Unequal treatment in the US: lessons and recommendations for cancer care internationally

Healthcare practitioners' perspectives of providing palliative care to patients from culturally diverse backgrounds: a qualitative systematic review

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.

Analysis and Prediction of the Survival Trends of Patients with Clear-Cell Renal Cell Carcinoma: A Model-Based Period Analysis, 2001-2015

BACKGROUND

Clear-cell renal cell carcinoma (ccRCC) is one of the most common malignant tumors worldwide whose poor prognosis results in a serious disease burden on patients. The changing trend of the long-term relative survival rates (RSRs) of patients with ccRCC was analyzed in this study to evaluate their treatment results over a 15-year period.

METHODS

This study is a retrospective study, which assessed and predicted the 1-, 3-, and 5-year survival rates of patients with ccRCC during 2001-2005, 2006-2010, 2011-2015, and 2016-2020 using data extracted from the Surveillance, Epidemiology, and End Results (SEER) database. Period analysis was used in this study to analyze the data from the SEER database and to assess survival differences according to age, sex, race, and socioeconomic status (SES) during the 15-year study period by comparing Kaplan-Meier curves.

RESULTS

During 2001-2015, the 5-year RSR of patients with ccRCC increased from 78.4% to 83.0%, and the generalized linear model predicted that the 5-year RSR increased to 85.7% during 2016-2020. The RSR of patients with ccRCC differed significantly with SES, race, sex, and age. Compared with male patients, the survival advantage of female patients decreased as their age increased. The RSR of all patients with ccRCC was also lower in patients with a lower SES and of black race.

CONCLUSION

This study found an improvement in the RSR of patients with ccRCC during 2001-2020. Understanding the change trend of the survival rate of patients with ccRCC is helpful to improve the design of clinical trials. It also provides basic data and a scientific basis for evaluating the harm of ccRCC on the health of affected patients and the effect of cancer prevention, and developing cancer prevention plans.

Hospital food: When nurses' and ethnic minority patients' understanding of Islamic dietary needs differ

AIM

The aim of this study was to investigate how medical unit nurses assess their knowledge about Muslim patients' dietary preferences and needs and Muslim patients' needs regarding food.

DESIGN

Mixed-method design.

METHODS

Two-part study. Part 1: Two focus group interviews and a survey answered by medical unit nurses. Part 2: In-depth interviews with ten immigrant patients (eight Asians and two Africans). Hermeneutic analysis of qualitative data and SPSS were used for descriptive analysis of the quantitative data.

RESULTS

The nurses' knowledge about acceptable and prohibited food within Islam appears to be simplistic and Muslim patients tended to be perceived as a homogenous group. Patients' distrust about the preparation and content of the food served may result in insufficient nutritional intake. Serving food that is acceptable to individual patients requires insight and is an essential part of culturally sensitive nursing care.

Increased survival of patients aged 0-29 years with osteosarcoma: A period analysis, 1984-2013

Purpose

Osteosarcoma is the most common primary malignancy of bone, and typically occurs among children and adolescence. This study aims to evaluate treatment outcomes among children, adolescents and young adults with osteosarcoma over the three decades by the changes in the long‐term relative survival.

Methods

Osteosarcoma incidence and relative survival data from Surveillance, Epidemiology, and End Results (SEER) registries during 1984‐2013 were analyzed. The survival differences over three decades, age, sex, race, and socioeconomic status (SES) were assessed by comparing Kaplan‐Meier curves.

Results

The overall incidence of osteosarcoma kept relatively stable with 0.4 per 100 000 in the three decades with the peak incidence occurring in the aged 10‐19 group. The 10‐year relative survival rate (RSR) increased from 57.7% to 61.0% in the three decades, with the greatest increase in the aged 0‐9 group from 48.2% to 65.7%. The 10‐year RSR improved from 54.1% to 61.5% in males, and from 62.4% to 63.0% in females, respectively, in the three decades. Furthermore, survival dramatically improved from 30% to 60% in the high‐poverty group over the three decades.

Conclusion

This study demonstrated that the overall incidence of osteosarcoma remained stable, with an improvement in survival in the three decades. The improved survival was greater in males than in females in the three decades. Furthermore, the survival significantly increased in high‐poverty group, which was attributed to increasing improved health care system and patients with low finance can also have access to receiving effective and consistent treatment without distinction.

A pragmatic trial to improve adherence with scheduled appointments in an inner-city pain clinic by human phone calls in the patient's preferred language

STUDY OBJECTIVE

We investigated if human reminder phone calls in the patient's preferred language increase adherence with scheduled appointments in an inner-city chronic pain clinic. We hypothesized that language and cultural incongruence is the underlying mechanism to explain poor attendance at clinic appointments in underserved Hispanic populations.

DESIGN

Pragmatic randomized controlled clinical trial SETTING: Innercity academic chronic pain clinic with a diverse, predominantly African-American and Hispanic population PATIENTS: All (n=963) adult patients with a scheduled first appointment between October 2014 and October 2015 at the Montefiore Pain Center in the Bronx, New York were enrolled.

INTERVENTIONS

Patients were randomized to receive a human reminder call in their preferred language before their appointment, or no contact.

MEASUREMENTS

We recorded patients' demographic characteristics and as primary outcome attendance as scheduled, failure to attend and/or cancellation calls. We fit Bayesian and classical multinomial logistic regression models to test if the intervention improved adherence with scheduled appointments.

MAIN RESULTS

Among the 953 predominantly African American and Hispanic/Latino patients, 475 patients were randomly selected to receive a language-congruent, human reminder call, while 478 were assigned to receive no prior contact, (after we excluded 10 patients, scheduled for repeat appointments). In the experimental group, 275 patients adhered to their scheduled appointment, while 84 cancelled and 116 failed to attend. In the control group, 249 patients adhered to their scheduled appointment, 31 cancelled and 198 failed to attend. Human phone reminders in the preferred language increased adherence (RR 1.89, CI95% [1.42, 1.42], (p<0.01). The intervention seemed particularly effective in Hispanic patients, supporting our hypothesis of cultural congruence as possible underlying mechanism.

CONCLUSIONS

Human reminder phone calls prior in the patient's preferred language increased adherence with scheduled appointments. The intervention facilitated access to much needed care in an ethnically diverse, resource poor population, presumably by overcoming language barriers.

Distrust and patients in intercultural healthcare: A qualitative interview study

Background:

The importance of trust between patients and healthcare personnel is emphasised in nurses’ and physicians’ ethical codes. Trust is crucial for an effective healthcare personnel–patient relationship and thus for treatment and treatment outcomes. Cultural and linguistic differences may make building a trusting and positive relationship with ethnic minority patients particularly challenging. Although there is a great deal of research on cultural competence, there is a conspicuous lack of focus on the concepts of trust and distrust concerning ethnic minority patients, particularly in relation to the concept of ‘othering’.

Aim:

To study which factors help build trust or create distrust in encounters between healthcare professionals and hospitalised ethnic minority patients, as well as study the dynamic complexities inherent within the process of ‘othering’.

Research design:

Qualitative design, in-depth interviews and hermeneutic analysis.

Participants and research context:

The interviewees were 10 immigrant patients (six women and four men – eight Asians, two Africans – ages 32–85 years) recruited from a south-eastern Norwegian hospital.

Ethical considerations:

Study approval was obtained from the hospital’s Privacy Ombudsman for Research and the hospital’s leadership. Participation was voluntary and participants signed an informed consent form.

Conclusion:

Distrust and othering may be caused by differences in belief systems, values, perceptions, expectations, and style of expression and behaviour. Othering is a reciprocal phenomenon in minority ethnic patient–healthcare personnel encounters, and it influences trust building negatively. Besides demonstrating general professional skill and competence, healthcare personnel require cultural competence to create trust.

Oncology health workers' views and experiences on caring for ethnic minority patients: A mixed method systematic review

OBJECTIVES

To investigate what published research reveals about the views and experiences of oncology health workers when caring for ethnic minority patients.

DESIGN

Systematic review of qualitative and quantitative studies.

DATA SOURCES

The following databases were systematically screened: PubMed, CINAHL, Web of Science, and AnthroSource. Reference lists were checked for additional articles.

REVIEW METHODS

Empirical studies or systematic reviews (1/2000 to 12/2013) were included if they concerned the oncology setting and the views or experiences of healthcare workers and care users belonging to an ethnic or cultural minority group. The methodological quality of each individual study was assessed using the Critical Appraisal Skills Programme for Qualitative Studies and the Quality Assessment Tool for Quantitative Studies.

RESULTS

Eighteen publications met the inclusion criteria. Thirteen articles had a qualitative, four a quantitative, and one a mixed methods design. The results in the individual studies were heterogeneous. Most studies reported challenges or barriers when caring for ethnic minority patients, whereas fewer than half of the articles discussed facilitating factors and opportunities. Oncology health workers participating in the included studies sought to provide professional standards of care and tried to adapt care to the needs of ethnic minority patients. However, they experienced formidable communication barriers and they feared doing things that might be considered culturally insensitive. The organizational aspects of care for the oncology patient appeared to have a significant influence on how healthcare providers view and experience oncology care for ethnic minority patients.

CONCLUSIONS

Views and experiences of participating oncology health workers were characterized by a willingness to provide proper care for ethnic minority patients, but this was hampered by a tangle of interrelated issues such as linguistic barriers, fear and uncertainty, and assumptions about cultural matters. Organizational aspects were shown to be a strong influence on healthcare workers caring for ethnic minority patients. Due to methodological limitations of the included studies, conclusions should be viewed with caution.

Caring for ethnic minority patients: a mixed method study of nurses' self-assessment of cultural competency

BACKGROUND

Research shows that nurses tend to be lacking cultural competence, which may influence treatment and care for ethnic minority patients negatively.

PURPOSE

To investigate how Medical Unit nurses and Psychiatric Unit nurses assess their own competency concerning patients with minority backgrounds. The topics covered are: intercultural knowledge, knowledge of medical traditions and differences in illness etiology, symptom assessment, and in-service education and availability of advice. These topics are seen in relation to the nurses' years of work experience.

METHODS

Three focus group interviews were conducted before the development of a Likert-type questionnaire containing six topics and a total of 35 statements. 145 Medical Unit nurses (90%) and 100 Psychiatric Unit nurses (81%) returned the questionnaire. SPSS was used to analyze the quantitative data; hermeneutic thematic analysis was used for the qualitative data.

RESULTS

Both the Medical Unit nurses and the Psychiatric Unit nurses indicated that knowledge about illness and treatment philosophies other than Western biomedicine was inadequate. The respondents also found symptom assessment difficult, and they were offered little, if any, in-service education. Work experience added little substantive knowledge.

CONCLUSION

Experience alone does not equip nurses with adequate knowledge for intercultural symptom assessment and culturally competent treatment and care. Formal education, in-service classes, courses, feedback and access to relevant information are needed together with reflection upon clinical practice.

Disparities in knowledge and willingness to donate research biospecimens: a mixed-methods study in an underserved urban community

Although research involving biospecimens is essential in advancing cancer research, minorities, especially African-Americans, are underrepresented in such research. We conducted a mixed-method (qualitative focus groups among African-Americans and quantitative cross-sectional surveys) study on factors associated with biospecimen knowledge and donation intent in the medically underserved urban communities in Southeast and Southwest Washington, DC. Focus groups were conducted among 41 African-Americans and survey data was available from 302 community residents of different races/ethnicities using convenience sampling. We used logistic regression to model the association between biospecimen knowledge and donation intent with selected sociodemographic variables using survey data. Only 47 % of the participants had knowledge of the different types of biospecimens. In multivariate logistic regression models, male gender, African-American race, and low education levels were significantly associated with lower knowledge about biospecimens. Compared to Whites (79 %), fewer African-Americans (39 %) and Hispanics (57 %) had knowledge of biospecimens but the difference was significant for African-Americans only. Positive intent to donate biospecimens for research was observed among 36 % of the survey respondents. After multivariate adjustment, only biospecimen knowledge was associated with donation intent (odds ratio = 1.91, 95 % confidence interval 1.12, 3.27). Contrary to popular opinion, "mistrust of the medical community" was not the most commonly reported barrier for biospecimen donation among African-Americans. "Not knowing how biospecimens will be used" and "lack of knowledge of biospecimens" were the most common barriers. Our study highlights the importance of education on biospecimens among community residents to increase minority participation in biospecimen research.

New insights in cross-cultural communication

Improving clinician-patient communication, improving clinical decision making, and eliminating mistrust have been identified as three key areas for reducing disparities in care. An important step is the training of cancer professionals to deliver culturally competent care in clinical settings as well as increasing the proportion of underrepresented minorities in the health care workforce. Providing care that is attuned to the patient's cultural preferences begins by talking to the patient about his or her cultural history and identifying the locus of decision making, preferences for disclosure of vital health information, and goals of care. Patients with low literacy and those with poor fluency of the dominant language require additional services. Language interpretation by trained professionals is fundamental to ensure that patients are able to provide informed consent for treatment. A working definition of culture involves multiple dimensions and levels and must be viewed as both dynamic and adaptive, rather than simply as a collection of beliefs and values. Effective cross-cultural education avoids stereotyping and promotes communication and negotiation to solve problems and minimize tension and conflict. Recent research has identified that unconscious biases held by clinicians affect their behavior and recommendations for treatment.