Cultural Awareness and Sensitivity Among Surgeons Do Not Always Result in Culturally Competent Care

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A survey of oncology surgeons from six hospitals in Washington State found that the surgeons in the sample “displayed and valued cultural awareness and sensitivity” but that “cultural awareness and sensitivity did not necessarily result in culturally competent behavior.” These findings highlight the need for improved interventions “to achieve the goal of genuinely culturally competent care,” Ardith Z. Doorehnbos, PhD, RN, of the University of Washington, Seattle, and colleagues wrote in the Journal of Oncology Practice.

Higher rates for mortality for the most common cancers among racial and ethnic minority groups are often attributed to limited resources and services or other structural issues, the authors noted. “However, a systematic review of treatment decision making among racial and ethnic minority patients with cancer indicates that patients also decline or delay care because of inadequate social support, dissatisfaction with patient-provider communication, and perceived lack of culturally congruent care and cultural competence among providers,” the authors wrote.

“Culturally congruent care happens,” the authors continued, “when the needs, preferences, and expectations of patients, families, and communities are aligned with clinician knowledge, attitudes, and skills.” Provider characteristics associated with cultural congruence include cross-cultural interactions, cultural awareness, and openness to learning about other cultures.

“In Washington State, according to Medicaid and Medicare data, approximately 2,000 cancer cases were diagnosed among American Indian and Alaskan natives from 2005 to 2014,” the investigators noted. The survey was undertaken as part of a large multimethod study to understand barriers to care among these populations. The six hospitals in the Puget Sound region invited to participate represented a mix or urban and rural areas and university and community settings. The survey was limited to practitioners in one of the following surgical specialties: general surgery, urology, obstetrics and gynecology, neurosurgery, oncology, ophthalmology, or orthopedic surgery.

Survey Results

The response rate to the survey was 51.1%. The mean age of the responders was 50 years, with a range of 32 to 77 years. Most respondents (69.6%) were male, and 77.5% self-identified as White/Caucasian only.

The 253 responders reported treating diverse patient populations, with 71% encountering patients from six or more racial and ethnic groups. Among the 147 responders (58%) who had completed cultural diversity training, nearly half had employer-sponsored training. “Most providers (92.7%) reported feeling either ‘somewhat’ or ‘very’ competent working with people from cultures other than their own,” the researchers wrote.

Although the surgeons generally had a high level of cultural awareness and sensitivity, “high levels of cultural awareness and sensitivity did not necessarily translate into culturally competent behaviors,” the authors noted. This could be due to less-than-optimal cultural competency training, the authors added. Culturally competent behaviors the researchers cited as lacking included having resource books and other materials available to learn about people from different cultures, documenting cultural assessments when providing direct patient care, and documenting adaptations made when providing direct patient care.

Participation in diversity training was the variable most significantly associated with the Cultural Competence Assessment (CCA) score, after controlling for hospital system and score on a scale accounting for social approval and perceived social norms. Other factors significantly associated with CCA scores were the respondents’ self-assessment of cultural competence and the hospital system where they practiced, which was consistent with the finding that 48% of respondents receiving diversity training did so at work. Females had higher CCA scores than men, but the association was not statistically significant.

The investigators had expected that cultural diversity training would be less frequent among older providers, but this turned out not to be the case. There were differences, however, in the sources of training. Younger respondents reported receiving more formal training during medical school, whereas their older colleagues reported more informal sources, such as attending public school or serving in the military.

“We also did not find any age-related differences in culturally competent behaviors,” the researchers noted. They hypothesized that “among older respondents, experiential learning on the basis of years in practice and exposure to multiple cultural groups compensated for their lack of access to the more formalized training reported by younger respondents.” ■

Doorenbos AZ, et al: J Oncol Pract 12:61-62, 2016.