Skip to main content

Advertisement

SpringerLink
Log in

Patient-Provider Language Concordance and Colorectal Cancer Screening

  • Original Research
  • Published:
Journal of General Internal Medicine Aims and scope Submit manuscript

ABSTRACT

Background and Objective

Patient-provider language barriers may play a role in health-care disparities, including obtaining colorectal cancer (CRC) screening. Professional interpreters and language-concordant providers may mitigate these disparities.

Design, Subjects, and Main Measures

We performed a retrospective cohort study of individuals age 50 years and older who were categorized as English-Concordant (spoke English at home, n = 21,594); Other Language-Concordant (did not speak English at home but someone at their provider’s office spoke their language, n = 1,463); or Other Language-Discordant (did not speak English at home and no one at their provider’s spoke their language, n = 240). Multivariate logistic regression assessed the association of language concordance with colorectal cancer screening.

Key Results

Compared to English speakers, non-English speakers had lower use of colorectal cancer screening (30.7% vs 50.8%; OR, 0.63; 95% CI, 0.51–0.76). Compared to the English-Concordant group, the Language-Discordant group had similar screening (adjusted OR, 0.84; 95% CI, 0.58–1.21), while the Language-Concordant group had lower screening (adjusted OR, 0.57; 95% CI, 0.46–0.71).

Conclusions

Rates of CRC screening are lower in individuals who do not speak English at home compared to those who do. However, the Language-Discordant cohort had similar rates to those with English concordance, while the Language-Concordant cohort had lower rates of CRC screening. This may be due to unmeasured differences among the cohorts in patient, provider, and health care system characteristics. These results suggest that providers should especially promote the importance of CRC screening to non-English speaking patients, but that language barriers do not fully account for CRC screening rate disparities in these populations.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Figure 1

Similar content being viewed by others

REFERENCES

  1. US Census Bureau, American FactFinder. Available at: http://factfinder.census.gov/ Accessed August 19, 2010.

  2. National Healthcare Disparities Report, 2008. Available at: http://www.ahrq.gov/qual/qrdr08.htm Accessed August 19, 2010.

  3. Fiscella K, Franks P, Doescher MP, Svaer BG. Disparities in health care by race, ethnicity and language among the insured. Med Care. 2002;40:52–9.

    Article  PubMed  Google Scholar 

  4. Flores G. The impact of medical interpreter services on the quality of health care: a systematic review. Med Care Res Rev. 2005;62(3):255–99.

    Article  PubMed  Google Scholar 

  5. Lavizzo-Mourey R. Improving quality of US health care hinges on improving language services. JGIM. 2007;22(Suppl 2):279–80.

    Article  PubMed  Google Scholar 

  6. Collins KS, Hughes DL, Doty MM, Ives BL, Edwards JN, Tenney K. Diverse communities, common concerns: assessing health care quality for minority americans. The Commonwealth Fund, 2002. Available at: http://www.cmwf.org publication number 523 Accessed August 19, 2010.

  7. Wilson E, Chen AH, Grumbach K, Wang F, Fernandez A. Effects of limited English proficiency and physician language on health care comprehension. JGIM. 2005;20:800–6.

    Article  PubMed  Google Scholar 

  8. Pippins JR, Alegria M, Haas JS. Association between language proficiency and the quality of primary care among a national sample of insured Latinos. Med Care. 2007;45:1020–5.

    Article  PubMed  Google Scholar 

  9. Chan KS, Keeler E, Schonlau M, Rosen M, Mangione-Smith R. How do ethnicity and primary language spoken at home affect management practices and outcomes in children and adolescents with asthma? Arch Pediatr Adolesc Med. 2005;159:283–9.

    Article  PubMed  Google Scholar 

  10. Cheng EM, Chen A, Cunningham W. Primary language and receipt of recommended health care among Hispanics in the United States. JGIM. 2007;22(Suppl 2):283–8.

    Article  PubMed  Google Scholar 

  11. Hu DJ, Covell RM. Health care usage by Hispanic outpatients as a function of primary language. West J Med. 1986;144(4):490–3.

    CAS  PubMed  Google Scholar 

  12. Ponce NA, Hays RD, Cunningham WE. Linguistic disparities in health care access and health status among older adults. JGIM. 2006;21:786–91.

    Article  PubMed  Google Scholar 

  13. Harmsen JAM, Bernsen RMD, Bruijnzeels MA, Meeuwesen L. Patients’ evaluation of quality of care in general practice: what are the cultural and linguistic barriers? Pat Educ Couns. 2008;72:155–62.

    Article  CAS  Google Scholar 

  14. Whitlock EP, Lin JS, Liles E, Beil T, Fu R. Screening for colorectal cancer: a targeted, updated systematic review for the US Preventive Services Task Force. Ann Intern Med. 2008;149:638–58.

    PubMed  Google Scholar 

  15. Jamal A, Siegel R, Ward E, Murray T, Xu J, Thun MJ. Cancer statistics, 2007. CA Cancer J Clin. 2007;57(1):43–66.

    Article  Google Scholar 

  16. Peterson NB, Murff HJ, Ness RM, Dittus RS. Colorectal cancer screening among men and women in the United States. J Womens Health. 2007;16(1):57–65.

    Article  Google Scholar 

  17. Natale-Pereira A, Marks J, Vega M, Mouzon D, Hudson S, Salas-Lopex D. Barriers and facilitators for colorectal cancer screening practices in the Latino community: perspectives from community leaders. Cancer Control. 2008;15(2):157–165.

    PubMed  Google Scholar 

  18. Diaz JA, Roberts MB, Goldman RE, Weitzen S, Eaton CB. Effect of language on colorectal cancer screening among Latinos and non-Latinos. Cancer Epidemiol Biomarkers Prev. 2008;17(8):2169–73.

    Article  PubMed  Google Scholar 

  19. Nguyen GT, Barg FK, Armstrong K, Holmes JH, Hornik RC. Cancer and communication in the health care setting: experiences of older Vietnamese immigrants, a qualitative study. JGIM. 2007;23(10):45–50.

    PubMed  Google Scholar 

  20. Wee CC, McCarthy EP, Phillips RS. Factors associated with colon cancer screening: the role of patient factors and physician counseling. Prev Med. 2005;41:23–9.

    Article  PubMed  Google Scholar 

  21. Guerra CE, Schwartz JS, Armstrong K, Brown JS, Halbert CH, Shea JA. Barriers of and facilitators to physician recommendation of colorectal cancer screening. JGIM. 2007;22(12):1681–8.

    Article  PubMed  Google Scholar 

  22. Dunn AS, Shridharani KV, Lou W, Bernstein J, Horowitz CR. Physician-patient discussions of controversial cancer screening tests. Am J Prev Med. 2001;20:130–4.

    Article  CAS  PubMed  Google Scholar 

  23. Carcaise-Edinboro P, Bradley CJ. Influence of patient-provider communication on colorectal cancer screening. Med Care. 2008;46:738–45.

    Article  PubMed  Google Scholar 

  24. Ware JE, Kosinski M, Keller SD. A 12-Item Short-Form health survey. Med Care. 1996;34(3):220–33.

    Article  PubMed  Google Scholar 

  25. Hershey JC, Luft HS, Gianaris JM. Making sense out of utilization data. Med Care. 1975;13(10):838–854.

    Article  CAS  PubMed  Google Scholar 

  26. Wolf MS, Baker DW, Makoul G. Physician-patient communication about colorectal cancer screening. JGIM. 2007;22(11):1493–9.

    Article  PubMed  Google Scholar 

  27. Safran DG, Taira DA, Rogers WH, Kosinski M, Ware JE, Tarlov AR. Linking primary care performance to outcomes of care. J Fam Pract. 1998;47:213–220.

    CAS  PubMed  Google Scholar 

  28. Etzioni DA, Ponce NA, Babey SH, et al. A population-based study of colorectal cancer test use: results from the 2001 California Health Interview Survey. Cancer. 2004;101:2523–32.

    Article  PubMed  Google Scholar 

  29. Sudore RL, Landefeld CS, Perez-Stable EJ, Bibbins-Domingo K, Williams BA, Schillinger D. Unraveling the relationship between literacy, language proficiency, and patient-physician communication. Patient Educ Couns. 2009;75:398–402.

    Article  PubMed  Google Scholar 

  30. Kazis LE, Nethercot VA, Ren XS, Lee A, Selim A, Miller DR. Medication effectiveness studies in the United States Veterans Administration health care system: a model for large integrated delivery systems. Drug Dev Res. 2006;67:217–226.

    Article  CAS  Google Scholar 

Download references

Acknowledgements

This research was unfunded. Results were presented in poster format at the national meetings of the American College of Preventive Medicine, February 2010, Washington DC and AcademyHealth, June 2010, Boston MA.

Conflict of Interest

None disclosed.

Author information

Authors and Affiliations

  1. General Internal Medicine, Boston Medical Center, 801 Massachusetts Avenue, 2nd Floor, GIM, Boston, MA, USA

    Amy Linsky MD, MSc

  2. Department of Health Policy and Management, Boston University School of Public Health, 715 Albany Street, Boston, MA, USA

    Nathalie McIntosh MSc

  3. Biostatistics, Boston University, Boston, MA, 02118, USA

    Howard Cabral PhD

  4. Center for the Assessment of Pharmaceutical Practices (CAPP)/Department of Health Policy and Management, Boston University School of Public Health, Boston, MA, USA

    Lewis E. Kazis ScD

Authors
  1. Amy Linsky MD, MSc
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Nathalie McIntosh MSc
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Howard Cabral PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Lewis E. Kazis ScD
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Amy Linsky MD, MSc.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Linsky, A., McIntosh, N., Cabral, H. et al. Patient-Provider Language Concordance and Colorectal Cancer Screening. J GEN INTERN MED 26, 142–147 (2011). https://doi.org/10.1007/s11606-010-1512-9

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11606-010-1512-9

KEY WORDS

Search

Navigation