Barriers Beyond Words: Cancer, Culture, and Translation in a Community of Russian Speakers

Abstract

BACKGROUND: Language and culture relate in complex ways. Addressing this complexity in the context of language translation is a challenge when caring for patients with limited English proficiency (LEP).OBJECTIVE: To examine processes of care related to language, culture and translation in an LEP population is the objective of this study. DESIGN:We used community based participatory research to examine the experiences of Russian-speaking cancer patients in San Francisco, California. A Russian Cancer Information Taskforce (RCIT), including community-based organizations, local government, and clinics, participated in all phases of the study.PARTICIPANTS: A purposeful sample of 74 individuals were the participants of the study. APPROACH:The RCIT shaped research themes and facilitated access to participants. Methods were focus groups, individual interviews, and participant observation. RCIT reviewed data and provided guidance in interpreting results. RESULTS:Four themes emerged. (1) Local Russianlanguage resources were seen as inadequate and relatively unavailable compared to other non-English languages; (2) a taboo about the word "cancer" led to language "games" surrounding disclosure; (3) this taboo, and other dynamics of care, reflected expectations that Russian speakers derived from experiences in their countries of origin; (4) using interpreters as cultural brokers or establishing support groups for Russian speakers could help address barriers. CONCLUSIONS:The language barriers experienced by this LEP population reflect cultural and linguistic issues. Providers should consider partnering with trained interpreters to address the intertwining of language and culture. INTRODUCTIONReflecting the resumption of trans-national migration, the number of U.S. States residents over the age of 5 who speak a language other than English at home exceeded 45 million in the 2000 census.1,2 Addressing the health care needs of LEP patients requires attention to both language and culture, which connect in complex ways among diverse patient populations. [3][4][5][6] Research has documented that differences in language and culture can cause breakdowns in provider-patient communication; that communication may be aided by language and cultural concordance between providers and patients; and that when providers and patients do not share a common language, well-trained providers and professional interpretation services provide the best outcomes. for continued exploration include how language and culture together shape the clinical encounter, how the interaction of language and culture is affected by the presence of a trained interpreter, and how health care delivery systems can best meet the challenge of communicating across the linked landscapes of language and culture.

Knowledge, Behavior and Beliefs Related to Cervical Cancer and Screening Among Turkish Women

“…Women in Turkey stated in the research made by Guvenc et al (2010) that they preferred to see a female physician and that they were embarrassed to have a smear test. The reasons for the barrier are reported, as in some other studies (Kim et al, 1999;Nguyen et al, 2000;Paskettet al, 2004;Dohan et al, 2007;Allahverdipour & Emami, 2008), to be caused by religious and cultural factors. Wong et al (2008) reported, for example, that due to religious affiliation and cultural beliefs, Muslim women in particular felt most comfortable with female health care providers.…”

“…The studies on the issue (Dohan et al, 2007;Allahverdipour & Emami, 2008) have yielded to similar results, emphasizing that lack of knowledge, cultural values and religious beliefs cause a significant barrier. Especially in Eastern and Asian societies, barriers are significantly caused by the privacy of woman's body, their lack of a say on their own lives, their traditional roles in meeting the needs of their family before their own needs and their thought that there is no need for them to see a doctor in the absence of any symptoms for a diseases.…”

Increased Access to Professional Interpreters in the Hospital Improves Informed Consent for Patients with Limited English Proficiency

“…While having a family advocate present for these discussions may be beneficial even for English-speaking patients, there is evidence that ad-hoc family interpreters commit a higher rate of errors 41 and may also attempt to shield the patient from information they are uncomfortable discussing with their loved ones. 42,43 Our findings have important implications for hospital systems seeking to improve quality and decrease disparities for patients with LEP. First, the impact of the bedside interpreter phone intervention may be generalizable to other hospital systems with similar patient populations and should be considered as an effective method to improve informed consent and decrease communication disparities for patients with LEP.…”

A Culturally Tailored Navigator Program for Colorectal Cancer Screening in a Community Health Center: A Randomized, Controlled Trial

“…22,23 These unique barriers may contribute to observed disparities in care. [24][25][26][27][28][29][30][31] Strategies shown to modestly increase preventive cancer screening rates in low income and limited English proficiency populations have included both mailed reminders with educational information for patients and physician-directed efforts to increase recommendation rates. [32][33][34] Recently, "navigator programs" specifically designed to overcome patients' perceived barriers to screening have been evaluated.…”