Language barriers are an obstacle that delays diagnoses and lowers cancer screening rates. Patients with a limited English proficiency (LEP) may have a lower treatment adherence, reduced engagement in care, and poorer cancer outcomes. Language concordant care—when a doctor and patient speak the same language—is not always available. To receive proper, comprehensive medical care, patients without access to language concordant care need access to translation services, such as an interpreter or translator.

What is the difference between an interpreter and a translator?

“Interpreter” and “translator” can sometimes be used interchangeably, but both have distinct roles in a healthcare setting. An interpreter is someone who works with spoken language in real time and facilitates conversations between patients and healthcare providers. A translator works more closely with written language, including informed consent documents and medication labels.

Availability of translation services

According to a study from the Journal of General Internal Medicine, physicians frequently rely on the patient’s family or bilingual staff members for interpretation. By doing so, “39.9% of respondents reported never using professional interpreters”. A family member providing translation services is able to provide more comfort, valuable background information on the patient, and may be trusted by both the physician and patient. However, there may be overt omissions of medical information by a patient’s family members or a risk of information being kept from healthcare providers. A professional medical interpreter is able to share comprehensive information regarding medical terminology and help the provider give an accurate diagnosis. In the same study, less than one-third of outpatient physicians had regular use of professional interpreters when speaking to patients with limited English proficiency (LEP).

Hospitals provide both on-site and off-site interpretation services. Off-site interpretation can be done entirely over the phone or through a video screen. Between these methods, on-site interpretation is able to provide clearer communication and higher patient satisfaction.

While the availability of different languages may vary depending on the local population’s needs, professional medical interpreters are provided at no cost to the patient.

Access to interpretation alone is not enough

Melissa Martos, MD, a Pediatric Oncologist at Seattle Children’s Hospital with research focused on language barriers in oncology in the United States, weighed in for The Cancer News.

"Access to professional interpreters is essential to improving care for patients and families who use a language other than English, but access alone is not enough,” Martos said. “Providers need to use professional interpreters for every encounter, communicate frequently rather than ‘batching’ conversations, and ensure that interpreted encounters are as rich in communication as those conducted in English. Equitable care requires taking the time to explain complex concepts, build and earn trust, connect with patients and families as whole people, and meaningfully involve them in their care and decision-making.”

In the case of a medical emergency, time constraints may also deter healthcare professionals from using an interpreter or receiving medical interpreter services, even when one is available. This may lead a healthcare provider to rely on a patient’s family member to provide translation services. Given that 40% of physicians have never used a professional medical interpreter, there may be difficulty when an interpreter is needed in real time.

"Just as critical as providing interpreter and translation services, is providing additional time for the visit that requires use of these services,” said Mortuma Murry, DNP, an Assistant Professor of Pediatrics at Oregon Health & Science University. “We do ourselves and our patients a disservice when we fight for these services but maintain visit constraints that still allow for a poor experience even when the right resources are present."

With LEP patients being more likely to present with advanced-stage cancers, the underuse of professional translation services can be detrimental to patient care during both the initial cancer diagnosis and stage at diagnosis.

Cultural competence and why it matters

Cultural competence is sometimes referred to as cultural humility, cultural safety, or cultural sensitivity. The National Standards for Culturally and Linguistically Appropriate Services in Health and Health Care defines cultural competence in healthcare as providers and organizations meeting patients’ social, cultural, and linguistic needs. These guidelines emphasize the importance of educating staff members, conducting assessments of community health needs, and providing language assistance.

"The definition of cultural competency goes far beyond meeting social, cultural, and linguistic needs,” said Murry. “The most important element of the definition is meeting individuals of different cultures where they are at, and gaining their trust and respect, which truly allows us to understand their unique needs, setting us up to meaningfully satisfy those needs.”

A lack of cultural sensitivity can severely impact patient outcomes. For instance, in a study about hospice experience between English speaking and Spanish speaking families, Spanish-speaking families were frustrated with the emergency department because their child was present for the delivery of bad news about their condition. In a recent literature review, it was found that cultural competency education improved healthcare professionals’ competencies through lecture-based and interactive teachings. LEP patients may also be hesitant to use a medical interpreter due to their experience of translations being “overly technical, culturally insensitive, or lacking actionable guidance”. A culturally insensitive translation could include a lack of understanding of cultural references and connotations of particular words that are different to English. This could change their level of trust in the physician and their interpretation of a treatment plan or severity of the diagnosis.

With LEP patients being underrepresented in cancer research due to a lack of translation resources and language-based exclusion criteria, cultural competence paired with access to translation services can best set up LEP patients for increased cancer screening rates and early detection.


Key Takeaways

  • The use of professional medical interpreters and translators are vital to patient satisfaction and provide clearer communication to healthcare providers.
  • There may be instances where it is difficult to access an interpreter, such as the physician not knowing how to access one or the patient speaking a less commonly spoken language by the local population in the service area. However, physicians should not have to rely on a patient’s family members for translation services.
  • A lack of translation services and/or cultural competence can be addressed through cultural competency training and conducting regular assessments of the local population’s health needs.

References

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