Abstract A12: Challenges to patient-centered care for limited English proficient breast cancer patients

Background: Provision of high quality patient-centered care is fundamental to eliminating healthcare disparities in breast cancer. This is particularly true for the large and growing population of women with limited English proficiency (LEP). These women are less likely to experience patient-centered care because their communication with their physicians is complicated by a language barrier. We set out to investigate physicians' experiences communicating with LEP breast cancer patients, and to assess their perceived difficulty in discussing treatment options and prognosis across a language barrier

Methods: We conducted a survey of a representative sample of California physicians by randomly selecting 1250 surgeons and oncologists from the American Medical Association Masterfile. Physicians were excluded if they spent <10% of their time in clinical practice or if fewer than 10% of their patients had breast cancer, if they had retired or moved out of state, or if their contact information was no longer valid, resulting in an eligible sample of 628.

Results: Of the 313 respondents (50% participation rate), 301 reported having some patients in their panel (mean 19%, s.d. 19; range 1–98%) with a limited ability to communicate in English. Of those 301 respondents, 58% were surgeons, 75% were male, and 67% were in private practice. They had been in practice on average 19 years (s.d. 10, range 2–50); and, on average 33% (s.d 23, range 10–100) of their patients had breast cancer, and 21% (s.d. 16, range 0–95) had less than a high school education. Of the 173 physicians who reported ever speaking directly with patients in a non-English language, only two-thirds reported adequate language skills to do so. Additionally, only 40% reported often/sometimes using any kind of professional interpretation services (in-person, telephonic, videoconferencing). Half (52%) reported setting aside extra time for visits with LEP patients. Although 75% of physicians surveyed felt they were usually able to communicate effectively when treating a breast cancer patient who is LEP, 47% said they tend to be more directive about treatment recommendations, 54% said they tend to simplify their discussion of risks and benefits, and 64% worry that their LEP patients may not have asked all of their questions. Many more physicians reported difficulty discussing both treatment options and prognosis with LEP patients (59% and 57%) than with patients either from a different culture (25% and 33%) or with a low level of education (24% and 29%).

Conclusions: California oncologists and surgeons caring for breast cancer patients find communication about both treatment options and prognosis markedly more challenging when it takes place across a language barrier than across cultures or education levels. Despite this, the majority of respondents do not use professional interpreters, even over the telephone; and many of them simplify important discussions with their LEP patients, worrying that these women are not asking all of their questions. In addition to increased access to, reimbursement for, and use of professional interpreters, these physicians and their LEP patients may benefit from the development and implementation of best practice communication tools to assist in complex treatment and prognosis discussions.