Researchers have revealed that non–English speakers who seek information from hospitals across the United States may face a concerning lack of access to cancer care services, according to a new study published by Chen et al in JNCCN–Journal of the National Comprehensive Cancer Network.
Background
“Spanish-speaking patients, as well as others who are not English proficient, face preventable barriers in access to care starting at one of the most basic expectations we have when calling our health-care providers—the ability to call in for an appointment or advice. This health inequity from the very start can lead to late detection, erosion of trust, disengagement from the health-care system, and many other adverse health outcomes that serve to only deepen cancer care disparities,” underscored Darcie Green, Executive Director of Latinas Contra Cancer, who was not involved in this study.
Study Methods and Results
In the new study, the researchers performed 1,296 simulated patient calls to the general information lines of 144 random selection of hospitals evenly distributed across 12 demographically diverse U.S. states and spoke in either English, Spanish, or Mandarin. The calls were made between November 8, 2021, and June 23, 2022, from Monday through Friday and from 8:00 AM to 5:00 PM local time.
The researchers found that 53% of the speakers were provided with next steps to access cancer care. While 94% of the English speakers were provided with the next steps they needed to access cancer care—such as a telephone number for a clinic or a transfer to a department that would provide the requested care—38% of the Spanish speakers and 28% of the Mandarin speakers received the information.
The researchers hypothesized that patients who speak other, less commonly spoken, non-English languages may face even greater barriers to care.
“Our study found significant language-based disparities in patients’ access to cancer care well before they are seen by a physician,” stressed lead study author Debbie W. Chen, MD, of the University of Michigan. “If patients with cancer cannot access information on where to obtain the appropriate cancer care, what other critical information and services are they not able to access in our health-care system?” she emphasized.
In a previous study conducted in 2005, researchers simulated calls from Spanish speakers and contacted the general information line of New York City hospitals to request the telephone number for one of the hospital’s outpatient clinics.
Conclusions
“Even though our study takes place 16 years later, during a time when more than 25 million individuals with limited English proficiency live in the United States, our study found even lower success rates for non–English [speakers] seeking to access cancer care services. Most of the barriers that the simulated non–English [speakers] encountered were systems-level issues—including being told ‘no’ or being hung up on by hospital staff, or being disconnected because the hospital’s automated message required input but did not provide language-concordant instructions, plus issues at the level of Interpreter Services,” Dr. Chen revealed.
The researchers proposed several potential interventions depending on the reasons for the incomplete calls—including that automated messages should provide instructions for accessing the message in different languages and should default to a representative instead of disconnecting in instances where no input is made. They also recommended that general information personnel remain on the line when connecting callers to a language interpreter in order to help deliver the information they need through a translator, who may not be able to answer questions about care on their own.
“The results of this important study highlight what we see every day on the ground level. [A]s we lean into greater investment in community health workers and patient navigation to reduce disparities in detection, treatment, and survivorship, it is crucial that the patients who need these services the most do not face unnecessary barriers to accessing them. This study should serve as an affirming but urgent call to action for accountability and to support and invest in the strategies and infrastructure needed to eliminate language-based health inequities in access to [cancer] care,” concluded Ms. Green.
Disclosure: For full disclosures of the study authors, visit jnccn.org.
