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Accessing cancer care is more difficult in the United States if English is the second language

Accessing cancer care is more difficult in the United States if English is the second language

Most research on language barriers in health care focuses on patient-physician interactions

MONDAY, Sept. 11, 2023 (HealthDay News) — Much has been said about how a lack of English proficiency can interfere with a patient’s ability to interact with their doctor and get the best medical care possible.

But language barriers may prevent cancer patients from even having their first visit with a specialist, according to a new study.

The results showed that English speakers who called the public information line in US hospitals were successful in nearly 94% of cases, either obtaining the cancer clinic number or being taken directly to the clinic.

By comparison, Spanish speakers advanced to the next step only 38% of the time, and Mandarin speakers only 28% of the time, according to results published Sept. 6 in the Journal of the National Comprehensive Cancer Network.

“Disparities in access to cancer care begin before a doctor visits a patient,” said lead researcher Dr. Debbie Chen, a clinical instructor at the University of Michigan. “I think there’s a great need to really understand those barriers before the first doctor-patient visit.”

The inability to make even basic hospital contact could have a profound impact on millions of Americans, Chen said.

More than 60 million people speak a language other than English at home, and more than 25 million have limited English proficiency, according to 2010 Census statistics cited by Chen. This is a significant portion of the total US population, which now exceeds 330 million.

Most research on language barriers in health care focuses on patient-physician interactions, but Chen and his colleagues believe clear communication is important even early in health care.

“When we think about getting care, a lot of it starts long before we ever see a doctor,” Chen said. “Studies have shown that the general hospital information line generally acts as a first point of entry for many people, when they are trying to understand where to go to clinics or services offered in the hospital. So we felt it was a place of great importance to assess access to cancer care.”

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For the study, callers who spoke English, Spanish or Chinese contacted 144 hospitals in 12 US states between November 2021 and June 2022.

Approximately 1,300 calls were made, evenly distributed among the three languages. Respondents specifically asked about colon, lung, and thyroid cancer — three types of cancer that disproportionately affect people of Hispanic and Asian descent.

The goal was to see who could make it through that first contact with the hospital.

“The next step would be one, the phone number of the clinic they’re inquiring about, or two, taking them to the clinic or department that will provide that type of care,” Chen said.

Almost all English speakers moved on to the next step, while Spanish and Chinese speakers were less likely to move beyond the initial information call.

This is not good for anyone who needs medical care, but it is especially dangerous for someone with cancer, not only because of the accessibility at all, but also because of the type of access required to treat a person’s cancer, Chen said.

“For many types of cancer, including thyroid cancer, seeing a doctor with a large patient population is very important for patient outcomes,” Chen said. “And if you can’t get information about how to get to that clinic or which clinic to go to, you may not be able to see those doctors or you may not be able to receive timely care.”

The study also found that non-native English speakers contacting a teaching hospital were 57% more likely to successfully move on to the next step, compared to non-teaching hospitals.

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“There appear to be specific differences in how much and to what extent hospitals have access to language resources,” Chen said.

Chen pointed to previous research that found teaching hospitals are more likely to have interpreters, outside translation agencies, or multilingual telephone services.

“There was also a discrepancy in terms of reimbursement for language-based services, with non-teaching hospitals less likely to receive reimbursement than teaching hospitals,” Chen said.

“When you think about it, if you have fewer resources, you may be less willing to provide services to a particular population,” Chen said. “At the same time, it is difficult to know why these discrepancies exist.”

Chen and his colleagues suggest that automated messages on public information lines should include instructions for accessing the message in different languages. The line should also default to a live person instead of hanging up in cases where no information is entered.

They also recommend that people handling the public information number stay on the line when connecting callers to a language interpreter. This way, they can be available to provide answers about the hospital that the interpreter may not know.

“If their role is to explain, they need something to explain,” Chen said. “Often, these interpreters, some from outside agencies, cannot provide information because they are not hospital employees.”

These findings “don’t really surprise me, unfortunately,” said Maria Lugo, director of health initiatives at the Hispanic Federation, a Latino nonprofit that works to advance health equity as part of its overall mission.

“We have seen that there are disparities in access to information about health care resources among communities of color,” Legault said. “This has been going on for years, which is why the Hispanic Federation is actively working to address these disparities and advance health equity for people of color across the country.”

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Lugo agrees that hospitals can help by providing more practical guidance to people with limited English skills.

“We certainly see that when you give someone information, they won’t necessarily accept that information or follow through on it,” Legault said. “Sometimes you have to hold someone’s hand and walk them through the process, because the health care system is so complex.

“When we get a call or when we meet someone in the community, we don’t just say, ‘Hey, go to this center,'” Lugo added. “We actually pick up the phone, call the center and connect them with a real person to make navigation easier.”

Legault also recommended people with limited English skills find a federally qualified health center in the community that aims to focus on underserved populations.

“There are many federally qualified health centers that provide many of these services — early detection of cancer, early detection of any other chronic condition — and they are not being utilized,” Legault said. “Sometimes community members are afraid to seek any care, believing that they either do not have health insurance or have health insurance, but it is limited. Many of these centers have doctors who speak their language.”

more information

The American Journal of Medicine has more information about language barriers to accessing health care.

Sources: Debbie Chen, MD, Clinical Instructor, University of Michigan; Maria Lugo, MA, Senior Director, Health Initiatives, Spanish Federation; Journal of the National Comprehensive Cancer Network, September 6, 2023.