OBJECTIVE To assess Chinese American primary care physicians' knowledge, attitude, and barriers to recommending colorectal cancer (CRC) screening to their Chinese American patients. METHODS Chinese American primary care physicians serving Chinese American patients in two metropolitan areas were invited to complete a mailed survey on CRC screening knowledge, attitudes toward shared decision making and CRC screening, and CRC screening recommendation patterns. RESULTS About half of the 56 respondents did not know CRC incidence and mortality figures for Chinese Americans. Those aged 50 and younger, graduating from U.S. medical schools, or working in non-private settings had higher knowledge scores (p < 0.01). Physicians graduating from U.S. medical schools had more favorable attitudes toward shared decision making (p < 0.01). Lack of health insurance, inconsistent guidelines, and insufficient time were the most frequently cited barriers to recommending CRC screening. CONCLUSIONS Most Chinese American physicians had knowledge, attitude, and communication barriers to making optimal CRC screening recommendations.