Cancer Counseling of Low-Income Limited English Proficient Latina Women Using Medical Interpreters: Implications for Shared Decision-Making
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In cancer genetic counseling (CGC), communication across language and culture challenges the model of practice based on shared decision-making. To date, little research has examined the decision-making process of low-income, limited English proficiency (LEP) patients in CGC. This study identified communication patterns in CGC sessions with this population and assessed how these patterns facilitate or inhibit the decision-making process during the sessions. We analyzed 24 audio recordings of CGC sessions conducted in Spanish via telephone interpreters at two public hospitals. Patients were referred for risk of hereditary breast and ovarian cancer; all were offered genetic testing. Audio files were coded by two bilingual English-Spanish researchers and analyzed using conventional content analysis through an iterative process. The 24 sessions included 13 patients, 6 counselors, and 18 interpreters. Qualitative data analyses identified three key domains – Challenges Posed by Hypothetical Explanations, Misinterpretation by the Medical Interpreter, and Communication Facilitators – that reflect communication patterns and their impact on the counselor’s ability to facilitate shared decision-making. Overall, we found an absence of patient participation in the decision-making process. Our data suggest that when counseling LEP Latina patients via medical interpreter, prioritizing information with direct utility for the patient and organizing information into short- and long-term goals may reduce information overload and improve comprehension for patient and interpreter. Further research is needed to test the proposed counseling strategies with this population and to assess how applicable our findings are to other populations.
KeywordsCancer genetic counseling Limited-English proficiency Shared decision-making Health communication Language access Medical interpreter Health disparities Health literacy Low-income
This study was funded by Susan G. Komen for the Cure grant # IIR12221854 (PI Joseph) and was conducted to fulfill degree requirement (Kamara). We are grateful to the patients who participated in this study, and to the genetic counselors who allowed us to observe them in their daily practice. The first author would also like to thank Dr. Amy Lemke, PhD for her expertise and support.
Compliance with Ethical Standards
This study was funded by Susan G Komen for the Cure (Grant number: IIR12221854).
Conflict of Interest
Daniella Kamara, Jon Weil, Janey Youngblom, Claudia Guerra, Galen Joseph declare that they have no conflict of interest.
Human Studies and Informed Consent
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. Informed consent was obtained from all individual participants included in the study.
No animal studies were carried out by the authors for this article.
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