants with a higher level in cue to action, and lower perceived knowledge barriers and severity-fear were significantly associated with participation in CRC screening. But there were no significant associations between fatalism and cancer fear with screening.
Conclusions
The prevalence of CRC screening was low in Hong Kong Chinese community-dwelling elders. A number of modifiable factors associated with CRC screening were identified which provides specific targets for interventions. This study also adds to the knowledge regarding the associations between fatalism and fear with CRC screening behaviors among Chinese older people.
The purpose of the study was to translate the M.D. Anderson Symptom Inventory-Heart Failure (MDASI-HF), a specific instrument to assess symptoms in cancer patients with concurrent heart failure (HF), into Mandarin Chinese and to examine its psychometric properties in Chinese cancer patients.
Design
A translation and psychometric evaluation design was used.
Methods
The translation of the MDASI-HF into Mandarin Chinese followed Brislin's model with the four steps: translation, monolingual assessment, backward translation, and comparison. The Chinese version MDASI-HF was tested among 135 cancer patients with concurrent HF from a cancer hospital in Tianjin, China. Psychometric properties of content validity, internal consistency, test–retest reliability, concurrent validity, and sensitivity of the instrument were evaluated.
Findings
The Cronbach's α was .913 for the core items, .835 for the HF items, and .897 for the interference items. The test–retest reliability was satisfactory with intra-class coefficients >.9 and content validity index was .94. The Chinese version MDASI-HF was significantly correlated with the Eastern Cooperative Oncology Group performance grade (correlation coefficients .456–.600) and the New York Heart Association classification (correlation coefficients .477–.631), indicating the established concurrent validity of the translated instrument.
Conclusions
The Chinese version MDASI-HF is a valid and reliable instrument to assess the symptoms of Chinese cancer patients with concurrent HF.
Clinical Relevance
Symptom assessment and management play important roles in cancer rehabilitation. The Chinese version MDASI-HF can assist appropriate and timely symptom assessment in cancer patients with concurrent HF and can promote communication between health care professionals and patients. Based on the assessment, the rehabilitation team could provide effective symptom management, evaluate the effectiveness of interventions, and improve patients' quality of life.
Objective: The aim of this study was to evaluate the effectiveness of PEI on managing symptom clusters in patients with cancer.
Methods: Six databases were searched, together with hand searching, to identify eligible randomized controlled trials from the year 2001 to July 2014. Data selection, quality appraisal of studies, and data extraction were conducted independently by 2 reviewers. Data were synthesized by use of a systematic narrative approach, and meta-analysis was conducted when this was possible.
Results: Four eligible studies involving 343 cancer patients were included in the review. The methodological quality of the studies was generally fair. Symptom clusters seemed to improve with the provision of PEI. Meta-analysis shows significant improvement in functional performance.
Conclusions: The evidence that PEI could alleviate cancer symptom clusters is encouraging but inconclusive in this review. Future well-designed investigations testing some commonly used PEI such as progressive muscle relaxation and patient education on various types of cancer symptom clusters are warranted.
Implications for Practice: This review suggests a promising role of PEI in managing cancer symptom clusters. Healthcare providers should increase their awareness of managing symptom clusters using PEI to yield more effective and efficient cancer care.
Colorectal cancer (CRC) is one of the most common cancers. This study aimed to compare the uptake of CRC testing in the general public and in ethnic minorities in Hong Kong.
Materials and Methods:
This cross-sectional survey covered 2,327 South Asian and Chinese adults aged over 50, recruited from two separate studies. A structured questionnaires were administered by research staff over the telephone or in faceto-face interviews.
Results:
The uptake rate of CRC testing among South Asians was significantly lower than that of the general population in Hong Kong. Factors associated with the uptake rate were health professional’s recommendation, perception of regular visits to doctor, use of complementary therapy, ethnicity, perceived susceptibility to cancer, presence of chronic illness, and education level. In addition, a significant interaction (p<0.05) between ethnicity and health professionals’ recommendations was found, after adjustment for the main independent factors identified.
Conclusions:
Older people with lower educational attainment, without chronic illness and those have lower perceived susceptibility to cancer may be targeted for CRC testing promotion in the society. In addition, health professionals can play a highly influential role in promoting such testing, particularly among ethnic minorities.