Chapter 3: Cross-Cultural Communication

Background

Clear communication between health care providers (HCPs) and patients is imperative for the delivery of safe and effective medical services (Li et al., 2017). In their research, Fox et al. (2020) revealed that it was common for HCPs to state that they had witnessed communication errors that negatively affected patient safety. These errors often went unreported. If such errors go unreported, then the mistakes will not be addressed, and changes cannot be made. This section will discuss the barriers for patients with limited English proficiency (LEP) and strategies for improving cross-cultural communication in the clinical setting.

Barriers for Patients with LEP

Patients with LEP experience disparities in health care safety and quality, such as:

• an increased risk of unnecessary diagnostic testing
• incomplete health assessment
• misdiagnosis
• delayed treatment
• repeat emergency room visits
• decreased understanding of diagnosis and treatment
• poor symptom management
• higher rates of hospital readmission
• severe adverse events
• negative overall experiences compared to patients who are proficient in English

(de Moissac & Bowen, 2019; Fox et al., 2020).

HCPs have reported feeling a lack of confidence in their abilities to communicate effectively and to form therapeutic relationships with LEP patients and families (Fox et al., 2020). If trusting, therapeutic relationships have not been formed, patients experience additional stress and decreased confidence in their diagnoses and in the health care system (de Moissac & Bowen, 2019).

Some HCPs may avoid conversations with LEP and culturally diverse patients due to time constraints. This conveys an unconscious bias, with attention diverted to patients who have more straightforward needs (Barwise et al., 2019). Infrequent communication leads to family mistrust, distress, and inadvertent misconceptions. It also displays a lack of empathy and caring toward culturally diverse and LEP patients (Barwise et al., 2019).

Culturally Responsive Practice Points for Health Care Providers

The Saskatchewan Health Authority (SHA) does not have language services on site at its hospitals. Instead, it has a contract with CanTalk Canada for patients and HCPs who need medical interpretation. CanTalk Canada (2020) is an over-the-phone translation, interpretation, and cultural support service that includes over 200 languages and dialects. CanTalk Canada (2020) has services available 24 hours a day, with the option to pre-book an interpreter for specific encounters. It is unclear if the professional interpreters are specifically trained for medical, emergency, and/or end-of-life conversations. CanTalk does attempt to address the issue of language barriers in the health care setting. It can be considered as an option for HCPs and patients.

Some additional actions that HCPs can take with patients include:

• avoiding the use of applications such as Google Translate for difficult care conversations. These applications may be an option for general conversations and relationship building.
• pairing HCPs who have languages in common with patients together as much as possible for relationship building and ease of communication.
• advocating for interpreter use over family interpretation.
• reporting any unsafe practices witnessed due to language barriers; and
• advocating for additional services for LEP patients, such as a mobile application to aid in daily care provision.

References

Barwise, A. K., Nyquist, C. A., Espinoza Suarez, N. R., Jaramillo, C., Thorsteinsdottir, B., Gajic, O., & Wilson, M. E. (2019). End-of-life decision-making for ICU patients with limited English proficiency: A qualitative study of healthcare team insights. Critical Care Medicine, 47(10), 1380–1387. DOI:10.1097/CCM.0000000000003920

CanTalk Canada. (2020). About CanTalk.  https://cantalk.com/about-cantalk/

De Moissac, D., & Bowen, S. (2019). Impact of language barriers on quality of care and patient safety for official language minority francophones in Canada. Journal of Patient Experience, 6(1), 24–32. https://doi.org/10.1177/2374373518769008

Fox, M. T., Godage, S. K., Kim, J. M., Bossano, C., Muñoz-Blanco, S., Reinhardt, E., Linxuan, W., Karais, S., & DeCamp, L. R. (2020). Moving from knowledge to action: Improving safety and quality of care for patients with limited English proficiency. Clinical Pediatrics, 59(3), 266–277. DOI:10.1177/0009922819900950

Li, C., Son, N., Abdulkerim, B. A., Jordan, C. A., & Son, C. G. E. (2017). Overcoming communication barriers to healthcare for culturally and linguistically diverse patients. North American Journal of Medicine and Science, 10(3), 103–109. DOI:10.7156/najms.2017.1003103]