A recently published study identifies Spanish-speaking status as a protective factor for patients who received colorectal cancer care in a safety-net hospital (SNH) setting. Findings suggest that other SNHs and healthcare settings could include and engage Spanish-speaking patients to improve their care outcomes, authors say.
Researchers from Loma Linda University Health, University of California Riverside (UCR), and Riverside University Health System (RUHS) published their study, “Spanish-speaking status: A protective factor in colorectal cancer presentation at a safety-net hospital,” in the Journal of Surgical Research last week. The study adds to a growing body of knowledge about how minority individuals experience cancer care in the U.S. healthcare system — especially in the context of an SNH, facilities with decreased levels of monetary compensation, an increased uninsured or public insurance burden, and a lower income patient population.
Findings revealed that compared to patients who spoke other languages, Spanish-speaking patients at this SNH located in Riverside, CA, were more likely to have engaged in care that improves colorectal cancer outcomes, such as being initially seen by a surgeon in an outpatient setting, undergoing an elective operation, and receiving a definitive tumor resection. These study outcomes depart from prior studies associating Hispanic ethnicity with lower colorectal screening rates and Spanish-speaking status with poorer colorectal cancer outcomes.
Cultural competence between Spanish-speaking staff and Spanish-speaking patients may partly explain these unexpected findings, says David Caba Molina, MD, a surgical oncologist at LLU Cancer Center and a co-author of the study.
“Some hospitals are culturally molded to serve particular communities, something I call cultural competency,” he says. “The location can impact the patients being served, as well as the employees and care teams serving the patients. In some instances, we construct a form of cultural competency without even intending to do so, but it can help a patient population.”
Caba Molina and researchers reviewed data from colorectal cancer patients who had been seen by the SNH Riverside University Health System's (RUHS) surgical service. Records from the three years between September 2016 and December 2019 provided information about patients' demographic data, cancer stage, acuity and intervention variables, and follow-up status. Of the 157 patients analyzed, about 54% were men, 58% had colon cancer, nearly 43% primarily spoke Spanish, and almost 53% of patients presented with late-stage (III or IV).
Researchers then performed statistical comparisons to investigate whether patient-reported primary spoken language bore significant associations with other characteristics, including insurance type, stage, cancer type, surgery class (elective versus urgent), initial surgeon contact setting (outpatient clinic versus inpatient consult), operation (resection versus diversion), and follow-up.
Compared to patients who spoke other languages, Spanish-speaking patients at this SNH were more likely to have been initially seen by a surgeon in an outpatient setting rather than an initial inpatient consult, undergo an elective rather than urgent operation, and received a definitive tumor resection rather than diversion.
The SNH studied is a network including primary care and satellite clinics; Caba Molina says findings reveal how patients were processed into the system in a way that allowed them to follow a smooth path toward their treatment: they were seen at a primary care setting, identified as high-risk, underwent diagnostic tools, and consulted with a specialist for treatment. In addition, Caba Molina says another unexpected outcome of the analysis associated Spanish-speaking status with a lower likelihood of emergent presentation — trending towards earlier stage (I-II) presentation.
“Although this safety net setting is known to carry a large burden of uninsured and indigent patients, we now know that this traditionally marginalized population of Spanish-speaking patients is not at higher risk of not receiving proper care for colorectal cancer,” he says.
A possible underlying reason Caba Molina and authors cite to explain the findings is the culturally competent nature of the ancillary staff working at this facility in Riverside County, CA, where native Spanish-speakers make up 34.5% of the population.
"If providers can engage in a conversation with their patients and patients feel more connected and cared for with the shared language, then patients are more likely to follow the care pathway set out for them," Caba Molina says.
Whether or not this language-specific protective factor is only significant in the SNH setting warrants further investigation in other SNHs and different hospital settings, authors say. In the meantime, Caba Molina says he hopes studies like these can show care settings what is achievable while encouraging further research about ways to better care for traditionally underserved populations.
“There’s a lot of ground left to cover in terms of understanding how at their conception, hospitals can be nurtured to serve these traditionally marginalized populations and reduce these disparities,” he says.
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