Chapter 3: Cross-Cultural Communication
Gillian Spring
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 Trans