Patient-Provider Language Concordance and Colorectal Cancer Screening

Abstract

BACKGROUND AND OBJECTIVE: Patient-provider language barriers may play a role in health-care disparities, including obtaining colorectal cancer (CRC) screening. Professional interpreters and language-concordant providers may mitigate these disparities. DESIGN, SUBJECTS, AND MAIN MEASURES:We performed a retrospective cohort study of individuals age 50 years and older who were categorized as EnglishConcordant (spoke English at home, n=21,594); Other Language-Concordant (did not speak English at home but someone at their provider's office spoke their language, n=1,463); or Other Language-Discordant (did not speak English at home and no one at their provider's spoke their language, n=240). Multivariate logistic regression assessed the association of language concordance with colorectal cancer screening. KEY RESULTS: Compared to English speakers, nonEnglish speakers had lower use of colorectal cancer screening (30.7% vs 50.8%; OR, 0.63; 95% CI, 0.51-0.76). Compared to the English-Concordant group, the Language-Discordant group had similar screening (adjusted OR, 0.84; 95% CI, 0.58-1.21), while the Language-Concordant group had lower screening (adjusted OR, 0.57; 95% CI, 0.46-0.71). CONCLUSIONS: Rates of CRC screening are lower in individuals who do not speak English at home compared to those who do. However, the Language-Discordant cohort had similar rates to those with English concordance, while the Language-Concordant cohort had lower rates of CRC screening. This may be due to unmeasured differences among the cohorts in patient, provider, and health care system characteristics. These results suggest that providers should especially promote the importance of CRC screening to non-English speaking patients, but that language barriers do not fully account for CRC screening rate disparities in these populations.

Navigating Language Barriers: A Systematic Review of Patient Navigators’ Impact on Cancer Screening for Limited English Proficient Patients

“…25,26 RESULTS Figure 1 presents a PRISMA flow diagram demonstrating the systematic review process and the final 15 articles that were included in the narrative review. The 15 studies were subdivided according to type of cancer screening that was evaluated, including breast (combined with other cancers), [27][28][29][30][31] colorectal cancer, [32][33][34][35][36][37][38][39][40][41][42][43][44] and cervical cancer, [45][46][47] represented in Table 1. Fifteen non-English languages were evaluated in these studies.…”

Relationship Between Self-assessed and Tested Non–English-language Proficiency Among Primary Care Providers

“…7, 11 Language concordance leads to lower emergency room use, likelihood of missing medications, and cost. 8, 12, 13 While the few language concordance and cancer screening studies have found lower screening rates for LEP patients with language concordant clinicians, 14-16 it is unclear if the “language concordant” clinicians in these studies were truly fluent or had adequate non-English language skills.…”

Racial healthcare disparities: A social psychological analysis

“…For instance, in the US, limited English language proficiency is associated with decreased utilization of preventive healthcare services (Linsky, McIntosh, Cabral, & Kazis, 2010), longer hospital stays (John-Baptiste et al, 2004), poorer health control (Fernandez et al, 2010), and increased medical errors (Divi, Koss, Schmaltz, & Loeb, 2007; see Norredam et al, 2004 for similar findings from Denmark). However, the fact remains that in many countries, healthcare disparities commonly occur among members of racial minorities comprised almost exclusively of native language speakers (Kirby, Taliaferro, & Zuvekas, 2006), suggesting that language barriers only explain a portion of healthcare disparities.…”