Low language access limits patient appointment scheduling

Spanish-speaking patients are about a third as likely to access cancer care as their English-speaking counterparts, an issue that's likely due to poor language access during the appointment scheduling process, a JAMA Network Open study concluded.

Similar issues crop up for patients who primarily speak Mandarin, the researchers added. For this population, the odds of getting a clinic appointment for cancer care were one-eighth that of English-speaking people.

This secret-shopper study spotlights continued language access hiccups at healthcare organizations nationwide.

Under Section 1557 of the Affordable Care Act (ACA), healthcare organizations are required to provide meaningful language access to individuals with limited English proficiency (LEP). This includes training staff on language access and providing access to medical interpreters.

But a high level of language access isn't always happening, at least during the appointment scheduling process, the JAMA study showed.

The researchers tested healthcare access by using a secret shopper approach and dialing 479 different cancer clinic telephone numbers provided by 143 hospitals. The researchers used scripts to assume the roles of English, Spanish and Mandarin-speaking patients seeking an appointment for colon, lung or thyroid cancer.

Of the 985 calls made, 41.5% resulted in a new appointment being scheduled. But appointment scheduling was not equal across demographic groups, the research showed.

While 61% of the calls made by English speakers resulted in a scheduled appointment, only 36% of those made by Spanish speakers and 19% of those made by Mandarin speakers yielded the same.

Around half (49.7%) of calls made by Spanish or Mandarin speakers ended due to language barriers, while another quarter ended due to workflow barriers.

All said, Spanish-speaking patients were about a third as likely to access cancer care as their English-speaking counterparts, and Mandarin speakers were about an eighth as likely.

These findings follow a previous study indicating that there were language barriers when contacting a hospital's general information line. This informational line might be used to get a phone number for a specific clinic within a hospital network or other basic information related to care access.

"Thus, to improve access to cancer care for patients with LEP, our findings suggest that interventions to address linguistic barriers are needed at multiple access points along the cancer care continuum," the researchers recommended.

Notably, language barriers were a bigger problem at clinics that were not affiliated with teaching hospitals. Obtaining a cancer care appointment was about half as likely at these hospitals compared to those affiliated with teaching hospitals.

"While more research is needed to understand the reason for this observation, it may potentially be related to differential access to and availability of language-based resources," the researchers explained.

The JAMA researchers referenced previous data that showed that nonteaching hospitals are less likely to have access to medical interpreters, either in-person staff or via telehealth, than teaching hospitals.

Addressing language barriers will be key to ameliorating existing health disparities, the research team added. Right now, colon, lung and thyroid cancers disproportionately affect Hispanic and Asian populations. Although early access to cancer care can mitigate complications, this most recent study showed inequities in that care access.

"Thus, there is a need for intervention to reduce these communication barriers and optimize the clinic appointment scheduling workflow," the research team concluded. "Otherwise, this access point in the cancer care continuum will continue to function as a gatekeeper to cancer care services, with many patient populations, including patients with LEP, unable to even get in the door to see a physician for their cancer care."

Sara Heath has been covering news related to patient engagement and health equity since 2015.