A University of Michigan study published this past September found that patients with limited English proficiency are less likely to be given additional cancer care information when calling general hospital hotlines. This research was supported and funded by the Rogel Cancer Center.
In the study, the researchers hired six trained “investigators” who called different hospital information service lines speaking in English, Spanish or Mandarin — the most commonly spoken languages in the United States.
Researchers conducted the study over eight months, during which 1,296 calls were made to randomly selected hospitals from 12 demographically diverse states. The study specifically examined the responses from hospital information service lines; these calls are often the first step many people take to seek care rather than booking appointments with doctors.
In an interview with The Michigan Daily, Dr. Debbie Chen, co-author of the study and thyroid cancer researcher at Michigan Medicine, spoke on how language barriers can cause challenges in the first step of seeking care.
“Accessing information through a hospital phone line is one part of getting access to care,” Chen said. “If this is a language barrier in the beginning, imagine all of the downstream barriers that one could potentially encounter in their process of seeking care.”
Chen and the other researchers for the U-M study compared their findings to data collected in a 2005 audit study conducted by New York City’s Comptroller’s Office in which Spanish-speaking patients called the general hospital line. The New York Comptroller study found that Spanish-speaking callers were unable to get information from hospitals’ general information phone lines a third of the time and a lack of language access prevented the callers from scheduling appointments with a third of hospitals tested. The researchers compared the data using a ANOVA statistical analysis test, which determines differences between research results from two or more sample groups.
The analysis showed that Spanish-speaking and Mandarin-speaking callers were provided with the next steps to access cancer care 37.7% and 27.5% of the time, respectively. However, English-speaking callers were directed to the next steps 93.5% of the time and had longer calls compared to the non-English-speaking callers.
Researchers also found some hospital general information lines defaulted to an automatic message that is spoken only in English with no option to hear the message in another language. If no one responds to the automatic message, researchers found hospital hotlines that were studied will automatically disconnect, preventing those who cannot understand the automated message from receiving the necessary services. The study recommends that hospitals should connect those who do not respond to the automated message to a real person instead of disconnecting the call to overcome these language barriers. It also recommended that hospitals employ readily accessible interpreters to answer calls or translate automatic messages.
Mousumi Banerjee, co-author of the study and U-M research professor of biostatistics, spoke with The Daily about the added burden language barriers create for patients, particularly when it comes to interacting with automated messages.
“These patients already have emotional and financial burdens from navigating through a complex health condition and a cancer diagnosis,” Banerjee said. “To have this hidden language barrier on top of that just makes it even worse for the patients.”
Engineering senior Margaret Lasonde is the co-director of event execution for the American Cancer Society. ACS focuses on providing access to information and resources regarding cancer care. Lasonde spoke with The Daily in an interview about her reaction to hearing the results of the new U-M study.
“I believe that I could speak on behalf of everyone who is involved with the American Cancer Society that hearing the results from this study was incredibly difficult and frustrating to hear because we are working so hard to get cancer care information out there,” Lasonde said.
Chen said though there are no clear solutions to resolve this barrier at the moment, there are still crucial takeaways from this study. Chen said it felt like a success to add this study’s results to the dialogue about language barriers in cancer care access.
“There is not a simple solution to this language barrier, but I think, overall, there are some strategies that we can implement based on the study results,” Chen said. “This study highlights an understudied area that needs more funding and more research to provide and essentially create a system where patients with English proficiency have more access to equitable care.”
Daily News Reporter Emma Lapp can be reached at email@example.com.
Correction: A previous version of this article incorrectly stated automatic messages automatically disconnect only in Michigan hospitals. The automatic messages disconnect in the hospitals studied by Chen and other researchers around the U.S., not just in Michigan.