Perceptions of Patient-Provider Communication in Breast and Cervical Cancer-Related Care: A Qualitative Study of Low-Income English- and Spanish-Speaking Women

Abstract

To explore patient perceptions of patient-provider communication in breast and cervical cancer-related care among low-income English- and Spanish- speaking women, we examined communication barriers and facilitators reported by patients receiving care at safety net clinics. Participants were interviewed in English or Spanish after receiving an abnormal breast or cervical cancer screening test or cancer diagnosis. Following an inductive approach, interviews were coded and analyzed by the language spoken with providers and patient-provider language concordance status. Of 78 participants, 53% (n = 41) were English-speakers and 47% (n = 37) were Spanish-speakers. All English-speakers were language-concordant with providers. Of Spanish-speakers, 27% (n = 10) were Spanish-concordant; 38% (n = 14) were Spanish-discordant, requiring an interpreter; and 35% (n = 13) were Spanish mixed-concordant, experiencing both types of communication throughout the care continuum. English-speakers focused on communication barriers, and difficulty understanding jargon arose as a theme. Spanish-speakers emphasized communication facilitators related to Spanish language use. Themes among all Spanish-speaking sub-groups included appreciation for language support resources and preference for Spanish-speaking providers. Mixed-concordant participants accounted for the majority of Spanish-speakers who reported communication barriers. Our data suggest that, although perception of patient-provider communication may depend on the language spoken throughout the care continuum, jargon is lost when health information is communicated in Spanish. Further, the respective consistency of language concordance or interpretation may play a role in patient perception of patient-provider communication.

Understanding the supportive care needs of Hispanic men cancer survivors

“…In our study, these concerns were exacerbated by the inability to satisfactorily communicate with providers and receive treatment-related information in Spanish – even among bilingual survivors. Other studies conducted with Hispanic cancer survivors also report the expressed need for more readily available treatment and health-related information in Spanish (Simon et al 2013). We suggest that Hispanic men’s concerns related to the need for treatment information stems in part from the inability to communicate directly with providers in their preferred language.…”

“…When treating and working with Hispanic cancer survivors we need to be attuned to cultural variations in communication and conversation styles and recognize these are influenced by social norms that may affect where emphasis is placed. For example, Hispanics may be more contextually oriented and place more emphasis on paralinguistic cues and the situational context than on the content of information provided (Schouten and Meeuwesen 2006, Simon et al 2013). Furthermore, a patient’s assertiveness, also informed by social norms, may affect how their level of involvement is perceived by providers.…”

Sufficiency and relevance of information for inpatients in general ward settings: A qualitative exploration of information exchange between patients and nurses

“…However, there is the potential for 'easily understood' information to be perceived as 'sufficient' information. Difficulties with jargon are well documented: jargon distances patients from health professionals; can be used to exert control; and increases dissatisfaction with the information received (Fields et al 2008;Liu et al 2013;Simon et al 2013).…”

Addressing the Barriers to Cervical Cancer Prevention Among Hispanic Women

“…Hispanic women receiving breast and cervical cancer care who are able to communicate directly with their Spanishspeaking providers report a greater appreciation for, as well as a sense of security and confidence with, their providers [68]. Among women requiring interpretation services to communicate with their providers, women express appreciation for these services as well as confidence in the adequacy of the communication [68].…”

“…Among women requiring interpretation services to communicate with their providers, women express appreciation for these services as well as confidence in the adequacy of the communication [68]. A 2007 analysis by The Joint Commission identified multiple areas of weakness in our nation's hospitals, including the lack of a formal training and certification process for hospital interpreters and multi-lingual staff used to provide interpretation services.…”