Study Highlights the Need to Improve Treatment for Patient With Limited English Proficiency

A recent study found that cultural awareness among nurses is not enough. Clinicians need more training and resources to improve cancer care for patients with limited English proficiency.

Cancer centers have seen an increase in the amount of patients considered to have limited English proficiency (LEP), highlighting the need for cross-cultural training and educational development in strategies to best treat this patient population. And while recent research found that most oncology nurses have moderate to high levels of cultural awareness, they still expressed the need for resources on safe and equitable care.

“For individuals who are considered LEP, English is not their primary language, and they have a limited ability to understand, speak, read, or write English. LEP adults diagnosed with cancer require nurses who are responsive to their language and cultural needs,” study author Stephanie Betancur, BSN, RN, said in an interview with Oncology Nursing News.

Betancur is a doctoral student and NIH T32 Training Grant Fellow at the University of North Carolina – Chapel Hill School of Nursing. She co-authored research that analyzed cultural awareness and cross-cultural training needs in 44 inpatient oncology nurses who worked in a unit that sees many Spanish-speaking patients.

“Our premise before conducting the study was that higher cultural awareness would give nurses the ability to effectively communicate and care for patients with limited English proficiency (LEP),” Betancur said. “It was important to conduct this study because we are seeing an increase in the number of adults who are considered LEP in cancer hospitals throughout the United States.”

Nurse participants in the study answered 23 questions on a range of agree, disagree, neutral, strongly agree, and disagree. Questions looked at whether or not their work on an oncology unit helped them become knowledgeable about health issues that certain racial/cultural groups face; if they felt comfortable working with patients of all ethnic groups; if they felt comfortable when surrounded by people of different ethnic groups; if they respected patients’ decisions that are influenced by their culture, even if they disagree with them; and more.

While nurses overall had a high level of cultural awareness, Betancur said that alone is not enough to provide effective care for patients with LEP.

“Study results were expected to confirm that higher levels of cultural awareness would correlate with the ability to confidently care for LEP patients diagnosed with cancer. However, study results showed no correlation between cultural awareness and ability,” Betancur said.

She noted that the following steps should also be pursued with the goal of quality, equitable care:

  • Have a unit interpreter readily available.
  • Increase bilingual staff.
  • Use dual-language materials and/or provide free language lessons for oncology nurses.

These steps can help decrease communication barriers, which often contribute to decreased quality in cancer care for patients with LEP.

“It is common for LEP adults diagnosed with cancer to not have a true understanding of their disease or treatment,” Betancur explained. “They can also be hesitant to ask questions, but quick to agree to understand information, even if they really do not. Being LEP negatively affects the patients’ ability to engage – along with their health care provider – in the active participation and decision-making process of their are. This can lead to poor outcomes and low quality of cancer care.”

Ultimately, by better understanding the difficulties that this patient population faces, nurses can work toward improving their care.

“Nurses who can recognize the needs of LEP adults diagnosed with cancer and provide care according to these needs are able to deliver the most effective care,” Betancur said.