Limited English Proficiency and Disparities in Health Care Engagement Among Patients With Breast Cancer

2021 ◽  
pp. OP.20.01093
Author(s):  
Mohana Roy ◽  
Natasha Purington ◽  
Mina Liu ◽  
Douglas W. Blayney ◽  
Allison W. Kurian ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Health Care ◽  
Clinical Trial ◽  
Genetic Counseling ◽  
English Proficiency ◽  
Primary Language ◽  
Patient Portal ◽  
Language Groups ◽  
English Speaking ◽  
Health Care Engagement

PURPOSE: Race and ethnicity have been shown to affect quality of cancer care, and patients with low English proficiency (LEP) have increased risk for serious adverse events. We sought to assess the impact of primary language on health care engagement as indicated by clinical trial screening and engagement, use of genetic counseling, and communication via an electronic patient portal. METHODS: Clinical and demographic data on patients with breast cancer diagnosed and treated from 2013 to 2018 within the Stanford University Health Care system were compiled via linkage of electronic health records, an internal clinical trial database, and the California Cancer Registry. Logistic and linear regression models were used to evaluate for association of clinical trial engagement and patient portal message rates with primary language group. RESULTS: Patients with LEP had significantly lower rates of clinical trial engagement compared with their English-speaking counterparts (adjusted odds ratio [OR], 0.29; 95% CI, 0.16 to 0.51). Use of genetic counseling was similar between language groups. Rates of patient portal messaging did not differ between English-speaking and LEP groups on multivariable analysis; however, patients with LEP were less likely to have a portal account (adjusted OR, 0.89; 95% CI, 0.83 to 0.96). Among LEP subgroups, Spanish speakers were significantly less likely to engage with the patient portal compared with English speakers (estimated difference in monthly rate: OR, 0.43; 95% CI, 0.24 to 0.77). CONCLUSION: We found that patients with LEP had lower rates of clinical trial engagement and odds of electronic patient portal enrollment. Interventions designed to overcome language and cultural barriers are essential to optimize the experience of patients with LEP.

scholarly journals A Medical Translation Assistant for Non–English-Speaking Caregivers of Children With Special Health Care Needs: Proposal for a Scalable and Interoperable Mobile App

10.2196/21038 ◽  
2020 ◽  
Vol 9 (10) ◽  
pp. e21038
Author(s):  
Emre Sezgin ◽  
Garey Noritz ◽  
Jeffrey Hoffman ◽  
Yungui Huang
Keyword(s):  
Health Care ◽  
Mobile App ◽  
Special Health Care Needs ◽  
Patient Portal ◽  
Health Care Needs ◽  
Care Needs ◽  
Special Health Care ◽  
Medical Translation ◽  
English Speaking ◽  
Special Health

Background Communication and comprehension of medical information are known barriers in health communication and equity, especially for non–English-speaking caregivers of children with special health care needs. Objective The objective of this proposal was to develop an interoperable and scalable medical translation app for non–English-speaking caregivers to facilitate the conversation between provider and caregiver/patient. Methods We employed user-centered and participatory design methods to understand the problems and develop a solution by engaging the stakeholder team (including caregivers, physicians, researchers, clinical informaticists, nurses, developers, nutritionists, pharmacists, and interpreters) and non–English-speaking caregiver participants. Results Considering the lack of interpreter service accessibility and advancement in translation technology, our team will develop and test an integrated, multimodal (voice-interactive and text-based) patient portal communication and translation app to enable non–English-speaking caregivers to communicate with providers using their preferred languages. For this initial prototype, we will focus on the Spanish language and Spanish-speaking families to test technical feasibility and evaluate usability. Conclusions Our proposal brings a unique perspective to medical translation and communication between caregiver and provider by (1) enabling voice entry and transcription in health care communications, (2) integrating with patient portals to facilitate caregiver and provider communications, and (3) adopting a translation verification model to improve accuracy of artificial intelligence–facilitated translations. Expected outcomes include improved health communications, literacy, and health equity. In addition, data points will be collected to improve autotranslation services in medical communications. We believe our proposed solution is affordable, interoperable, and scalable for health systems.

A Comprehensive Program Enabling Effective Delivery of Regional Genetic Counseling

2018 ◽  
Vol 28 (5) ◽  
pp. 996-1002 ◽  
Author(s):  
Jubilee Brown ◽  
Aly Athens ◽  
David L. Tait ◽  
Erin K. Crane ◽  
Robert V. Higgins ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Ovarian Cancer ◽  
Health Care ◽  
Genetic Counseling ◽  
Cancer Patients ◽  
Health Care System ◽  
Patient Navigation ◽  
Counseling Services ◽  
Comprehensive Program ◽  
Genetic Counseling Services

ObjectivesThe aim of this study was to demonstrate the utility of a comprehensive program involving management-based evidence, telemedicine, and patient navigation to provide genetic counseling services for patients with ovarian and breast cancer across a geographically large health care system.MethodsWe identified all patients with newly diagnosed ovarian and breast cancer in our health care system from January 2013 to December 2015 through the cancer registry. Referral characteristics and testing outcomes were recorded for each year and compared using the χ2 or Fisher exact test.ResultsBecause the implementation of this program, the number of new ovarian cancer cases remained constant (109–112 cases/year) but patients referred for genetic counseling increased annually from 37% to 43% to 96% (P < 0.05). The percentage of ovarian cancer patients who underwent genetic testing increased annually from 24% to 27% to 53% (P < 0.05). The number of new breast cancer patients was constant (1543–1638 cases/year). The percentage of patients with triple negative breast cancer referred for genetic counseling rose from 69% in 2013 to 91% in 2015; the percentage of patients who underwent testing increased annually from 59% to 86% (P < 0.05). Of women with breast cancer diagnosed at less than 45 years of age, 78% to 85% were referred for genetic counseling across this period; the percentage of patients who underwent testing increased annually from 66% to 82% (P < 0.05). Patient navigation was initiated and was available to all patients in the system during this period. Telemedicine consults were performed in 118 breast/ovarian patients (6%) during this period.ConclusionsA comprehensive program may improve access to effective genetic counseling services in patients with ovarian and breast cancer despite geographic barriers.

scholarly journals A Medical Translation Assistant for Non–English-Speaking Caregivers of Children With Special Health Care Needs: Proposal for a Scalable and Interoperable Mobile App (Preprint)

2020 ◽  
Author(s):  
Emre Sezgin ◽  
Garey Noritz ◽  
Jeffrey Hoffman ◽  
Yungui Huang
Keyword(s):  
Health Care ◽  
Mobile App ◽  
Special Health Care Needs ◽  
Patient Portal ◽  
Health Care Needs ◽  
Care Needs ◽  
Special Health Care ◽  
Medical Translation ◽  
English Speaking ◽  
Special Health

BACKGROUND Communication and comprehension of medical information are known barriers in health communication and equity, especially for non–English-speaking caregivers of children with special health care needs. OBJECTIVE The objective of this proposal was to develop an interoperable and scalable medical translation app for non–English-speaking caregivers to facilitate the conversation between provider and caregiver/patient. METHODS We employed user-centered and participatory design methods to understand the problems and develop a solution by engaging the stakeholder team (including caregivers, physicians, researchers, clinical informaticists, nurses, developers, nutritionists, pharmacists, and interpreters) and non–English-speaking caregiver participants. RESULTS Considering the lack of interpreter service accessibility and advancement in translation technology, our team will develop and test an integrated, multimodal (voice-interactive and text-based) patient portal communication and translation app to enable non–English-speaking caregivers to communicate with providers using their preferred languages. For this initial prototype, we will focus on the Spanish language and Spanish-speaking families to test technical feasibility and evaluate usability. CONCLUSIONS Our proposal brings a unique perspective to medical translation and communication between caregiver and provider by (1) enabling voice entry and transcription in health care communications, (2) integrating with patient portals to facilitate caregiver and provider communications, and (3) adopting a translation verification model to improve accuracy of artificial intelligence–facilitated translations. Expected outcomes include improved health communications, literacy, and health equity. In addition, data points will be collected to improve autotranslation services in medical communications. We believe our proposed solution is affordable, interoperable, and scalable for health systems.

scholarly journals Limited English Proficiency, Primary Language at Home, and Disparities in Children's Health Care: How Language Barriers are Measured Matters

2005 ◽  
Vol 120 (4) ◽  
pp. 418-430 ◽  
Author(s):  
Glenn Flores ◽  
Milagros Abreu ◽  
Sandra C. Tomany-Korman
Keyword(s):  
Health Care ◽  
Health Status ◽  
Health Care Disparities ◽  
English Proficiency ◽  
Language Barriers ◽  
Children's Health ◽  
Children’S Health ◽  
Primary Language ◽  
Language Spoken At Home ◽  
At Home

Background. Approximately 3.5 million U.S. schoolchildren are limited in English proficiency (LEP). Disparities in children's health and health care are associated with both LEP and speaking a language other than English at home, but prior research has not examined which of these two measures of language barriers is most useful in examining health care disparities. Objectives. Our objectives were to compare primary language spoken at home vs. parental LEP and their associations with health status, access to care, and use of health services in children. Methods. We surveyed parents at urban community sites in Boston, asking 74 questions on children's health status, access to health care, and use of health services. Results. Some 98% of the 1,100 participating children and families were of non-white race/ethnicity, 72% of parents were LEP, and 13 different primary languages were spoken at home. “Dose-response” relationships were observed between parental English proficiency and several child and parental sociodemographic features, including children's insurance coverage, parental educational attainment, citizenship and employment, and family income. Similar “dose-response” relationships were noted between the primary language spoken at home and many but not all of the same sociodemographic features. In multivariate analyses, LEP parents were associated with triple the odds of a child having fair/poor health status, double the odds of the child spending at least one day in bed for illness in the past year, and significantly greater odds of children not being brought in for needed medical care for six of nine access barriers to care. None of these findings were observed in analyses of the primary language spoken at home. Individual parental LEP categories were associated with different risks of adverse health status and outcomes. Conclusions. Parental LEP is superior to the primary language spoken at home as a measure of the impact of language barriers on children's health and health care. Individual parental LEP categories are associated with different risks of adverse outcomes in children's health and health care. Consistent data collection on parental English proficiency and referral of LEP parents to English classes by pediatric providers have the potential to contribute toward reduction and elimination of health care disparities for children of LEP parents.

scholarly journals 9. Influenza Vaccine Rates Amongst Patients With Limited English Proficiency In A Primary Health Care Clinic; Our 3 Years Experience

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S27-S27
Author(s):  
Eloho Ajayi ◽  
Atsoufui kpehor ◽  
Shristi Khanal ◽  
Samavia Munir ◽  
Adrian Estepa
Keyword(s):  
Health Care ◽  
Primary Health Care ◽  
Influenza Vaccine ◽  
Limited English Proficiency ◽  
English Proficiency ◽  
Medical Attention ◽  
Care Clinic ◽  
Primary Health Care Clinic ◽  
Language Groups ◽  
Primary Health

Abstract Background Influenza has been recognized to be a significant cause of morbidity and mortality. It was the cause of 10.1% of all deaths recorded on death certificates during the week ending January 20, 2018.In order to reduce the risk of influenza, Centers for Disease Control recommends that every person six months and older who have no contraindications be vaccinated with the influenza vaccine. Limited English Proficiency (LEP) describes individuals who have limited ability to speak, read, write or understand English language. Sadly, there is an increasing body of data that suggest that patients with LEP are less likely to seek out medical attention in a timely manner, are less adherent to medically recommended preventive and therapeutic measures. The purpose of this study was to determine the rate of acceptance of the Influenza vaccine amongst patients with LEP in our resident ran out-patient clinic. Methods This study was retrospective, data was obtained through chart review of the electronical medical records (EMR). Patients had to be at least 18 years old and registered patients at our primary health care clinic to be enrolled in this study. Data was gathered for the 2015–2016, 2016–2017 and 2017–2018 influenza seasons. The months of October to May were designated as the Influenza season as these months have been identified as the time frame that the influenza virus has the most activity. Results 109 of 499 the randomly selected participants were not included in the final analysis due to reasons like: no visit to the primary health care clinic during specified periods, ability to communicate in English, insufficient data in to the EMR. Data from 390 patients were analyzed. 43.3% spoke Spanish, 36.2% were Portuguese speaking and 20.5% spoke other languages. A large majority of patients across all language groups did not receive the influenza vaccine each season. Table 1 Figure 1 Figure 2 Conclusion Results from this study indicate that there was an alarmingly low rate of influenza vaccination among patients with LEP in our primary care clinic in during the 2015–2016, 2016–2017 and 2017–2018 influenza seasons. This highlights the need for implementing interventions aimed at both understanding why this vaccination gap exist and improving the vaccine acceptance rate amongst this venerable population. Disclosures All Authors: No reported disclosures

scholarly journals Spanish As a Primary Language and Its Effect on Breast Cancer Presentation

2011 ◽  
Vol 7 (3) ◽  
pp. 165-167 ◽  
Author(s):  
Kristin Oliveira ◽  
Steven Clark ◽  
Ernest Dunn ◽  
Alicia Mangram
Keyword(s):  
Breast Cancer ◽  
Patient Population ◽  
Primary Language ◽  
Hispanic Patients ◽  
Advanced Stages ◽  
English Speaking

In the authors' patient population, non–English-speaking Hispanic patients presented at more advanced stages than their English-speaking counterparts.

scholarly journals Factors Influencing Perceptions of Breast Cancer Genetic Counseling among Women in an Urban Health Care System

2007 ◽  
Vol 16 (6) ◽  
pp. 735-753 ◽  
Author(s):  
Marvella E. Ford ◽  
Sharon Hensley Alford ◽  
Diandra Britton ◽  
Beth McClary ◽  
Howard S. Gordon
Keyword(s):  
Breast Cancer ◽  
Health Care ◽  
Genetic Counseling ◽  
Health Care System ◽  
Urban Health ◽  
Urban Health Care ◽  
Cancer Genetic Counseling ◽  
Cancer Genetic ◽  
Factors Influencing ◽  
Care System
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