To worry or not to worry: breast cancer genetic counseling communication with low-income Latina immigrants

Abstract

The purpose of this pilot study was to describe communication practices during hereditary breast cancer genetic counseling (GC) with low-income immigrant Latina patients in a public hospital setting. We utilized qualitative ethnographic methods, including direct observation of GC appointments with Latina patients at a public hospital offering free GC and BRCA testing and in-depth qualitative interviews with patients after they had received their BRCA genetic test results. Twenty-five patients participated; 20 were observed during genetic counseling appointments, and ten participated in interviews after BRCA testing with six participating in both observations and an interview. Analyses of qualitative data from observation field notes and interviews identified both strengths and limitations of current communication practices within the following themes: (1) family health history communication, (2) education regarding genes and genetics and patient information needs, (3) the purpose of the genetic test, (4) genetic test results and cancer risk, (5) building rapport and providing support, and (6) medical interpretation for monolingual Spanish speakers. As access to cancer GC expands in the public safety net settings and for the diverse populations they serve, it is critical to ensure effective communication in order for patients, whether or not they have a BRCA mutation, to understand the nature of their cancer risk and recommended methods of screening and prevention. Intervention strategies that address both structural constraints and patient-provider communication are needed to improve GC communication with immigrant Latinas, especially monolingual Spanish speakers.

Cancer genetic counseling communication with low-income Chinese immigrants

“…Coders included the first author, a bilingual bicultural (Cantonese/Chinese) social psychologist, and bilingual/bicultural (Spanish/Latina) research associate and the PI, a medical anthropologist. Coders independently reviewed the initial transcripts using a combination of open coding and a priori codes based on the interview guide, the literature, and preliminary research (Joseph and Guerra 2015). Coders then met to reconcile discrepancies and establish a codebook.…”

Working with the Hmong Population in a Genetics Setting: Genetic Counselor Perspectives

“…There is, however, a fine line between the liberty to translate in a close and culturally meaningful way, and translating information that was not originally conveyed. Joseph and Guerra (2015) found that the technical information of cancer genetic counseling appointments caused professional Spanish interpreters to translate meaning and facts of statements incorrectly. Since the Hmong language does not, by its very structure, allow for word-to-word translation of genetic terms and concepts, any translation from English to Hmong has the potential to be different than intended by the counselors.…”

Cancer Counseling of Low‐Income Limited English Proficient Latina Women Using Medical Interpreters: Implications for Shared Decision‐Making

“…As such, the increasing linguistic diversity in the U.S., and the accompanying cultural diversity, present a challenge for genetic counselors (GCs) (Lewis 2002;Ota Wang 2001;Weil and Mittman 1993). The possibility of genetic counseling services that may lead to inappropriate screening or treatment due to language barriers is a serious concern (Bhogal and Brunger 2010; Joseph and Guerra 2015).…”