Diversity Training Key to Increasing Cultural Competence Among Oncology Surgeons

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A study in the Journal of Oncology Practice (JOP)1 measured the level of cultural competence among surgeons from six hospitals in the Puget Sound region of Washington State, home to a large population of American Indians and Alaskan Natives. According to the study, “Assessing Cultural Competence Among Oncology Surgeons,” the term “culturally congruent” denotes an alignment between patients’ needs, preferences, and expectations on one side and clinicians’ knowledge, attitudes, and skills on the other.

To measure levels of cultural competence, the researchers sent out Cultural Competence Assessments (CCAs) to 495 surgeons from several specialties, including oncology. The CCA assessed several characteristics, including cultural awareness and sensitivity, culturally competent behaviors, and diversity experience. Respondents used a five-point Likert scale to rate how strongly they agreed with statements such as “I believe that everyone should be treated with respect no matter what their cultural heritage.”

A total of 253 surgeons (51% of all those contacted) completed the CCA. The data showed that 71% of surgeons encountered patients from six or more racial groups and that 58% completed cultural diversity training. The study also found that surgeons who received diversity training scored significantly higher on the CCA compared to those who did not receive training; in fact, participating in diversity training was the variable most significantly associated with higher scores. To control for the possibility that surgeons filled out the survey with an eye toward filling out the “right” answers, all respondents filled out the Marlowe-Crowne Social Desirability Scale, which assesses whether respondents are responding truthfully or are answering a survey in a way they believe will reflect well upon them.

Cultural Competence a Factor in Health Disparities

Cultural congruence in oncology is important in light of data showing that racial and ethnic minorities die of certain cancers at higher rates than people in majority groups. According to a 2013 study2, one explanation for this health disparity is the fact that racial and ethnic minorities are more likely to delay, and even decline, treatment—and that they do so because of a perception that health providers may not be culturally sensitive, as shown in a second study.3

Scores Exceeded Expectations

Ardith Z. Doorenbos, PhD, RN, FAAN

Ardith Z. Doorenbos, PhD, RN, FAAN

The researchers were “thrilled” with the results, according to the study’s first author, Ardith Z. Doorenbos, PhD, RN, FAAN, a nursing professor at the University of Washington in Seattle.

“No one had really measured cultural competence among surgeons before, so it was an unknown going into this,” Dr. Doorenbos said. “The results were better than what we expected. We were excited that, one, we had a survey response rate of more than 50% from providers at six different hospitals, and that two, we found out surgical providers do see a very diverse patient population, with 71% of our respondents encountering patients from six or more racial or ethnic groups.”

Dr. Doorenbos added that having strong skills in cultural competence is important all over the United States, and especially so in a city such as Seattle, which serves as a point of entry for many immigrants. The University of Washington’s associated hospitals alone have translators available for 45 different languages.

The researchers were also pleased with the finding showing that surgeons who undergo diversity training score higher in cultural competence than those who do not. Dr. Doorenbos said this finding might inspire hospital management to take a strong stand on cultural diversity training.

“This was a phenomenal finding for doctors but also for hospital administrators who might look at this article and think, ‘An investment in cultural diversity training makes a difference and will help give every patient we encounter the best quality care possible,’” Dr. Doorenbos said. ■


1. Doorenbos AZ, Morris AM, Haozous EA, et al: ReCAP: Assessing cultural competence among oncology surgeons. J Oncol Pract 12:61-62, 2016.

2. Siegel R, Naishadham D, Jemal A: Cancer statistics, 2013. CA Cancer J Clin 63:11-30, 2013.

3. Mead EL, Doorenbos AZ, Javid SH, et al: Shared decision-making for cancer care among racial and ethnic minorities: A systematic review. Am J Public Health 103:e15-e29, 2013.

Originally printed in the ASCO Quality Care Symposium Daily News. © American Society of Clinical Oncology. “Diversity Training Key to Increasing Cultural Competence Among Oncology Surgeons.” February 22, 2016. All rights reserved.