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Cancer Counseling of Low-Income Limited English Proficient Latina Women Using Medical Interpreters: Implications for Shared Decision-Making

  • Original Research
  • Published:
Journal of Genetic Counseling

Abstract

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.

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Notes

  1. “(Interpreter)” indicates when the GC and/or patient paused to allow the interpreter to translate. The transcriptions do not include the interpreter’s speech except when the interpreter’s translation is relevant.

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Acknowledgements

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.

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Authors and Affiliations

  1. Women’s Cancer Program, Cedars-Sinai Medical Center, Los Angeles, CA, USA

    Daniella Kamara

  2. Department of Biological Sciences and Human Genetics, California State University, Stanislaus, Stanislaus, CA, USA

    Jon Weil & Janey Youngblom

  3. Department of General Internal Medicine, University of California, San Francisco, San Francisco, CA, USA

    Claudia Guerra

  4. Department of Anthropology, History, and Social Medicine, University of California, San Francisco, San Francisco, CA, USA

    Galen Joseph

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  1. Daniella Kamara
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  2. Jon Weil
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  3. Janey Youngblom
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  4. Claudia Guerra
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  5. Galen Joseph
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Correspondence to Daniella Kamara.

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Funding

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.

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No animal studies were carried out by the authors for this article.

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Kamara, D., Weil, J., Youngblom, J. et al. Cancer Counseling of Low-Income Limited English Proficient Latina Women Using Medical Interpreters: Implications for Shared Decision-Making. J Genet Counsel 27, 155–168 (2018). https://doi.org/10.1007/s10897-017-0132-5

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