Key takeaways:

• Only 52.9% of non-English-speaking simulated patient callers received guidance about next steps to access cancer care.
• Most (93.5%) English-speaking callers received this information.

Non-English-speaking individuals experienced significant systems-level barriers when they called hospitals trying to obtain information about cancer care services, according to study results.

The findings — published in Journal of the National Comprehensive Cancer Network — indicate a need for efforts to mitigate communication barriers that disproportionately affect vulnerable patient populations with cancer, researchers concluded.

Rationale and methodology

Racial and ethnic minorities with cancer in the U.S. experience a disproportionate burden of disease, Debbie W. Chen, MD, researcher at University of Michigan, told Healio.

Debbie W. Chen

“In addition, about one-third of the U.S. Hispanic and Asian population has limited English proficiency. Unfortunately, the limited English-proficient patient population remains underrepresented in the cancer disparities literature,” Chen said. “We were interested in examining the systems-level barriers to cancer care access for limited English-proficient patients — a vulnerable and highly relevant population — at the level of the hospital general information telephone line.”

The researchers rationalized that a hospital general information line would serve as the initial entry point for many individuals looking for information about hospital clinics and services, making it “a highly relevant site to evaluate cancer care access for patients,” Chen said.

Study investigators audited 144 hospitals across 12 demographically diverse states.

They assigned trained investigators to the roles of English-speaking, Spanish-speaking and Mandarin-speaking patients. They called hospital general information telephone lines and used a standardized script to seek access to care for three cancer types that disproportionately impact Hispanic and Asian populations — colon, lung and thyroid cancers.

Researchers used chi-square tests and logistic regression analysis to assess associations between the primary outcome — whether the simulated patient caller received next steps to access a clinic number or clinic transfer — and language type, region type, hospital teaching status and cancer care requested.

Findings

The trained investigators placed 1,296 calls — 432 calls each in English, Spanish and Mandarin.

Results showed that only 52.9% (n = 686) of simulated patient callers received guidance about the next steps to access cancer care.

Simulated non-English-speaking patient callers appeared less likely to receive next steps than English-speaking callers (Mandarin, 27.5%; Spanish, 37.7%; English, 93.5%; P < .001).

Multivariable logistic regression analyses showed significant associations between the primary outcome and Mandarin (OR = 0.02; 95% CI, 0.01–0.04) and Spanish language (OR = 0.04; 95% CI, 0.02–0.06), as well as nonteaching hospital status (OR = 0.43; 95% CI, 0.32–0.56) vs. teaching status.

Researchers acknowledged study limitations, including the potential of the study findings to not reflect the type or quality of cancer care patients may receive once seen and treated at the hospital. In addition, the findings may not be generalizable to all non-English-speaking patients with cancer, and the study did not capture the complexities of hospital call center workflows. Thus, investigators were unable to fully determine the reasons behind the observed outcomes.

Implications

“All patients with cancer should have access to high-quality health care, regardless of English language proficiency,” Chen told Healio. “Unfortunately, our study identified significant systems-level barriers that non-English-speaking patients may encounter when attempting to access cancer care, well before they see a physician for treatment of their cancer. Thus, there is a need to develop focused interventions to mitigate these communication barriers that disproportionately impact the health of vulnerable patient populations with cancer.”

More research is needed to examine and address disparities in access to cancer care services, Chen said.

“The inclusion of underrepresented patient populations, including those with limited English proficiency, in cancer disparities-focused research studies is also important,” she added.

References:

For more information:

Debbie W. Chen, MD, can be reached at chendeb@med.umich.edu.