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Leung YW, Kwong EWY, Wong KLY, So J, Poon F, Cheng T, Chen E, Molasiotis A, Howell D. Understanding Elderly Chinese Cancer Patients in a Multicultural Clinical Setting: Embracing Mortality and Addressing Misperceptions of Vulnerability. Curr Oncol 2024; 31:2620-2635. [PMID: 38785478 PMCID: PMC11119118 DOI: 10.3390/curroncol31050197] [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: 03/23/2024] [Revised: 04/26/2024] [Accepted: 04/30/2024] [Indexed: 05/25/2024] Open
Abstract
Chinese patients face higher risks of gastrointestinal (GI) cancers and greater cancer-related deaths than Canadian-born patients. The older population encounters barriers to quality healthcare, impacting their well-being and survival. Previous studies highlighted Chinese immigrant perceptions of not requiring healthcare support. During the COVID-19 pandemic, their underutilization of healthcare services garnered attention. The present study explores the experiences of older Chinese cancer patients to improve culturally sensitive cancer care. A total of twenty interviews carried out in Cantonese and Mandarin were conducted with Chinese immigrants, aged 60 or above, diagnosed with Stage 3 or 4 GI cancer. These interviews were transcribed verbatim, translated, and subjected to qualitative descriptive analysis. Among older Chinese immigrant patients, a phenomenon termed "Premature Acceptance: Normalizing Death and Dying" was observed. This involved four key themes: 1. acceptance and letting go, 2. family first, 3. self-sufficiency, and 4. barriers to supportive care. Participants displayed an early acceptance of their own mortality, prioritizing family prosperity over their own quality of life. Older Chinese patients normalize the reality of facing death amidst cancer. They adopt a pragmatic outlook, acknowledging life-saving treatments while willingly sacrificing their own support needs to ease family burdens. Efforts to enhance health literacy require culturally sensitive programs tailored to address language barriers and differing values among this population. A strengths-based approach emphasizing family support and practical aspects of care may help build resilience and improve symptom management, thereby enhancing their engagement with healthcare services.
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Affiliation(s)
- Yvonne W. Leung
- Department of Psychiatry, University of Toronto, Toronto, ON M5S 1A1, Canada
- College of Professional Studies, Northeastern University, Boston, MA 02115, USA
| | - Enid W. Y. Kwong
- School of Nursing, Hong Kong Polytechnic University, Kowloon, Hong Kong
| | - Karen Lok Yi Wong
- School of Social Work, University of British Columbia, Vancouver, BC V6T 1Z4, Canada
| | - Jeremiah So
- Department of Psychiatry, University of Toronto, Toronto, ON M5S 1A1, Canada
| | - Frankie Poon
- Department of Psychiatry, University of Toronto, Toronto, ON M5S 1A1, Canada
| | - Terry Cheng
- Department of Psychiatry, University of Toronto, Toronto, ON M5S 1A1, Canada
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, ON M5G 2C4, Canada
| | - Eric Chen
- Department of Medical Oncology, Princess Margaret Cancer Centre, University Health Network, Toronto, ON M5G 2C4, Canada
| | - Alex Molasiotis
- School of Nursing, Hong Kong Polytechnic University, Kowloon, Hong Kong
| | - Doris Howell
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, ON M5G 2C4, Canada
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McErlean G, Bajel A, Bhattacharyya A, Brown N, De Abreu Lourenco R, Greenwood M, Kerridge I, Kim N, Kliman D, Maneze D, O'Brien T, Szer J, Twist I. If we do not count it, it does not count: ethnicity in allogeneic haemopoietic stem cell transplant in Australia. Intern Med J 2023; 53:2155-2158. [PMID: 37814833 DOI: 10.1111/imj.16232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Accepted: 08/20/2023] [Indexed: 10/11/2023]
Affiliation(s)
- Gemma McErlean
- School of Nursing, University of Wollongong, Wollongong, New South Wales, Australia
- St George Hospital, South Eastern Sydney Local Health District, New South Wales, Sydney, Australia
| | - Ashish Bajel
- Peter MacCallum Cancer Centre & The Royal Melbourne Hospital, Melbourne, Victoria, Australia
- University of Melbourne, Melbourne, Victoria, Australia
| | - Abir Bhattacharyya
- Department of Haematology, Westmead Hospital, New South Wales, Sydney, Australia
| | - Ngaire Brown
- Ngaoara Ltd, Wollongong, New South Wales, Australia
- South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
| | - Richard De Abreu Lourenco
- Centre for Health Economics Research and Evaluation, University of Technology Sydney, Sydney, New South Wales, Australia
| | - Matthew Greenwood
- Department of Haematology, Royal North Shore Hospital, New South Wales, Sydney, Australia
- Faculty of Medicine, University of Sydney, Sydney, New South Wales, Australia
| | - Ian Kerridge
- Department of Haematology, Royal North Shore Hospital, New South Wales, Sydney, Australia
- Faculty of Medicine, University of Sydney, Sydney, New South Wales, Australia
| | - Nancy Kim
- Centre for Health Economics Research and Evaluation, University of Technology Sydney, Sydney, New South Wales, Australia
| | - David Kliman
- Department of Haematology, Royal North Shore Hospital, New South Wales, Sydney, Australia
| | - Della Maneze
- School of Nursing, University of Wollongong, Wollongong, New South Wales, Australia
| | - Tracey O'Brien
- Cancer Institute NSW, NSW Health, Sydney, New South Wales, Australia
- University of New South Wales, School of Clinical Medicine, New South Wales, Sydney, Australia
| | - Jeff Szer
- Peter MacCallum Cancer Centre & The Royal Melbourne Hospital, Melbourne, Victoria, Australia
- University of Melbourne, Melbourne, Victoria, Australia
| | - Ida Twist
- Cancer Centre for Children, Children's Hospital Westmead, New South Wales, Sydney, Australia
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Chen DW, Banerjee M, He X, Miranda L, Watanabe M, Veenstra CM, Haymart MR. Hidden Disparities: How Language Influences Patients' Access to Cancer Care. J Natl Compr Canc Netw 2023; 21:951-959.e1. [PMID: 37673110 PMCID: PMC11033703 DOI: 10.6004/jnccn.2023.7037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Accepted: 05/19/2023] [Indexed: 09/08/2023]
Abstract
BACKGROUND Patients with limited English proficiency, a vulnerable patient population, remain understudied in the literature addressing cancer disparities. Although it is well documented that language discordance between patients and physicians negatively impacts the quality of patient care, little is known about how patients' preferred spoken language impacts their access to cancer care. PATIENTS AND METHODS Between November 2021 and June 2022, we conducted an audit study of 144 hospitals located across 12 demographically diverse states. Using a standardized script, trained investigators assigned to the roles of English-speaking, Spanish-speaking, and Mandarin-speaking patients called the hospital general information telephone line seeking to access care for 3 cancer types that disproportionately impact Hispanic and Asian populations (colon, lung, and thyroid cancer). Primary outcome was whether the simulated patient caller was provided with the next steps to access cancer care, defined as clinic number or clinic transfer. We used chi-square tests and logistic regression analysis to test for associations between the primary outcome and language type, region type, hospital teaching status, and cancer care requested. We used multivariable logistic regression analysis to determine factors associated with simulated patient callers being provided the next steps. RESULTS Of the 1,296 calls, 52.9% (n=686) resulted in simulated patient callers being provided next steps to access cancer care. Simulated non-English-speaking (vs English-speaking) patient callers were less likely to be provided with the next steps (Mandarin, 27.5%; Spanish, 37.7%; English, 93.5%; P<.001). Multivariable logistic regression found significant associations of the primary outcome with language spoken (Mandarin: odds ratio [OR], 0.02 [95% CI, 0.01-0.04] and Spanish: OR, 0.04 [95% CI, 0.02-0.06] vs English) and hospital teaching status (nonteaching: OR, 0.43 [95% CI, 0.32-0.56] vs teaching). CONCLUSIONS Linguistic disparities exist in access to cancer care for non-English-speaking patients, emphasizing the need for focused interventions to mitigate systems-level communication barriers.
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Affiliation(s)
- Debbie W. Chen
- Division of Metabolism, Endocrinology, and Diabetes, University of Michigan, Ann Arbor, Michigan
| | - Mousumi Banerjee
- Department of Biostatistics, University of Michigan, Ann Arbor, Michigan
| | - Xin He
- Division of Endocrinology, Signature Healthcare, Brockton, Massachusetts
| | - Lesley Miranda
- College of Literature Science and the Arts, University of Michigan, Ann Arbor, Michigan
| | - Maya Watanabe
- Department of Biostatistics, University of Michigan, Ann Arbor, Michigan
| | | | - Megan R. Haymart
- Division of Metabolism, Endocrinology, and Diabetes, University of Michigan, Ann Arbor, Michigan
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Dunne W, Adebayo N, Danner S, Post S, O'Brian C, Tom L, Osei C, Blum C, Rivera J, Molina E, Trosman J, Weldon C, Ekong A, Adetoro E, Rapkin B, Simon MA. A Learning Health System Approach to Cancer Survivorship Care Among LGBTQ+ Communities. JCO Oncol Pract 2023; 19:e103-e114. [PMID: 36475752 PMCID: PMC10166358 DOI: 10.1200/op.22.00386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Revised: 10/19/2022] [Accepted: 10/26/2022] [Indexed: 12/12/2022] Open
Abstract
PURPOSE Lesbian, gay, bisexual, transgender, and queer (LGBTQ+) individuals who receive primary care services at community health centers are often referred to external specialty care centers after cancer diagnosis, upon which primary care services are disrupted and may be discontinued because of gaps in communication between primary and oncologic care providers. This qualitative study evaluated barriers and facilitators to effective care coordination for LGBTQ+ patients with cancer and the utility of a novel cancer care coordination tool to mitigate identified barriers. MATERIALS AND METHODS Semistructured interviews with LGBTQ+ cancer survivors, caregivers to LGBTQ+ persons, clinical team members who provide care to LGBTQ+ patients, and members of community-based organizations that work with LGBTQ+ patients were conducted. Interview analysis was a multistage process, wherein a constant comparison approach was used. Transcripts were reviewed and coded using Atlas.ti Cloud. RESULTS A total of 26 individuals were interviewed: 10 patients, four caregivers, 10 clinical care team members, and two community organization representatives. Interview analysis yielded insight regarding (1) LGBTQ+ patient experiences engaging with primary and oncologic care at the clinic level and (2) perceptions of patient-provider and provider-provider communication and coordination. CONCLUSION Interview findings indicate a need for further development of interventions aimed at improving care coordination, patient experience, and outcomes in the cancer care continuum for LGBTQ+ patients. Learning health systems, like the one studied, show great potential for contributing to the development of such interventions.
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Affiliation(s)
- Will Dunne
- Center for Health Equity Transformation, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Nihmotallahi Adebayo
- Center for Health Equity Transformation, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Sankirtana Danner
- Center for Health Equity Transformation, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Sharon Post
- Center for Health Equity Transformation, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Catherine O'Brian
- Center for Health Equity Transformation, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Laura Tom
- Center for Health Equity Transformation, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Cassandra Osei
- Center for Health Equity Transformation, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | | | | | | | - Julia Trosman
- Center for Health Equity Transformation, Feinberg School of Medicine, Northwestern University, Chicago, IL
- Center for Business Models in Healthcare, Glencoe, IL
| | - Christine Weldon
- Center for Health Equity Transformation, Feinberg School of Medicine, Northwestern University, Chicago, IL
- Center for Business Models in Healthcare, Glencoe, IL
| | | | | | - Bruce Rapkin
- Department of Epidemiology & Population Health, Albert Einstein College of Medicine, Bronx, NY
| | - Melissa A. Simon
- Center for Health Equity Transformation, Feinberg School of Medicine, Northwestern University, Chicago, IL
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Tan NQP, Maki KG, López-Olivo MA, Geng Y, Volk RJ. Cultural influences on shared decision-making among Asian Americans: A systematic review and meta-synthesis of qualitative studies. PATIENT EDUCATION AND COUNSELING 2023; 106:17-30. [PMID: 36344320 DOI: 10.1016/j.pec.2022.10.350] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Revised: 10/19/2022] [Accepted: 10/28/2022] [Indexed: 06/16/2023]
Abstract
OBJECTIVE To summarize how Asian Americans negotiate involvement in shared decision-making (SDM) with their providers, the cultural influences on SDM, and perceived barriers and facilitators to SDM. METHODS This is a systematic review of qualitative studies. We searched six electronic databases and sources of gray literature until March 2021. Two reviewers independently screened studies, performed quality appraisal, and data extraction. Meta-synthesis was performed to summarize themes using a three-step approach. RESULTS Twenty studies with 675 participants were included. We abstracted 275 initial codes and grouped these into 19 subthemes and 4 major themes: (1) negotiating power and differing expectations in SDM; (2) cultural influences on SDM; (3) importance of social support in SDM; and (4) supportive factors for facilitating SDM. CONCLUSIONS Asian Americans have important perspectives, needs, and preferences regarding SDM that impacts how they engage with the provider on medical decisions and their perception of the quality of their care. PRACTICE IMPLICATIONS Asian American patients valued good communication and sufficient time with their provider, and that it is important for health professionals to understand patients' desired level of involvement in the SDM process and in the final decision, and who should be involved in SDM beyond the patient. OTHER This systematic review was registered on PROSPERO (CRD42021241665).
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Affiliation(s)
- Naomi Q P Tan
- Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, USA
| | - Kristin G Maki
- Department of Oncology, Wayne State University Medical School, Detroit, USA; Population Studies and Disparities Research Program, Barbara Ann Karmanos Cancer Institute, Detroit, USA
| | - Maria A López-Olivo
- Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, USA
| | - Yimin Geng
- Research Medical Library, The University of Texas MD Anderson Cancer Center, Houston, USA
| | - Robert J Volk
- Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, USA.
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Lewis-Thames MW, Tom LS, Leung IS, Yang A, Simon MA. An examination of the implementation of a patient navigation program to improve breast and cervical cancer screening rates of Chinese immigrant women: a qualitative study. BMC Womens Health 2022; 22:28. [PMID: 35120523 PMCID: PMC8815179 DOI: 10.1186/s12905-022-01610-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Accepted: 01/27/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Chinese Americans have lower breast and cervical cancer screening rates than the national average and experience multiple barriers to cancer care. Patient navigators have improved screening and follow-up rates for medically underserved populations, yet investigations of cancer navigation programs and their implementation among Chinese Americans are limited. To address this gap, we used the Consolidated Framework for Implementation Research (CFIR) to examine facilitators and barriers to implementing the Chicago-based Chinatown Patient Navigation Program (CPNP) for breast and cervical cancer screening, follow-up, and treatment. METHODS Stakeholders from clinical care, supportive care services, and community organizations were invited to participate in qualitative interviews to illuminate implementation processes and stakeholder perspectives of facilitators and barriers to implementing the CPNP. Interviews were audio-recorded, transcribed, and deductively coded according to CFIR domains, including (1) intervention characteristics; (2) outer setting; (3) inner setting; and (4) the implementation process. RESULTS We interviewed a convenience sample of 16 stakeholders representing a range of roles in cancer care, including nurses, clinical team members, administrators, physicians, a community-based organization leader, and a CPNP navigator. Findings detail several facilitators to implementing the CPNP, including patient navigators that prepared Chinese-speaking patients for their clinic visits, interpretation services, highly accessible patient navigators, and high-quality flexible services. Barriers to program implementation included limited regular feedback provided to stakeholders regarding their program involvement. Also, early in the program's implementation there was limited awareness of the CPNP navigators' roles and responsibilities, insufficient office space for the navigators, and few Chinese language patient resource materials. CONCLUSIONS These findings provide valuable information on implementation of future patient navigation programs serving Chinese American and other limited-English speaking immigrant populations.
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Affiliation(s)
- Marquita W Lewis-Thames
- Department of Medical Social Science, Center for Community Health, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Laura S Tom
- Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.,Center for Health Equity Transformation, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Ivy S Leung
- Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.,Center for Health Equity Transformation, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Anna Yang
- Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.,Center for Health Equity Transformation, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Melissa A Simon
- Department of Medical Social Science, Center for Community Health, Northwestern University Feinberg School of Medicine, Chicago, IL, USA. .,Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA. .,Center for Health Equity Transformation, Northwestern University Feinberg School of Medicine, Chicago, IL, USA. .,Robert H. Lurie Comprehensive Cancer Center, Northwestern University Feinberg School of Medicine, Chicago, IL, USA. .,Departments of Obstetrics and Gynecology, Preventive Medicine and Medical Social Science, Northwestern University Feinberg School of Medicine, 625 N Michigan Ave, Suite 1100, Chicago, IL, 60611, USA.
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Simon MA, Tom LS, Leung I, Wong E, Knightly EE, Vicencio DP, Yau A, Ortigara K, Dong X. The Chinatown Patient Navigation Program: Adaptation and Implementation of Breast and Cervical Cancer Patient Navigation in Chicago's Chinatown. Health Serv Insights 2019; 12:1178632919841376. [PMID: 31037032 PMCID: PMC6475834 DOI: 10.1177/1178632919841376] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2019] [Accepted: 03/09/2019] [Indexed: 01/09/2023] Open
Abstract
Background As health care reform continues within the United States, navigators may play increasingly diverse and vital roles across the health care continuum. The growing interest in patient navigation programs for underserved populations calls for detailed descriptions of intervention components to facilitate implementation and dissemination efforts. Methods In Chicago's Chinatown, Chinese immigrant women face language, cultural, and access barriers in obtaining breast and cervical cancer screening and follow-up. These barriers spurred the research partnership between Northwestern University, the Chinese American Service League, Mercy Hospital & Medical Center, and Rush University Medical Center to formalize the Chinatown Patient Navigation Collaborative for adapting and implementing previously developed patient navigation models. Results In this report, we describe the adaptation of patient navigation to build the Chinatown Patient Navigation Collaborative's community-based patient navigation program for breast and cervical cancer. We offer insights into the roles of community patient navigators in safety net hospital and underserved Chinese immigrant communities, and describe implications for patient navigation initiatives to maximize community benefits by improving access to health care for vulnerable populations. Conclusions Our adaptation and implementation of a patient navigation intervention in Chicago's Chinatown illustrates promising approaches for future navigator research.
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Affiliation(s)
- Melissa A Simon
- Department of Obstetrics and Gynecology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.,Robert H. Lurie Comprehensive Cancer Center, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.,Preventive Medicine and Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Laura S Tom
- Department of Obstetrics and Gynecology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Ivy Leung
- Department of Obstetrics and Gynecology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.,Chinese American Service League, Chicago, IL, USA
| | - Esther Wong
- Chinese American Service League, Chicago, IL, USA
| | - Eileen E Knightly
- University of Illinois Hospital & Health Sciences System, Chicago, IL, USA
| | | | - Ann Yau
- Mercy Hospital & Medical Center, Chicago, IL, USA
| | | | - XinQi Dong
- Institute for Health, Health Care Policy, and Aging Research, Rutgers, The State University of New Jersey, New Brunswick, NJ, USA
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