Tips on Helping Patients With Limited English Navigate Cancer Care


From medical information cards to visual cues, a nurse navigator offers advice on ensuring quality care for patients who do not speak English.

Navigating cancer care is often complex, but has an added level of difficulty for patients who do not speak English or have low health literacy — or both. In a recent presentation at the 46th Annual ONS Congress, Megan Wachlin, BSN, RN, OCN, an oncology nurse navigator at the University of Pennsylvania’s Abramson Cancer Center stressed the importance of innovative oncology navigation to better serve this patient population.

“Imagine you have found yourself in another country where you do not know the language and cannot even decipher the alphabet or numbers, and now you have a serious health condition — a cancer diagnosis that needs medical attention,” Wachlin said. “How can you get the care that you need? How can you understand what is going on?”

Medical Information Cards

Wachlin advocated for simple, yet effective tools to help patients who do not speak English, which, first and foremost, includes having the hospital interpreter “on speed dial,” she said.

A personalized emergency medical card can also be helpful for patients to have, in case they go to the emergency room and are interacting with clinicians who are not familiar with them, their disease, or their treatment. These cards should include the following information:

  • Patient name and date of birth
  • Name and contact information for a person to reach out in case of an emergency
  • Language the patient speaks, and a call for clinicians to contact an interpreter
  • Basic information on their cancer diagnosis, the drugs they are taking, and the contact of their oncology care team

Visual Aids

For the patient’s cancer care, if written instructions for oral medications do not work, Wachlin said that a calendar could be beneficial. She described one that she recently set up for a patient.

“With the help of the hospital pharmacist, we were able to create a medication calendar … We used a photo of the actual oral chemotherapy pill and symbols of the sun and the moon to indicate taking 2 pills in the morning and 2 pills in the evening,” Wachlin said.

Visual cues can also work in other instances, such as using product or manufacturer videos to show the patient and their caregiver how to properly use a medical device.

“Communication for safety and treatment adherence is achieved using conceptual creativity and interdisciplinary coordination by the navigator to develop personalized, accessible tools for self-care and education,” Wachlin said.

Map It Out

Penn Medicine is a large hospital that spans many city blocks in Philadelphia. Providing patients with maps and meeting them in the lobby to help them find the provider they need to see is beneficial to patients who may be prone to getting lost.

“Navigating a health system and getting to the physical location of provider offices and treatment locations on a campus that spans several blocks in a major city can be daunting,” Wachlin said. “It was comforting to the patient that a familiar face met her in the lobby and walked her to radiation oncology, for example, which is located in the basement of the main hospital.”

Once the patient is with the provider, the nurse navigator should stay with them, if possible, so that they can be familiarized with the treatment plan and address any questions if they arise.

“In conclusion, innovative oncology navigation for the person with limited or no literacy requires principle-based navigation to support a close and consistent relationship between the patient, their family, and the navigator,” Wachlin said.


Wachlin M. Personalizing Navigation When the Person Is Unfamiliar With Cancer and Lacks English-Language and Health Literacy. Presented at: 46th Annual ONS Congress. April 20, 22, 27, 29, 2021. Virtual.

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