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Shete M, Kocher M, Pratt R, Lee H, Zierhut H. Genetic counseling processes and strategies for racially and ethnically diverse populations: A systematic review. J Genet Couns 2024; 33:842-861. [PMID: 37743585 DOI: 10.1002/jgc4.1773] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Revised: 06/26/2023] [Accepted: 08/12/2023] [Indexed: 09/26/2023]
Abstract
Genetic counseling outcomes are influenced by the processes and strategies used by counselors, yet little is known about how these strategies directly impact patients and populations. In particular, tailoring genetic counseling consultations to best meet the needs of cultural, racial, and ethnically diverse populations has been explored. This review aims to identify genetic counseling strategies tailored for a diversity of racial and ethnic populations with the goal to find ways to improve genetic counseling outcomes. Medline, Cochrane CENTRAL, Embase, PsychInfo, and CINAHL databases were searched for original research articles published in English that employed genetic counseling processes and strategies to improve genetic counseling outcomes, specifically for participants from ethnically or racially diverse populations. A review of 5300 titles and abstracts resulted in the identification of 36 articles that met the inclusion criteria. Three themes emerged: (1) community involvement in culturally tailoring genetic counseling, (2) creation and use of culturally tailored resources, and (3) modifications to the genetic counseling process. The effectiveness of genetic counseling strategies could not be evaluated due to lack of consistent outcome measures in the articles. The involvement of diverse ethnic and racial populations in developing inclusive genetic counseling tools and practices will help the profession provide better patient care in the future. More research connecting genetic counseling processes and outcomes will help to assess how well these modified approaches meet the needs of diverse populations.
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Affiliation(s)
- Mrunmayee Shete
- Department of Genetics, Cell Biology & Development, University of Minnesota-Twin Cities, Minneapolis, Minnesota, USA
| | - Megan Kocher
- University Libraries, University of Minnesota-Twin Cities, Minneapolis, Minnesota, USA
| | - Rebekah Pratt
- Department of Family Medicine and Community Health, University of Minnesota-Twin Cities, Minneapolis, Minnesota, USA
| | - Heewon Lee
- Department of Genetics, Cell Biology & Development, University of Minnesota-Twin Cities, Minneapolis, Minnesota, USA
| | - Heather Zierhut
- Department of Genetics, Cell Biology & Development, University of Minnesota-Twin Cities, Minneapolis, Minnesota, USA
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Abu-Odah H, Chan EA, Molassiotis A. Factors Impacting on Patient-Centered Communication Skills and Their Opportunities to Be Involved in Decision-making From the Perspective of Patients With Cancer, Informal Caregivers, and/or Healthcare Professionals: A Systematic Review. Cancer Nurs 2024:00002820-990000000-00246. [PMID: 38652461 DOI: 10.1097/ncc.0000000000001357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/25/2024]
Abstract
BACKGROUND Active participation of cancer patients and their caregivers in decision-making, along with high-quality communication, is crucial in patient-centered cancer management. Although numerous factors affecting patients' communication and decision-making involvement have been identified, it is still unclear which ones are the most prevalent and critical. OBJECTIVE To identify factors that contribute to high-quality patient-centered communication and decision-making participation from the perspectives of cancer patients, informal caregivers, and/or healthcare professionals. METHODS A systematic review was conducted, using 9 databases to retrieve primary research articles published from 2010 to February 17, 2023, updated on December 13, 2023. Methodological quality was assessed using the Mixed Methods Appraisal Tool (version 18). The socioecological model of communication was utilized as analytical framework for summarizing the results. RESULTS Fifty-two studies were included. The most frequently reported factors were predominantly articulated at the individual, interpersonal, and societal levels. Although the patients' lack of knowledge and limited language proficiency were the frequent patient-level barriers, the perceived lack of knowledge and lack of training of professionals were the crucial and current professional-level barriers, as reported in studies published in 2016 onward. To circumvent these factors, it is critical to enhance professionals' knowledge, communication skills, and patient relationships. CONCLUSIONS Recognizing barriers and facilitators could help in the development of strategies to overcome these barriers and enhance patient participation in clinical communication. IMPLICATION FOR PRACTICE The findings could guide the development of programs to enhance patient-professional communication skills. Further cross-cultural studies are needed to understand culture's impact on communication effectiveness and decision-making participation.
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Affiliation(s)
- Hammoda Abu-Odah
- Author Affiliations: School of Nursing, The Hong Kong Polytechnic University, Hong Kong SAR (Dr Abu-Odah and Prof. Chan); and College of Arts, Humanities and Education, University of Derby, Derby, UK (Prof. Molassiotis)
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Burke C, Doody O, Lloyd B. Healthcare practitioners' perspectives of providing palliative care to patients from culturally diverse backgrounds: a qualitative systematic review. BMC Palliat Care 2023; 22:182. [PMID: 37978500 PMCID: PMC10655398 DOI: 10.1186/s12904-023-01285-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Accepted: 10/13/2023] [Indexed: 11/19/2023] Open
Abstract
BACKGROUND Palliative care practitioners are increasingly caring for patients and families from diverse cultural backgrounds. There is growing awareness of the influence of culture on many aspects of care in the palliative phase of an illness. However, disparities have been noted in the provision of palliative care to patients from culturally diverse backgrounds and challenges have been reported in meeting their needs and those of their families. METHOD A qualitative systematic review of research papers identified through searching four databases. Papers were screened against inclusion criteria within the timeframe of January 2012 to March 2022. Data was extraction from all included studies and methodological quality assessed utilising the Critical Appraisal Skills Programme Tool. Thematic analysis followed Braun and Clarke's framework and the review is reported in line with PRISMA guidelines. FINDINGS The search yielded 1954 results of which 26 were included for appraisal and review. Four themes were identified: communication and connection, the role of the family in death and dying, the role of education in addressing uncertainty, and institutional and societal factors. The findings highlighted challenges of communication and a fear of acting in a culturally insensitive way, the pivotal role of the family, the need for an individualised approach to care, the universality of needs when approaching end of life and the need for education of practitioners. CONCLUSION These findings suggest that healthcare practitioners draw on their existing skills to adapt their practice to meet the needs of patients from culturally diverse backgrounds. However, results also indicate a need for further education and identification of educational approaches best suited to supporting healthcare professionals in practice.
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Affiliation(s)
- Colette Burke
- Milford Care Centre, Castletroy, Limerick, V94 H795, Ireland
| | - Owen Doody
- Department of Nursing and Midwifery, Faculty of Education and Health Sciences, University of Limerick, Limerick, V94 T9PX, Ireland
| | - Barbara Lloyd
- Department of Nursing and Midwifery, Faculty of Education and Health Sciences, University of Limerick, Limerick, V94 T9PX, Ireland.
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Alfar ZA. Hospital Nurses' Experiences of Providing Care for Muslim Patients in the United States. J Transcult Nurs 2023; 34:279-287. [PMID: 37144407 DOI: 10.1177/10436596231169784] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/06/2023] Open
Abstract
INTRODUCTION Understanding a patient's culture is imperative to providing holistic patient care. The purpose of the study is to describe and explore the lived experiences of non-Muslim hospital-employed registered nurses providing care for Muslim patients in the United States. METHOD This study used a qualitative exploratory research design based on semi-structured interviews utilizing Husserlian phenomenology. A snowball technique was used to recruit the participants. RESULTS Ten nurses who cared for hospitalized Muslim patients were interviewed and three major themes emerged from the participants' narratives: Nurse-Patient Relationship, Nurses' Knowledge and Western Health Care Systems, and Family Influence. DISCUSSION Muslim patients have cultural expectations and differences that may not be anticipated by nurses, which affects nurses' experiences when providing care. As the Muslim population continues to grow in the United States, there is a need for increased education on culturally congruent care to assure the highest quality of nursing care.
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Lubuzo B, Hlongwana K, Ginindza T. Model for Achieving a Coordinated Access to Lung Cancer Care in Selected Public Health Facilities in KwaZulu-Natal, South Africa: Protocol for a Qualitative Study. JMIR Res Protoc 2023; 12:e34341. [PMID: 36867453 PMCID: PMC10024215 DOI: 10.2196/34341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Revised: 08/02/2022] [Accepted: 08/04/2022] [Indexed: 03/04/2023] Open
Abstract
BACKGROUND Timely delivery of high-quality cancer care to all patients is barely achieved in South Africa and many other low- and middle-income countries, mainly due to poor care coordination and access to care services. After health care visits, many patients leave facilities confused about their diagnosis, prognosis, options for treatment, and the next steps in their care continuum. They often find the health care system disempowering and inaccessible, thereby making access to health care services inequitable, with the resultant outcome of increased cancer mortality rates. OBJECTIVE The aim of this study is to propose a model for cancer care coordination interventions that can be used to guide and achieve coordinated access to lung cancer care in the selected public health care facilities in KwaZulu-Natal. METHODS This study will be conducted through a grounded theory design and an activity-based costing approach that will include health care providers, patients, and their caregivers. The study participants will be purposively selected, and a nonprobability sample will be selected based on characteristics, experiences of the health care providers, and the objectives of the study. With the study's objectives in mind, communities in Durban and Pietermaritzburg were selected as study sites, for the study along with the 3 public health facilities that provide cancer diagnosis, treatment, and care in the province. The study involves a range of data collection techniques, namely, in-depth interviews, evidence synthesis reviews, and focus group discussions. A thematic and cost-benefit analysis will be used. RESULTS This study receives support from the Multinational Lung Cancer Control Program. The study obtained ethics approval and gatekeeper permission from the University's Ethics Committee and the KwaZulu-Natal Provincial Department of Health, as it is being conducted in health facilities in KwaZulu-Natal province. As of January 2023, we had enrolled 50 participants, both health care providers and patients. Dissemination activities will involve community and stakeholder dissemination meetings, publications in peer-reviewed journals, and presentations at regional and international conferences. CONCLUSIONS This study will provide comprehensive data to inform and empower patients, professionals, policy architects, and related decision makers to manage and improve cancer care coordination. This unique intervention or model will address the multifactorial problem of cancer health disparities. If successful, this study will affect the design and implementation of coordination programs to promote optimal cancer care for underserved patients. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/34341.
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Affiliation(s)
- Buhle Lubuzo
- Discipline of Public Health Medicine, School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa
| | - Khumbulani Hlongwana
- Discipline of Public Health Medicine, School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa
| | - Themba Ginindza
- Discipline of Public Health Medicine, School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa
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Lubuzo B, Hlongwana KW, Ginindza TG. Lung Cancer Patients' Conceptualization of Care Coordination in Selected Public Health Facilities of KwaZulu-Natal, South Africa. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:13871. [PMID: 36360759 PMCID: PMC9657230 DOI: 10.3390/ijerph192113871] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Revised: 10/19/2022] [Accepted: 10/21/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND Cancer patients commonly receive care, including comprehensive treatment options, from multiple specialists within and across facilities offering varying levels of care. Given this multi-layered approach to cancer care, there is a need for coordinated care enhanced through integrated information flow for optimal patient care and improved health outcomes. OBJECTIVE This study aimed to explore how patients conceptualized cancer care coordination in an integrated health care system in KwaZulu-Natal. METHODS The study employed a grounded theory design to qualitatively explore the patients' experiences and views on cancer care coordination using in-depth interviews. Guided by the grounded theory principles, data generation and analysis were conducted iteratively, followed by systematic thematic analysis to organize data, and review and interpret comprehensive findings. This process culminated in the development of themes relating to barriers to cancer care coordination and the interface between the primary and tertiary settings. Theoretical saturation was achieved at 21 in-depth interviews with consenting respondents. RESULTS This study revealed that care coordination was affected by multilevel challenges, including pertinent health system-level factors, such as difficulty accessing specialty care timeously, weak communication between patients and healthcare providers, and unmet needs concerning supportive care. We found that negative experiences with cancer care erode patient trust and receptiveness to cancer care, and patients advocated for better and proactive coordination amongst different care facilities, services, and providers. CONCLUSIONS An integrated care coordination setup is essential to create and sustain a high-performance health care system. These findings make a case for developing, implementing, and evaluating interventions to enhance the quality of cancer care for patients and ultimately improve health outcomes for patients in KwaZulu-Natal. This study will provide comprehensive data to inform professionals, policymakers, and related decisionmakers to manage and improve cancer care coordination.
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Affiliation(s)
- Buhle Lubuzo
- Discipline of Public Health Medicine, School of Nursing and Public Health, University of KwaZulu-Natal, Durban 4001, South Africa
- Cancer & Infectious Diseases Epidemiology Research Unit (CIDERU), College of Health Sciences, University of KwaZulu-Natal, Durban 4000, South Africa
| | - Khumbulani W. Hlongwana
- Discipline of Public Health Medicine, School of Nursing and Public Health, University of KwaZulu-Natal, Durban 4001, South Africa
- Cancer & Infectious Diseases Epidemiology Research Unit (CIDERU), College of Health Sciences, University of KwaZulu-Natal, Durban 4000, South Africa
| | - Themba G. Ginindza
- Discipline of Public Health Medicine, School of Nursing and Public Health, University of KwaZulu-Natal, Durban 4001, South Africa
- Cancer & Infectious Diseases Epidemiology Research Unit (CIDERU), College of Health Sciences, University of KwaZulu-Natal, Durban 4000, South Africa
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Yılmaz NG, Sungur H, van Weert JCM, van den Muijsenbergh METC, Schouten BC. Enhancing patient participation of older migrant cancer patients: needs, barriers, and eHealth. ETHNICITY & HEALTH 2022; 27:1123-1146. [PMID: 33316171 DOI: 10.1080/13557858.2020.1857338] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Accepted: 11/24/2020] [Indexed: 06/12/2023]
Abstract
OBJECTIVES To gain insight into (1) the unfulfilled instrumental and affective needs of Turkish-Dutch and Moroccan-Dutch older cancer patients/survivors, (2) the barriers perceived by healthcare professionals in fulfilling these needs, and (3) how the Health Communicator, a multilingual eHealth tool, can support the fulfillment of patients'/survivors' needs, and decrease professionals' barriers. DESIGN We conducted a pre-implementation study of the Health Communicator using semi-structured interviews with Turkish-Dutch (n = 10; mean age = 69.10) and Moroccan-Dutch (n = 9; mean age = 69.33) older cancer patients/survivors, and held two focus groups with general practitioners (GPs; n = 7; mean age 45.14) and oncology nurses (ONs; n = 5; mean age = 49.60). Topic list consisted of questions related to needs and perceived barriers. Analysis was based on grounded theory. The acceptance of the Health Communicator was inquired by questions based on the concepts of the Technology Acceptance Model, and analyzed deductively. RESULTS Patients/survivors reported unfulfilled needs concerning: (1) information about cancer (treatment), (2) information about the healthcare system, (3) possibilities regarding psychosocial support, and (4) doctor-patient relationship. Among professionals, the main perceived barriers were: (1) patients'/survivors' low health literacy and language barrier, (2) cultural taboo, (3) lack of insight into patients' instrumental needs, and (4) patients'/survivors' lack of trust in Dutch healthcare. Both patients/survivors and professionals thought that implementing the Health Communicator could be effective in fulfilling most of the needs and decreasing the barriers. However, a majority of the patients/survivors were hesitant regarding the use of it, because they found it too difficult to use. Professionals showed a positive intention towards using the Health Communicator. CONCLUSIONS To enhance patient participation among older migrant cancer patients/survivors, the Health Communicator is, under certain conditions, a promising tool for fulfilling patients'/survivors' unfulfilled instrumental and affective needs and for bridging barriers perceived by professionals.
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Affiliation(s)
- Nida Gizem Yılmaz
- Department of Communication Science, Amsterdam School of Communication Research/ASCoR, University of Amsterdam, Amsterdam, The Netherlands
- Department of Public and Occupational Health, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Hande Sungur
- Department of Communication Science, Amsterdam School of Communication Research/ASCoR, University of Amsterdam, Amsterdam, The Netherlands
| | - Julia C M van Weert
- Department of Communication Science, Amsterdam School of Communication Research/ASCoR, University of Amsterdam, Amsterdam, The Netherlands
| | - Maria E T C van den Muijsenbergh
- Department of Primary and Community Care, Radboud University Medical Centre, Nijmegen, The Netherlands
- Prevention and care Programme, Pharos, National Centre of Expertise on Health Disparities, Utrecht, The Netherlands
| | - Barbara C Schouten
- Department of Communication Science, Amsterdam School of Communication Research/ASCoR, University of Amsterdam, Amsterdam, The Netherlands
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Riccetti N, Hempler I, Hermes-Moll K, Heidt V, Bayer O, Walawgo T, Merbach M, Singer S. Linguistic barriers in communication between oncologists and cancer patients with migration background in Germany: an explorative analysis based on the perspective of the oncologists from the mixed-methods study POM. RESEARCH IN HEALTH SERVICES & REGIONS 2022; 1:3. [PMID: 39177829 PMCID: PMC11264866 DOI: 10.1007/s43999-022-00001-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/20/2021] [Accepted: 05/02/2022] [Indexed: 08/24/2024]
Abstract
OBJECTIVE We aimed at investigating the predictors of linguistic barriers among office-based haemato-oncologists during consultation with migrant cancer patients in Germany. METHODS Physicians from haemato-oncological practices were invited to participate in a cross-sectional study. Linguistic barriers and family factors were ascertained using a newly developed online-questionnaire with the scales "Overall linguistic barriers", "Self-perceived linguistic barriers" and "Family factors - antagonistic behaviour". Predictors of linguistic barriers were identified using multivariate ANOVA via step-wise backwards selection. RESULTS Fifty-five physicians participated in the study. Treating patients from Sub-Saharan Africa predicted higher overall and self-perceived linguistic barriers (F [2,46] = 4.51, p = .04; and F [3,45] = 5.44, p = .02, respectively). Working in an single practice (F [3,45] = 4.19; p = .05) predicted higher self-perceived linguistic barriers. Employees who could act as translators predicted lower barriers in form of antagonistic behaviour from relatives (F [2,48] = 6.12; p = .02). CONCLUSIONS The results indicate that linguistic barriers are affected by the level of linguistic concordance between patients and medical personnel. A temporary solution might be the presence of linguistically competent personnel in the practice. However, the results of this study highlight the need for greater availability of linguistic competent translators for consultations in haemato-oncological practices.
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Affiliation(s)
- Nicola Riccetti
- University Medical Centre, Institute of Medical Biostatistics, Epidemiology and Informatics (IMBEI), Mainz, Germany.
- University Cancer Centre Mainz, Mainz, Germany.
| | - Isabelle Hempler
- Scientific Institute of Office-Based Haematologists and Oncologists (WINHO GmbH), Cologne, Germany
| | - Kerstin Hermes-Moll
- Scientific Institute of Office-Based Haematologists and Oncologists (WINHO GmbH), Cologne, Germany
| | - Vitali Heidt
- Scientific Institute of Office-Based Haematologists and Oncologists (WINHO GmbH), Cologne, Germany
| | - Oliver Bayer
- University Medical Centre, Institute of Medical Biostatistics, Epidemiology and Informatics (IMBEI), Mainz, Germany
- University Cancer Centre Mainz, Mainz, Germany
| | - Thomas Walawgo
- Scientific Institute of Office-Based Haematologists and Oncologists (WINHO GmbH), Cologne, Germany
| | - Martin Merbach
- Evangelisches Zentralinstitut Für Familienberatung, Berlin, Germany
| | - Susanne Singer
- University Medical Centre, Institute of Medical Biostatistics, Epidemiology and Informatics (IMBEI), Mainz, Germany
- University Cancer Centre Mainz, Mainz, Germany
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Assessing psychological health and social support in older adults with cancer, a how-to guide - A Young International Society of Geriatric Oncology and Nursing & Allied Health Interest Group initiative. J Geriatr Oncol 2022; 13:1050-1053. [PMID: 35717534 DOI: 10.1016/j.jgo.2022.05.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Revised: 05/09/2022] [Accepted: 05/26/2022] [Indexed: 11/23/2022]
Abstract
Older adults with cancer frequently have several unmet needs related to overlapping vulnerabilities caused by medical and social health challenges which are often overlooked in typical oncological assessments 1. Social support and psychological health are critical considerations for older adults with cancer and are therefore key components of a geriatric assessment.
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Communication in Health Care: Impact of Language and Accent on Health Care Safety, Quality, and Patient Experience. Am J Med Qual 2021; 36:355-364. [PMID: 34285178 DOI: 10.1097/01.jmq.0000735476.37189.90] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Permanent or temporary migration results in communication issues related to language barriers. The migrant's mother tongue is often different from that of the host country. Even when the same language is spoken, communication barriers arise because of differences in accent. These communication barriers have a significant negative impact on migrants accessing health care and their ability to understand instructions and seek follow-up care. A multidisciplinary team often has professionals from various countries. These migrant health care professionals find it difficult to communicate with patients of the host country and with their colleagues. Communication barriers, therefore, result in miscommunication or no communication between health care professionals and between health care professionals and patients. This increases the risk of medical errors and impacts quality of care and patient safety. This review looks at the impact of communication barriers in health care and endeavors to find effective solutions.
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Nic Giolla Easpaig B, Tran Y, Winata T, Lamprell K, Fajardo Pulido D, Arnolda G, Delaney GP, Liauw W, Smith K, Avery S, Rigg K, Westbrook J, Olver I, Currow D, Girgis A, Karnon J, Ward RL, Braithwaite J. Providing outpatient cancer care for CALD patients: a qualitative study. BMC Res Notes 2021; 14:304. [PMID: 34372907 PMCID: PMC8350263 DOI: 10.1186/s13104-021-05724-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Accepted: 07/30/2021] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVE There have been few descriptions of how outpatient cancer care is provided to patients from culturally and linguistically diverse (CALD) communities. As populations who experience disparities in cancer care access and outcomes, deeper understanding is needed to help identify those factors which can shape the receipt of multidisciplinary care in ambulatory settings. This paper reports on data collected and analysed as part of a multicentre characterisation of care in Australian public hospital cancer outpatient clinics (OPCs). RESULTS Analysis of data from our ethnographic study of four OPCs identified three themes: "Identifying CALD patient language-related needs"; "Capacity and resources to meet CALD patient needs", and "Making it work for CALD communities." The care team comprises not only clinicians but also families and non-clinical staff; OPCs serve as "touchpoints" facilitating access to a range of therapeutic services. The findings highlight the potential challenges oncology professionals negotiate in providing care to CALD communities and the ways in which clinicians adapt their practices, formulate strategies and use available resources to support care delivery.
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Affiliation(s)
- Bróna Nic Giolla Easpaig
- Australian Institute of Health Innovation, Macquarie University, Level 6, 75 Talavera Road, North Ryde, NSW 2109 Australia
| | - Yvonne Tran
- Australian Institute of Health Innovation, Macquarie University, Level 6, 75 Talavera Road, North Ryde, NSW 2109 Australia
| | - Teresa Winata
- Infant, Child and Adolescent Mental Health Services, Liverpool Hospital, Liverpool, NSW Australia
| | - Klay Lamprell
- Australian Institute of Health Innovation, Macquarie University, Level 6, 75 Talavera Road, North Ryde, NSW 2109 Australia
| | - Diana Fajardo Pulido
- Australian Institute of Health Innovation, Macquarie University, Level 6, 75 Talavera Road, North Ryde, NSW 2109 Australia
| | - Gaston Arnolda
- Australian Institute of Health Innovation, Macquarie University, Level 6, 75 Talavera Road, North Ryde, NSW 2109 Australia
| | - Geoff P. Delaney
- South-Western Sydney Local Health District, Liverpool, NSW Australia
- South Western Sydney Clinical School, University of New South Wales, Liverpool, NSW Australia
- Ingham Institute for Applied Medical Research, Liverpool, NSW Australia
| | - Winston Liauw
- St. George Cancer Care Centre, St. George Hospital, Kogarah, NSW Australia
- St. George Hospital Clinical School, University of New South Wales, Sydney, NSW Australia
| | - Kylie Smith
- South-Western Sydney Local Health District, Liverpool, NSW Australia
| | - Sandra Avery
- South-Western Sydney Local Health District, Liverpool, NSW Australia
| | - Kim Rigg
- St. George Cancer Care Centre, St. George Hospital, Kogarah, NSW Australia
| | - Johanna Westbrook
- Australian Institute of Health Innovation, Macquarie University, Level 6, 75 Talavera Road, North Ryde, NSW 2109 Australia
| | - Ian Olver
- Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, SA Australia
| | - David Currow
- College of Medicine and Public Health, Flinders University, Adelaide, SA Australia
- Faculty of Health, University of Technology Sydney, Sydney, NSW Australia
| | - Afaf Girgis
- South Western Sydney Clinical School, University of New South Wales, Liverpool, NSW Australia
- Ingham Institute for Applied Medical Research, Liverpool, NSW Australia
| | - Jonathan Karnon
- College of Medicine and Public Health, Flinders University, Adelaide, SA Australia
| | - Robyn L. Ward
- Prince of Wales Clinical School, University of New South Wales, Sydney, NSW Australia
- Faculty of Medicine and Health, The University of Sydney, Sydney, NSW Australia
| | - Jeffrey Braithwaite
- Australian Institute of Health Innovation, Macquarie University, Level 6, 75 Talavera Road, North Ryde, NSW 2109 Australia
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Balante J, Broek DVD, White K. How does culture influence work experience in a foreign country? An umbrella review of the cultural challenges faced by internationally educated nurses. Int J Nurs Stud 2021; 118:103930. [PMID: 33819641 DOI: 10.1016/j.ijnurstu.2021.103930] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Revised: 03/05/2021] [Accepted: 03/10/2021] [Indexed: 11/19/2022]
Abstract
BACKGROUND Internationally educated nurses experience multidimensional challenges affecting their acculturation process in a foreign country. Cultural differences have been highlighted by research as a common barrier. There is a need to understand the cross-cultural challenges experienced by internationally educated nurses to promote a culturally inclusive workplace, particularly when these nurses practice in another country wherein cultural attitudes and beliefs are different from their own. OBJECTIVES To identify and synthesise the challenges to cultural values, beliefs, and practices of internationally educated nurses working in a foreign country. DESIGN An umbrella review was undertaken by synthesising evidence from systematic reviews. DATA SOURCES Databases searched were MEDLINE, Embase, PsychINFO, CINAHL and Scopus. Reviews published between 2000-2019 were considered. METHODS The review protocol was guided by the guidelines from the Joanna Briggs Institute. The Joanna Briggs Institute Critical Appraisal Instrument for Systematic Reviews and Research Syntheses was used to evaluate the methodological quality of the retrieved reviews. The extracted findings were tabulated, categorised into themes, and presented in a narrative synthesis. RESULTS Ten reviews met the inclusion criteria. These reviews examined the experiences of internationally educated nurses from different countries. The reviews highlighted that cultural differences had impacted the adaptation and professional experiences of internationally educated nurses. Four themes were identified: cultural differences lead to the feeling of being an outsider, intercultural communication issues transcend beyond fluency, differing nursing cultures complicate adaptation, and ethnic identity challenges work adjustment. CONCLUSIONS Despite having a great interest in the literature on the experiences and issues faced by internationally educated nurses, a distinct gap still exists. There is an absence of knowledge on the challenges experienced by internationally educated nurses concerning their cultural beliefs, values, and practices. Further work is needed to enhance understanding and to promote a culturally sensitive workplace.
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Affiliation(s)
- Jay Balante
- Cancer Nursing Research Unit, Susan Wakil School of Nursing and Midwifery, Sydney Nursing School, Faculty of Medicine and Health, The University of Sydney, Level 6 - North, Chris O'Brien Lifehouse, Camperdown NSW 2050, Australia.
| | - Diane van den Broek
- Discipline of Work and Organisational Studies, Business School, The University of Sydney, Corner Abercrombie Street and Codrington St, Darlington NSW 2006, Australia.
| | - Kate White
- Cancer Nursing Research Unit, Susan Wakil School of Nursing and Midwifery, Sydney Nursing School, Faculty of Medicine and Health, The University of Sydney, Level 6 - North, Chris O'Brien Lifehouse, Camperdown NSW 2050, Australia.
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13
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Sacchi S, Capone R, Ferrari F, Sforacchi F, Di Leo S, Ghirotto L. "Achieve the best while rushing against time": A grounded theory study on caring for low-income immigrant cancer patients at end of life. Palliat Med 2021; 35:426-436. [PMID: 33356971 DOI: 10.1177/0269216320974275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Between 2000 and 2020, Europe experienced an annual net arrival of approximately 1.6 million immigrants per year. While having lower mortality rates, in the setting of severe diseases, immigrants bear a greater cancer-related burden due to linguistic and cultural barriers and socio-economic conditions. Professionals face a two-fold task: managing clinical conditions while considering the social, economic, cultural, and spiritual sphere of patients and their families. In this regard, little is known about the care provision to low-income immigrant cancer patients in real contexts. AIM To investigate the perspective of professionals, family members, and stakeholders on the caring process of low-income immigrant cancer patients at the end of life. DESIGN A Constructivist Grounded Theory study. SETTING/PARTICIPANTS The study, conducted at a Hospital in Northern Italy, involved 27 participants among health professionals, family caregivers, and other stakeholders who had recently accompanied immigrant cancer patients in their terminal phase of illness. RESULTS Findings evidenced that professionals feel they were not adequately trained to cope with immigrant cancer patients, nonetheless, they were highly committed in providing the best care they could, rushing against the (short) time the patients have left. Analyses evidenced four main categories: "providing and receiving hospitality," "understanding each other," "addressing diversity," and "around the patient," which we conceptualized under the core category "Achieve the best while rushing against time." CONCLUSIONS The model reveals the activation of empathic and compassionate behavior by professionals. It evidences the need for empowering professionals with cultural competencies by employing interpreters and specific training programs.
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Affiliation(s)
- Simona Sacchi
- Palliative Care Unit, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Roberto Capone
- Department of Rehabilitation, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Francesca Ferrari
- Department of Neurology, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Federica Sforacchi
- Guastalla Hospice, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Silvia Di Leo
- Psycho-oncology Unit, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Luca Ghirotto
- Qualitative Research Unit, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
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14
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Skaczkowski G, Pejoski N, Kaur J, White V, Livingston PM, Wilson C. Distress and problem assessment among people living with cancer from Culturally and Linguistically Diverse backgrounds. Psychooncology 2020; 29:1662-1669. [PMID: 32748467 DOI: 10.1002/pon.5503] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Revised: 07/07/2020] [Accepted: 07/22/2020] [Indexed: 11/08/2022]
Abstract
OBJECTIVE To examine whether routine assessment of distress, recommended as part of comprehensive cancer care, is utilised equally with culturally and linguistically diverse (CALD) vs non-CALD people living with cancer. METHODS A medical records review of all patients attending cancer-specific treatment units at a single tertiary hospital in Melbourne, Australia between 2015-2018. Recording of administration of the Distress Thermometer and Problem Checklist (DT and PC) was extracted for all patients. Details regarding how the DT and PC (used together) was administered were extracted for a random sub-sample of 294 CALD patients and 294 matched non-CALD patients. RESULTS A total of 6977 patients were identified (12.0% CALD). Just over half of the CALD (54.7%) and non-CALD (58.2%) patients had a recorded DT and PC (P > 0.05). For the sub-sample analysis, CALD patients were less likely to complete the form themselves (14.8% vs 75.9% non-CALD) and were more likely to have a family member complete the form (55.1% vs 15.1% non-CALD). CALD patients reported a similar level of distress to non-CALD patients. Distress scores for CALD and non-CALD patients were higher when family members completed the form. Provision of discussion, written information, referral offers and rates of referral acceptance were similar between CALD and non-CALD patients. CONCLUSIONS Assessment of distress and associated problems, and the process following assessment, were similar for CALD and non-CALD patients. However, differences in how the form was completed highlight the need for further improvements to ensure that CALD patients are actively involved in their care.
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Affiliation(s)
- Gemma Skaczkowski
- School of Psychology & Public Health, La Trobe University, Melbourne, Australia.,Olivia Newton-John Cancer Wellness & Research Centre, Melbourne, Australia.,Department of Rural Health, Allied Health and Human Performance, University of South Australia, Melbourne, Australia
| | - Natalie Pejoski
- Olivia Newton-John Cancer Wellness & Research Centre, Melbourne, Australia
| | - Jasmeen Kaur
- School of Psychology & Public Health, La Trobe University, Melbourne, Australia
| | - Victoria White
- School of Psychology, Deakin University, Melbourne, Australia
| | - Patricia M Livingston
- Faculty of Health, School of Nursing and Midwifery, Deakin University, Melbourne, Australia
| | - Carlene Wilson
- School of Psychology & Public Health, La Trobe University, Melbourne, Australia.,Olivia Newton-John Cancer Wellness & Research Centre, Melbourne, Australia
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15
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Levesque JV, Gerges M, Wu VS, Girgis A. Chinese-Australian women with breast cancer call for culturally appropriate information and improved communication with health professionals. Cancer Rep (Hoboken) 2020; 3:e1218. [PMID: 32671993 DOI: 10.1002/cnr2.1218] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2019] [Revised: 08/13/2019] [Accepted: 08/20/2019] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND For culturally and linguistically diverse patients, breast cancer presents complex physical, psychosocial, and health care challenges, often exacerbated by a lack of culturally appropriate information and communication barriers with the treating team (even with the help of interpreters). AIM This qualitative study aims to broadly explore the experience of breast cancer and coping strategies utilized by Chinese-Australian women. METHODS AND RESULTS Twenty-four Chinese-Australian women with breast cancer participated in either a semi-structured interview or a focus group conducted in participants' preferred language, audio-recorded, transcribed, and subjected to thematic analysis. Two prominent themes emerged, related to information seeking, and communication with health care professionals. The theme of information needs and seeking highlighted unmet information needs and the multiple sources that are consulted for information. The second theme, communication with health care professionals, language barriers, and preferences, identified varying degrees of involvement in treatment decision-making, preference for information and interactions in Cantonese or Mandarin, and problems with interpreter services. CONCLUSION Chinese women with breast cancer face significant challenges in obtaining adequate information and can feel excluded from treatment decision-making. Women in this study expressed their eagerness for obtaining accurate information and engaging in open communication with their doctors. There is a need for culturally sensitive information resources and decision aids to enhance communication between Chinese migrant patients with cancer and health care professionals. Clinician participation in cultural awareness training is also recommended.
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Affiliation(s)
- Janelle V Levesque
- Psycho-Oncology Research Group, Centre for Oncology Education and Research Translation (CONCERT), Ingham Institute for Applied Medical Research, South Western Sydney Clinical School, University of New South Wales, Sydney, Australia
| | - Martha Gerges
- Psycho-Oncology Research Group, Centre for Oncology Education and Research Translation (CONCERT), Ingham Institute for Applied Medical Research, South Western Sydney Clinical School, University of New South Wales, Sydney, Australia
| | - Verena S Wu
- Psycho-Oncology Research Group, Centre for Oncology Education and Research Translation (CONCERT), Ingham Institute for Applied Medical Research, South Western Sydney Clinical School, University of New South Wales, Sydney, Australia
| | - Afaf Girgis
- Psycho-Oncology Research Group, Centre for Oncology Education and Research Translation (CONCERT), Ingham Institute for Applied Medical Research, South Western Sydney Clinical School, University of New South Wales, Sydney, Australia
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16
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Krystallidou D, Vaes L, Devisch I, Wens J, Pype P. Study protocol of OncoTolk: an observational study on communication problems in language-mediated consultations with migrant oncology patients in Flanders (Belgium). BMJ Open 2020; 10:e034426. [PMID: 32513878 PMCID: PMC7282320 DOI: 10.1136/bmjopen-2019-034426] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2019] [Revised: 03/11/2020] [Accepted: 04/28/2020] [Indexed: 01/07/2023] Open
Abstract
INTRODUCTION Effective doctor-patient communication in oncology settings can be challenging due to the complexity of the cancer disease trajectory. The challenges can become greater when doctors and patients do not share a common language and need to rely on language mediators. The aim of this study is to provide evidence-based recommendations for healthcare professionals, patients and language mediators on how to interact with each other during language-mediated consultations in oncology settings. METHODS AND ANALYSIS A systematic review of the literature on communication problems in monolingual and multilingual oncology settings will be conducted. Thirty language-mediated consultations with Turkish-speaking or Arabic-speaking cancer patients, language mediators and Dutch-speaking oncologists/haematologists will be video-recorded in three urban hospitals in Flanders, Belgium. All participants will be interviewed immediately after the consultation and 2 weeks after it by means of video-stimulated recall. Multimodal interaction analysis will be combined with qualitative content analysis to allow for the identification of communication practices when communication problems occur. ETHICS AND DISSEMINATION The study has been approved by the following ethics committees: Ghent University Hospital, Antwerp University Hospital, Antwerp Hospitals Network (ZNA). Results will be published via (inter)national peer-reviewed journals and the findings of the study will be communicated using a comprehensive dissemination strategy aimed at healthcare professionals, patients and language mediators.
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Affiliation(s)
| | - Lena Vaes
- Faculty of Arts, Sint Andries Campus, KU Leuven, Antwerp, Belgium
- Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
| | - Ignaas Devisch
- Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
| | - Johan Wens
- Department of Primary and Interdisciplinary Care, University of Antwerp, Antwerp, Belgium
| | - Peter Pype
- Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
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17
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Granek L, Nakash O, Ariad S, Shapira S, Ben-David MA. The Role of Culture/Ethnicity in Communicating with Cancer Patients About Mental Health Distress and Suicidality. Cult Med Psychiatry 2020; 44:214-229. [PMID: 31541335 DOI: 10.1007/s11013-019-09650-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
To explore the role of culture in communicating with cancer patients about mental health distress and suicidality. The Grounded Theory method of data collection and analysis was used. Healthcare professionals (HCPs) reported that language competency was a facilitator while being unable to speak the language or understand the nuances of their patient's communication could be a barrier. HCPs noted that being culturally matched with their patients helped them communicate effectively. HCPs also spoke about religious taboos on suicide as being a barrier to having conversations, either because patients did not feel comfortable discussing these issues, or because they perceived that this was not a topic they could bring up. Some HCPs reported that the culture/ethnicity of their patients had no effect on their ability to communicate effectively with them about mental health distress or suicidality. Advancing effective cross-cultural communication is a challenge faced by HCPs. Raising awareness about communication styles is an important step in addressing communication gaps about mental health and suicide with cancer patients. Training should facilitate skill development to engage in a culturally humble approach to cross-cultural communication including diversity training which encourages asking and actively listening to patients' needs and preferences.
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Affiliation(s)
- Leeat Granek
- School of Health Policy and Management, Faculty of Health, York University, 4700 Keele Street, Toronto, ON, M3J 1P3, Canada.
| | - Ora Nakash
- School for Social Work, Smith College, Northampton, MA, USA.,Baruch Ivcher School of Psychology, Interdisciplinary Center, Herzilya, Israel
| | - Samuel Ariad
- Department of Oncology, Soroka University Medical Center, Ben-Gurion University of the Negev, Beer Sheva, Israel
| | - Shahar Shapira
- Gender Studies Program, Ben-Gurion University of the Negev, Beer Sheva, Israel
| | - Merav A Ben-David
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.,Radiation Oncology Department, Sheba Medical Center, Ramat-Gan, Israel
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18
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Wittenberg E, Goldsmith J, Buller H, Ragan SL, Ferrell B. Communication Training: Needs Among Oncology Nurses Across the Cancer Continuum. Clin J Oncol Nurs 2020; 23:82-91. [PMID: 30682007 DOI: 10.1188/19.cjon.82-91] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Oncology nurses are responsible for communication-aimed prognosis, patient education about cancer care and treatment, survivorship, and care coordination. Communication difficulties and uncomfortable communication topics put nurses at risk for compassion fatigue. OBJECTIVES Supporting nurse communication skills requires institutional policies and structures to foster patient-centered communication. This study reports on communication training needs for oncology nurses to inform future development of communication curricula and institutional training. METHODS A national survey of oncology nurse teams (N = 355) attending one of four communication training courses was used. Surveys were used to evaluate institutions' current patient-centered communication practices and to ascertain institutional communication training needs. FINDINGS Nurses' role in communicating prognosis remains unclear, and training is needed for discussing survivorship. Curriculum development should be congruent with institutionally defined roles for nurse communication.
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19
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Lubuzo B, Ginindza T, Hlongwana K. The barriers to initiating lung cancer care in low-and middle-income countries. Pan Afr Med J 2020; 35:38. [PMID: 32499854 PMCID: PMC7245978 DOI: 10.11604/pamj.2020.35.38.17333] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2018] [Accepted: 11/09/2019] [Indexed: 12/18/2022] Open
Abstract
Lung cancer in low-and middle-income countries is the leading and the second leading cause of cancer deaths in males and females, respectively. This, in part, is due to late presentation of patients in health facilities and late diagnosis, thereby compromising the effectiveness of treatment and resulting in poor treatment outcomes. Investigating patients’ late presentation to health facilities and late diagnosis, as barriers to achieving good treatment outcomes, is an important step towards improving the existing pathways of care. Therefore, the aim of this paper is to critically review the published and unpublished literature, including government reports on lung cancer care, with regards to the barriers to patient access, referral, diagnosis and treatment in low-and middle-income countries. The emphasis is on access point and the primary care continuum. This review has been packaged into themes in order to efficiently inform researchers and cancer health professionals, on the existing gaps necessary for developing appropriate intervention strategies and policy guidelines. This review has revealed that the timeous and correct diagnosis of lung cancer enables lung specialists to engage on options for improved patient care. Currently, there are variations in lung cancer management in low-and middle-income countries. Many of the factors impacting on health care outcomes are a function of patient circumstances and/or understanding, leading to delays in presentation to health facilities. Factors pertaining to individual patient circumstances are further compounded by inefficiencies within the health care system. Therefore, limited health system capacities and competing health priorities in these settings require action.
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Affiliation(s)
- Buhle Lubuzo
- Discipline of Public Health Medicine, School of Nursing and Public Health, University of KwaZulu-Natal, Durban 4041, South Africa
| | - Themba Ginindza
- Discipline of Public Health Medicine, School of Nursing and Public Health, University of KwaZulu-Natal, Durban 4041, South Africa
| | - Khumbulani Hlongwana
- Discipline of Public Health Medicine, School of Nursing and Public Health, University of KwaZulu-Natal, Durban 4041, South Africa
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20
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Deem MJ, Stokes F. Culture and Consent in Clinical Care: A Critical Review of Nursing and Nursing Ethics Literature. ANNUAL REVIEW OF NURSING RESEARCH 2019; 37:223-259. [PMID: 30692159 DOI: 10.1891/0739-6686.37.1.223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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21
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Villalobos AVK, Phillips S, Zhang Y, Crawbuck GSN, Pratt-Chapman ML. Oncology healthcare provider perspectives on caring for diverse patients fifteen years after Unequal Treatment. PATIENT EDUCATION AND COUNSELING 2019; 102:1859-1867. [PMID: 31056266 DOI: 10.1016/j.pec.2019.04.030] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/17/2018] [Revised: 04/12/2019] [Accepted: 04/26/2019] [Indexed: 06/09/2023]
Abstract
OBJECTIVE The purpose of this study was to provide a snapshot of U.S. oncology provider perspectives on caring for diverse patients, including self-rated awareness, comfort, skills, practices, challenges, facilitators, and barriers. METHODS An online survey was administered to a convenience sample of multidisciplinary oncology providers. Descriptive statistics and bivariate analyses were computed for Likert-style items to investigate differences by level of past diversity training. Qualitative content analysis was conducted on open-response questions. RESULTS Roughly one-third (36.7%) of the 406 survey respondents reported receiving high levels of past diversity training, with statistically significant differences by training amount for self-rated skills and select awareness and practice items (p < 0.05). Key challenges qualitatively described included language barriers (n = 143) and alternative health beliefs (n = 52). Knowledge and training (n = 62), interpretation services (n = 53), and staff attitudes (n = 46) were the most frequently mentioned factors affecting culturally sensitive care. CONCLUSION Fifteen years after the publication of Unequal Treatment, the National Academies' landmark report on healthcare disparities, oncology healthcare providers have ongoing challenges caring for diverse patients and opportunities to implement recommendations from the report. PRACTICE IMPLICATIONS Content of diversity trainings should focus on identified gaps and practical challenges. Multi-level supports are needed, including resources and training for oncology providers.
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Affiliation(s)
- Aubrey V K Villalobos
- Institute for Patient-Centered Initiatives and Health Equity, The George Washington University Cancer Center, 2600 Virginia Avenue NW, Suite 300, Washington DC, 20037, USA
| | - Serena Phillips
- Institute for Patient-Centered Initiatives and Health Equity, The George Washington University Cancer Center, 2600 Virginia Avenue NW, Suite 300, Washington DC, 20037, USA
| | - Yuqing Zhang
- Institute for Patient-Centered Initiatives and Health Equity, The George Washington University Cancer Center, 2600 Virginia Avenue NW, Suite 300, Washington DC, 20037, USA
| | - Graham S N Crawbuck
- Institute for Patient-Centered Initiatives and Health Equity, The George Washington University Cancer Center, 2600 Virginia Avenue NW, Suite 300, Washington DC, 20037, USA
| | - Mandi L Pratt-Chapman
- Institute for Patient-Centered Initiatives and Health Equity, The George Washington University Cancer Center, 2600 Virginia Avenue NW, Suite 300, Washington DC, 20037, USA.
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22
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Odai-Afotey A, Kliss A, Hafler J, Sanft T. Defining the patient experience in medical oncology. Support Care Cancer 2019; 28:1649-1658. [PMID: 31286234 DOI: 10.1007/s00520-019-04972-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2018] [Accepted: 06/28/2019] [Indexed: 11/30/2022]
Abstract
PURPOSE Higher patient satisfaction is associated with improved health outcomes, treatment adherence, and quality of life. The goal of this study was to explore oncology patients' perceptions on their hospital experience, focusing on the quality of care in medical oncology. METHODS A qualitative and quantitative study design was implemented with a sample of 58 patients at Smilow Yale New Haven Hospital. Data were collected from patient interviews and observation of rounds. RESULTS Two themes emerged: hospital experience and physician communication skills. Within hospital experience, subthemes identified include: attended to (49%), facility/staff (35%), nurses (33%), long wait time (29%), doctors (20%), coordination of care (18%), unnecessary medical procedures (10%), medications (6%), night awakenings (4%), pain (4%), not getting better (4%), and decreased mobility (2%). Within physician communication skills, subthemes identified include: involving the patient and/or family in the care process (41%), method of information sharing (18%), lack of coordination of care (15%), use of medical jargon (10%), attending to patient's needs (8%), and lack of patient's perspective (8%). Patients reported that effective engagement of patients in the care process and attending to patient-specific needs were desired qualities in their hospital experience as well as patient-centered communication with their physician. The quantitative data supported qualitative results with 72% of patients giving the highest score in overall satisfaction with their patient experience. CONCLUSION Physician attentiveness or lack thereof is a defining aspect of the quality of patient experience and physician communication. The results are intended to inform clinical and operational interventions that care providers might incorporate into practice.
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Affiliation(s)
| | - Andrea Kliss
- Yale New Haven Hospital, Smilow Cancer Center, New Haven, CT, USA
| | - Janet Hafler
- Yale School of Medicine, Yale University, New Haven, CT, USA
| | - Tara Sanft
- Yale School of Medicine, Yale University, New Haven, CT, USA
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23
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Broom A, Parker RB, Kirby E, Kokanović R, Woodland L, Lwin Z, Koh ES. A qualitative study of cancer care professionals' experiences of working with migrant patients from diverse cultural backgrounds. BMJ Open 2019; 9:e025956. [PMID: 30904870 PMCID: PMC6475197 DOI: 10.1136/bmjopen-2018-025956] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVES To improve the experiences of people from diverse cultural backgrounds, there has been an increased emphasis on strengthening cultural awareness and competence in healthcare contexts. The aim of this focus-group based study was to explore how professionals in cancer care experience their encounters with migrant cancer patients with a focus on how they work with cultural diversity in their everyday practice, and the personal, interpersonal and institutional dimensions therein. DESIGN This paper draws on qualitative data from eight focus groups held in three local health districts in major metropolitan areas of Australia. Participants were health professionals (n=57) working with migrants in cancer care, including multicultural community workers, allied health workers, doctors and nurses. Focus group discussions were audio recorded and transcribed in full. Data were analysed using the framework approach and supported by NVivo V.11 qualitative data analysis software. RESULTS Four findings were derived from the analysis: (1) culture as merely one aspect of complex personhood; (2) managing culture at the intersection of institutional, professional and personal values; (3) balancing professional values with patient values and beliefs, and building trust and respect; and (4) the importance of time and everyday relations for generating understanding and intimacy, and for achieving culturally competent care. CONCLUSIONS The findings reveal: how culture is often misconstrued as manageable in isolation; the importance of a renewed emphasis on culture as interpersonal and institutional in character; and the importance of prioritising the development of quality relationships requiring additional time and resource investments in migrant patients for enacting effective intercultural care.
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Affiliation(s)
- Alex Broom
- Centre for Social Research in Health, Faculty of Arts and Social Sciences, University of New South Wales, Sydney, New South Wales, Australia
| | - Rhiannon Bree Parker
- Centre for Social Research in Health, Faculty of Arts and Social Sciences, University of New South Wales, Sydney, New South Wales, Australia
| | - Emma Kirby
- Centre for Social Research in Health, Faculty of Arts and Social Sciences, University of New South Wales, Sydney, New South Wales, Australia
| | - Renata Kokanović
- Social and Global Studies Centre, RMIT University, Melbourne, Victoria, Australia
- Monash Centre for Health Research and Innovation, Monash University, Melbourne, Victoria, Australia
| | - Lisa Woodland
- Multicultural Health Service, South Eastern Sydney Local Health District, Sydney, New South Wales, Australia
| | - Zarnie Lwin
- Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia
- Department of Medical Oncology, Royal Brisbane and Women’s Hospital, Brisbane, Queensland, Australia
| | - Eng-Siew Koh
- South Western Sydney Clinical School, University of New South Wales, Sydney, New South Wales, Australia
- Department of Radiation Oncology, Liverpool Hospital, Sydney, New South Wales, Australia
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24
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Broom A, Kirby E, Kokanović R, Woodland L, Wyld D, de Souza P, Koh ES, Lwin Z. Individualising difference, negotiating culture: Intersections of culture and care. Health (London) 2019; 24:552-571. [PMID: 30755040 DOI: 10.1177/1363459319829192] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
In this article, we focus on developing a critical sociology of 'cultural and linguistic diversity' as evident in cancer care praxis, drawing on the perspectives of cancer care health professionals. Set within the context of increasing efforts on the part of healthcare providers to 'accommodate difference' and 'incorporate diversity', we aimed to utilise participants' accounts of practice to ask: how do we and how should we think about and operationalise 'culture' (if at all) in cancer care settings. Drawing on eight focus groups with doctors, nurses, allied health staff and multicultural community workers, here we explore their accounts of: othering and over-simplification; the role of absences in biographical reciprocity; intimacy, care and carelessness; and entanglements of culture with other aspects of the person. Based on their accounts, we argue for a broadening of the examination of the nexus of culture and care, to focus on the problematics of othering, intimacy, reciprocity and complexity.
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Affiliation(s)
| | - Emma Kirby
- The University of New South Wales, Australia
| | | | - Lisa Woodland
- South Eastern Sydney Local Health District, Australia
| | - David Wyld
- Royal Brisbane and Women's Hospital, Australia; The University of Queensland, Australia
| | - Paul de Souza
- Liverpool Hospital, Australia; Western Sydney University, Australia
| | - Eng-Siew Koh
- The University of New South Wales, Australia; Liverpool Hospital, Australia
| | - Zarnie Lwin
- Royal Brisbane and Women's Hospital, Australia; The University of Queensland, Australia
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25
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Watts KJ, Meiser B, Zilliacus E, Kaur R, Taouk M, Girgis A, Butow P, Kissane DW, Hale S, Perry A, Aranda SK, Goldstein D. Perspectives of oncology nurses and oncologists regarding barriers to working with patients from a minority background: Systemic issues and working with interpreters. Eur J Cancer Care (Engl) 2017; 27:e12758. [PMID: 28892208 DOI: 10.1111/ecc.12758] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/22/2017] [Indexed: 11/29/2022]
Abstract
This study aimed to ascertain the systemic barriers encountered by oncology health professionals (HPs) working with patients from ethnic minorities to guide the development of a communication skills training programme. Twelve medical and five radiation oncologists and 21 oncology nurses were invited to participate in this qualitative study. Participants were interviewed individually or in a focus group about their experiences working with people from minority backgrounds. All interviews were transcribed verbatim and analysed thematically. HPs encountered language and communication barriers in their interactions with patients and their families, which were perceived to impact negatively on the quality and amount of information and support provided. There was a shortage of, and poor processes for engaging, interpreters and some HPs were concerned about the accuracy of interpretation. HPs expressed a need for training in cultural awareness and communication skills with a preference for face-to-face delivery. A lack of funding, a culture of "learning on the job", and time constraints were systemic barriers to training. Oncologists and oncology nurses encounter complex challenges in clinical interactions with minority patients and their families, including difficulties working with interpreters. Formal training programmes targeted to the development of culturally competent communication skills are required.
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Affiliation(s)
- K J Watts
- Prince of Wales Clinical School, The University of New South Wales, Sydney, Australia
| | - B Meiser
- Prince of Wales Clinical School, The University of New South Wales, Sydney, Australia
| | - E Zilliacus
- Prince of Wales Clinical School, The University of New South Wales, Sydney, Australia
| | - R Kaur
- Prince of Wales Clinical School, The University of New South Wales, Sydney, Australia
| | - M Taouk
- Prince of Wales Clinical School, The University of New South Wales, Sydney, Australia
| | - A Girgis
- Prince of Wales Clinical School, The University of New South Wales, Sydney, Australia.,Centre for Oncology Education and Research Translation, Ingham Institute for Applied Medical Research, South Western Sydney Clinical School, University of New South Wales, Sydney, Australia
| | - P Butow
- Psycho-Oncology Co-operative Research Group, Centre for Medical Psychology and Evidence-based Decision-Making, The University of Sydney, Sydney, Australia
| | - D W Kissane
- Department of Psychiatry, School of Clinical Sciences at Monash Health, Monash University, Clayton, Australia
| | - S Hale
- Faculty of Arts and Social Sciences, University of New South Wales, Sydney, Australia
| | - A Perry
- Multicultural Health Service, South Eastern Sydney Local Health District, Sydney, Australia
| | - S K Aranda
- School of Health Sciences, University of Melbourne, Melbourne, VIC, Australia.,Cancer Council Australia, Sydney, Australia
| | - D Goldstein
- Prince of Wales Clinical School, The University of New South Wales, Sydney, Australia.,Department of Medical Oncology, Prince of Wales Hospital, Sydney, NSW, Australia
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