How Language Barriers Impact Patient Experiences in Cancer Care

In a randomized trial, researchers sough to determine the impact of patient-provider language agreement and patients’ satisfaction with their cancer care. This study was published in the International Journal of Radiation Oncology, Biology, Physics.

“Delivering linguistically competent care is critical to serving patients who have limited English proficiency (LEP) and represents a key national strategy to help reduce health disparities,” wrote the study authors. “Current acceptable standards of communication with patients who have LEP include providers communicating through professional interpretive services or bilingual providers speaking the patients’ preferred language directly.”

Eighty-tree adults were enrolled in this study. Participants were all Spanish speakers and diagnosed with cancer. The cohort was randomized to either care from one of two bilingual physicians speaking directly in Spanish, or one of the two same physicians, but speaking in English and using a professional interpreter. Patients then completed satisfaction questionnaires regarding provider communication and overall care. The researchers also conducted analysis of consultation transcripts to assess content variability.

The researchers reported, “Compared with patients receiving care through professional interpretive services, patients cared for in direct Spanish reported significantly improved general satisfaction, technical quality of care, care team interpersonal manner, communication, and time spent with patient.”

The average satisfaction scores for quality of care in the Spanish-speaking versus interpreted groups were 4.41 and 4.06, respectively (P=0.05). For the other categories, mean scores were 4.37 vs. 3.88, respectively (P=0.004), for the team’s interpersonal manner, 4.50 vs. 4.25 (P=0.018) for communication, and 4.30 vs. 3.92 (P=0.028) for time spent with the patient. Additionally, patients who received care directly in Spanish reported a greater perception of opportunities to discuss concerns compared with the interpreted group (mean score, 4.91 vs. 4.62, P=0.001). Providers who spoke Spanish were also rated higher in terms of perceived empathy (P<0.001), and the patients’ confidence in their abilities (P<0.001) compared to when the providers who spoke English. Overall satisfaction with the physician was higher in the Spanish speaking versus interpreted group (P<0.001).

Upon analysis of the content of the encounters, the researchers identified differences in content between study arms. When physicians spoke Spanish, they talked more frequently about the patient’s medical history (P=0.01), and their partnering activities (P<0.001) compared to when they spoke English.

Patients being spoken to directly in Spanish were also more likely to initiate unprompted speech (P<0.001), and asked more questions (P=0.007) than patients receiving interpreted consultations.

“This study shows improved patient-reported satisfaction among patients with cancer who had LEP and were cared for in direct Spanish compared with interpreter-based communication,” wrote the authors in conclusion. “Further research into interventions to mitigate the patient-provider language barrier is necessary to optimize care for this population.”