A new study has revealed a disturbing lack of access for non-English speakers seeking advice on cancer care services from hospitals across the US. Researchers pretending to be patients calling general helplines in various hospitals were met with alarming results that highlight issues for these vulnerable patient populations.
In their experiment, researchers from the University of Michigan simulated patient calls to the general helplines of various hospitals while speaking in English, Spanish, and Mandarin.
They found that nearly all of the English-speaking callers were given information on the next steps needed to access cancer care – which included the telephone number of clinics or being transferred to the appropriate department – but little over a third of Spanish speakers had the same success. The situation was even worse for simulated Mandarin-speaking patients.
According to the study’s authors, “The rationale for contacting the hospital general information line is that it serves as the initial entry point for many individuals seeking to obtain information about hospital clinics and services”.
This means that these initial information hubs are an important site for evaluating cancer care access for patients from different backgrounds, making the results of the study worrying.
“Our study found significant language-based disparities in patients’ access to cancer care well before they are seen by a physician,” lead researcher Dr Debbie W. Chen of the University of Michigan said in a statement.
“If patients with cancer cannot access information on where to obtain the appropriate cancer care, what other critical information and services are they not able to access in our healthcare system?”
To test these services, Chen’s team simulated calls to a random selection of 144 hospitals that were evenly distributed across 12 demographically diverse US states: California, Florida, New York, Texas, Arizona, Illinois, Massachusetts, New Jersey, Michigan, Missouri, Oregon, and Pennsylvania.
All calls were made on weekdays between 8:00am and 5:00pm local time, between November 8, 2021, and June 23, 2022.
In total, the team made 1,296 calls, 432 for each language. They found that around 53 percent of the overall calls were provided with the information they sought. English speakers were connected to the next service around 94 percent of the time, while Spanish speakers were only connected 38 percent of the time and Mandarin speakers only 28 percent of the time.
Chen’s work added to previous research conducted in 2005, which simulated Spanish-speaking callers phoning hospital general information lines in New York City while seeking details about the hospital’s out-patient clinics.
“Even though our study takes place 16 years later, during a time when more than 25 million individuals with limited English proficiency live in the United States,” Chen added, “our study found even lower success rates for non-English-speaking persons seeking to access cancer care services.”
“Most of the barriers that the simulated non-English-speaking callers encountered were systems-level issues, including being told ‘no’ or being hung up on by hospital staff, or being disconnected because the hospital’s automated message required input but did not provide language-concordant instructions, plus issues at the level of Interpreter Services.”
According to Chen, there are several potential solutions to this problem. These include creating automatic messaging that provides instructions for accessing the information in different languages. There should also be a safeguard to ensure calls are directed to a person instead of disconnecting in situations where no input is made by a patient.
They also suggest the initial general information staff member should remain on the call as the patient speaks with an interpreter, so that relevant information concerning the care services can be accurately translated.
“The results of this important study highlight what we see every day on the ground level,” commented Darcie Green, Executive Director of Latinas Contra Cancer, who was not involved in this research.
“Spanish-speaking patients, as well as others who are not English-proficient, face preventable barriers in access to care starting at one of the most basic expectations we have when calling our health care provider – the ability to call in for an appointment or advice."
"This health inequity from the very start can lead to late detection, erosion of trust, disengagement from the healthcare system, and many other adverse health outcomes that serve to only deepen cancer care disparities.”
Green added that “as we lean into greater investment in community health workers and patient navigation to reduce disparities in detection, treatment, and survivorship, it is crucial that the patients who need these services the most do not face unnecessary barriers to accessing them."
"This study should serve as an affirming but urgent call to action for accountability and to support and invest in the strategies and infrastructure needed to eliminate language-based health inequity in access to care.”
The study is published in the Journal of the National Comprehensive Cancer Network.