Ming Sze

A bridge between cultures: interpreters' perspectives of consultations with migrant oncology patients.

BackgroundMigration is increasing worldwide. In previous research into people with cancer from culturally and linguistically diverse backgrounds, interpreter accuracy, professionalism and continuity have emerged as key concerns for patients. Little is known about interpreters’ perceptions of their role and the challenges they face. This study aimed to obtain their perspective.MethodsThirty interpreters (Greek n = 7, Chinese n = 11, and Arabic n = 12) participated in four focus groups which were audio-taped, transcribed and analysed for themes using N-Vivo software.ResultsSkills as an interpreter were broadly perceived as conveying information accurately, being confidential and impartial. Three broad dilemmas faced by interpreters emerged: accuracy versus understanding; translating only versus cultural advocacy and sensitivity; and professionalism versus providing support. Some saw themselves as merely an accurate conduit of information, while others saw their role in broader terms, encompassing patient advocacy, cultural brokerage and provision of emotional support. Perceived challenges in their role included lack of continuity, managing their own emotions especially after bad news consultations, and managing diverse patient and family expectations. Training and support needs included medical terminology, communication and counselling skills and debriefing. Interpreters suggested that oncologists check on interpreter/patient’s language or dialect compatibility; use lay language and short sentences; and speak in the first person.ConclusionsResolving potential conflicts between information provision and advocacy is an important area of cross-cultural communication research. Further training and support is required to enhance interpreters’ competence in managing delicate situations from a professional, cultural and psychological perspective; and to assist doctors to collaborate with interpreters to ensure culturally competent communication. Ultimately, this will improve interpreters’ well-being and patient care.

Grappling with cultural differences; Communication between oncologists and immigrant cancer patients with and without interpreters

OBJECTIVE Immigrants report challenges communicating with their health team. This study compared oncology consultations of immigrants with and without interpreters vs Anglo-Australian patients. METHODS Patients with newly diagnosed incurable cancer who had immigrated from Arabic, Chinese or Greek speaking countries or were Anglo-Australian, and family members, were recruited from 10 medical oncologists in 9 hospitals. Two consultations from each patient were audio-taped, transcribed, translated into English and coded. RESULTS Seventy-eight patients (47 immigrant and 31 Anglo-Australian) and 115 family members (77 immigrant and 38 Anglo Australian) participated in 141 audio-taped consultations. Doctors spoke less to immigrants with interpreters than to Anglo-Australians (1443 vs. 2246 words, p=0.0001), spent proportionally less time on cancer related issues (p=0.005) and summarising and informing (p≤0.003) and more time on other medical issues (p=0.0008) and directly advising (p=0.0008). Immigrants with interpreters gave more high intensity cues (10.4 vs 7.4). Twenty percent of cues were not interpreted. Doctors tended to delay responses to or ignore more immigrant than Anglo-Australian cues (13% vs 5%, p=0.06). CONCLUSIONS Immigrant cancer patients with interpreters experience different interactions with their doctors than Anglo-Australians, which may compromise their well-being and decisions. PRACTICE IMPLICATIONS Guidelines and proven training programmes are needed to improve communication with immigrant patients, particularly those with interpreters.

Interpretation in Consultations With Immigrant Patients With Cancer: How Accurate Is It?

PURPOSE Immigrants with cancer often have professional and/or family interpreters to overcome challenges communicating with their health team. This study explored the rate and consequences of nonequivalent interpretation in medical oncology consultations. PATIENTS AND METHODS Consecutive immigrant patients with newly diagnosed with incurable cancer, who spoke Arabic, Cantonese, Mandarin, or Greek, were recruited from the practices of 10 medical oncologists in nine hospitals. Their first two consultations were audio taped, transcribed, translated into English and coded. RESULTS Thirty-two of 78 participants had an interpreter at 49 consultations; 43% of interpreters were family, 35% professional, 18% both a professional and family, and 4% a health professional. Sixty-five percent of professional interpretations were equivalent to the original speech versus 50% for family interpreters (P= .02). Seventy percent of nonequivalent interpretations were inconsequential or positive; however, 10% could result in misunderstanding, in 5% the tone was more authoritarian than originally intended, and in 3% more certainty was conveyed. There were no significant differences in interpreter type for equivalency of interpretations. CONCLUSION Nonequivalent interpretation is common, and not always innocuous. Our study suggests that there may remain a role for family or telephone versus face-to-face professional interpreters. PRACTICE IMPLICATIONS careful communication between oncologists and interpreters is required to ensure optimal communication with the patient.

Inferior health-related quality of life and psychological well-being in immigrant cancer survivors: A population-based study

This study compared health-related quality of life (QOL) and psychological morbidity in a population-based sample of first generation immigrant and Anglo-Australian cancer survivors. Eligible participants, recruited via three State Cancer Registries, included those: with a new diagnosis of one of 12 most incident cancers (all stages) 1-6years earlier; aged 18-80 at diagnosis; born in a Chinese, Arabic, or Greek speaking country and able to speak one of these languages. A random sample of English-speaking Anglo-Australian-born controls frequency matched for cancer diagnosis was recruited. 596 patients (277 of whom were immigrants) participated (a 26% response rate). In multiple linear regression models adjusted for age, sex, education, marital status, socio-economic status, time since diagnosis and type of cancer, immigrants had clinically significantly worse QOL (5.4-8.5 points on Functional Assessment of Cancer Therapy - General (FACT-G), P<0·0001), higher depression (P<0·0001) and higher incidence of clinical depression (P<0·01) than Anglo-Australians. Understanding the health system partially mediated this relationship for depression (P=0·0004) and QOL (P=0·001). Immigrant survivors of cancer have worse psychological and QOL outcomes than Anglo-Australians. Potential targets for intervention include assistance in navigating the health system, translated information and cultural competency training for health professionals.

Should culture affect practice? A comparison of prognostic discussions in consultations with immigrant versus native-born cancer patients

OBJECTIVE Poor prognosis is difficult to impart, particularly across a cultural divide. This study compared prognostic communication with immigrants (with and without interpreters) versus native-born patients in audio-taped oncology consultations. METHODS Ten oncologists, 78 patients (31 Australian-born, 47 immigrants) and 115 family members participated. The first two consultations after diagnosis of incurable disease were audiotaped, transcribed and coded. 142 consultations were included in the analysis. RESULTS Fifty percent of doctor and 59% of patient prognostic speech units were not interpreted or interpreted non-equivalently when an interpreter was present. Immigrant status predicted few prognostic facts, and oncologist characteristics no prognostic facts, disclosed. Oncologists were significantly less likely to convey hope to immigrants (p=0.0004), and more likely to use medical jargon (p=0.009) than with Australian-born patients. Incurable disease status and a limited life span were commonly acknowledged, generally with no timeframe provided. Physical issues were discussed more commonly than emotional aspects. CONCLUSIONS While culture did not appear to influence doctor speech, interpreters filtered or blocked much prognostic communication. PRACTICE IMPLICATIONS Initiatives to empower all patients to attain needed information, optimise communication when an interpreter is present and train cancer health professionals in culturally appropriate care, are urgently required.

Migrant Health in Cancer: Outcome Disparities and the Determinant Role of Migrant-Specific Variables

BACKGROUND Multiethnic societies face challenges in delivering evidence-based culturally competent health care. This study compared health-related quality of life and psychological morbidity in a hospital-based sample of first-generation migrants and Australian-born Anglo cancer patients, controlling for potential confounders related to migrant status. Further, it explored the relative contribution of ethnicity versus migrant-related variables. METHODS Eligible participants, recruited via 16 oncology clinics in Australia, included those over the age of 18, diagnosed with cancer (any type or stage) within the previous 12 months and having commenced treatment at least 1 month previously. RESULTS In total, 571 migrant patients (comprising 145 Arabic, 248 Chinese, and 178 Greek) and a control group of 274 Anglo-Australian patients participated. In multiple linear regression models adjusted for age, sex, education, marital status, socioeconomic status, time since diagnosis, and type of cancer, migrants had clinically significantly worse health-related quality of life (HRQL; 3.6-7.3 points on FACT-G, p < .0001), higher depression and anxiety (both p < .0001), and higher incidence of clinical depression (p < .0001) and anxiety (p = .003) than Anglo-Australians. Understanding the health system (p < .0001 for each outcome) and difficulty communicating with the doctor (p = .04 to .0001) partially mediated the impact of migrancy. In migrant-only analyses, migrant-related variables (language difficulty and poor understanding of the health system), not ethnicity, predicted outcomes. CONCLUSION Migrants who develop cancer have worse psychological and HRQL outcomes than Anglo-Australians. Potential targets for intervention include assistance in navigating the health system, translated information, and cultural competency training for health professionals.

Communication challenges experienced by migrants with cancer: A comparison of migrant and English-speaking Australian-born cancer patients

Understanding the difficulties faced by different migrant groups is vital to address disparities and inform targeted health‐care service delivery. Migrant oncology patients experience increased morbidity, mortality and psychological distress, with this tentatively linked to language and communication difficulties. The objective of this exploratory study was to investigate the communication barriers and challenges experienced by Arabic, Greek and Chinese (Mandarin and Cantonese) speaking oncology patients in Australia.

“I might not have cancer if you didn’t mention it”: a qualitative study on information needed by culturally diverse cancer survivors

BackgroundImmigrants from culturally and linguistically diverse (CALD) backgrounds diagnosed with cancer face multiple challenges with health systems foreign to them. There is scarce understanding about their needs following cancer treatment in the survivorship phase. Unmet needs were examined in immigrant Chinese and Greek cancer survivors in order to assist development of relevant and useful information resources for these CALD groups.MethodsQualitative descriptive design was used. Adult cancer survivors, whose native language was Mandarin, Cantonese or Greek, were recruited through ethnic cancer support groups and cancer specialists in two Australian cities. Six focus groups were conducted, two in each native language group. Recorded responses were transcribed, translated into English, and thematically analysed.ResultsThirty-nine CALD cancer survivors participated from Greek (11), Cantonese (14) and Mandarin (14) backgrounds. Thematic findings included as follows: ongoing cancer-related stressors, cancer misunderstandings, coping strategies, ‘survivor’ seldom reflects self-appraisal, and additional CALD survivorship information needed. Immigrant cancer survivors may prefer ‘recovery’ to ‘survivorship’ descriptors and need information similar to Caucasian cancer survivors alongside as follows: resources for navigating health care, financial and community entitlements; caregiver-directed information to enhance their support; explanations about differences in health care approaches between survivors’ original and adopted countries; and acknowledgment of survivorship diversity within CALD groups.ConclusionsImmigrant cancer survivors’ additional requirements to native survivors likely reflect challenges in dealing with foreign environments and varied levels of acculturation within group members. Identification of immigrant cancer survivorship issues may support development of targeted resources for promoting survivors’ self-care and capacity for finding, choosing, and using existing support options.

Reducing disparity in outcomes for immigrants with cancer: a qualitative assessment of the feasibility and acceptability of a culturally targeted telephone-based supportive care intervention

PurposeAustralia has one of the most culturally diverse populations in the world. Immigrant cancer patients’ poorer outcomes compared to English-speaking patients confirm the need for culturally sensitive supportive care interventions. The aims of this study were (1) to identify cultural sensitivities that are important to the acceptability of a telephone-based supportive care intervention and (2) to identify cultural barriers and facilitators to intervention participation.MethodsPatients and carers attending Chinese or Arabic cancer support groups were recruited. Two focus groups comprising 12 patients and 4 carers, and two telephone interviews were conducted in the participants’ own language. A semi-structured interview format was utilised to determine potential cultural sensitivities that may influence the intervention delivery format as well as patients’ willingness to participate in telephone-based supportive care interventions. Content analysis confirmed similar themes across groups.ResultsThe intervention was viewed favourably as a means of providing information and support in the patient’s language. Cultural considerations included assurances of confidentiality, as cancer is not openly discussed within communities. An initial face-to-face contact was highlighted as the most important factor facilitating participation. Participants also recommended the inclusion of patient-initiated calls as part of the intervention.ConclusionsThis study provides cultural insights relevant to the development of a culturally sensitive telephone-based supportive care intervention for Arabic- and Chinese-speaking cancer patients. Participants highlighted the need for face-to-face contact and inclusion of patient-initiated calls as important methodological considerations.