Photo by Rebecca Wharton
The ability to diagnose telltale symptoms and administer effective treatments is a must for any accomplished physician. But what about cultural awareness?
A new Hutch study suggests that an appreciation of ethnic differences by health-care providers may go a long way toward improving cancer-screening rates among Hispanics.
Public Health Sciences Division investigators found that the majority of Hispanics in the Lower Yakima Valley of Eastern Washington do not undergo regular cancer screening because of a fatalistic attitude toward the disease - an attitude unbeknownst to their health-care providers.
"Only a minority of health-care providers and about half of representatives of community organizations mentioned different beliefs and attitudes toward cancer as an important factor for improving screening behaviors among Hispanics," said Dr. Beti Thompson, lead author of the study.
The findings, reported in the October edition of Health Education and Behavior, ultimately may encourage more doctors, medical support staff and community agencies to consider a patient's cultural background as an important component of their health care.
The study surveyed 380 residents of the Lower Yakima Valley, an area with a population of about 60,000 - approximately 50 percent of whom are of Hispanic origin - about their attitudes, beliefs and practices regarding cancer. Bilingual interviewers of Mexican-American ethnicity conducted the face-to-face surveys, which took place in participants' homes.
In addition, 40 health-care providers from the region and 14 representatives of community organizations serving Hispanics were questioned about their perceptions of cancer prevention among area residents.
Hutch researchers found that Hispanics were significantly less likely to have undergone screening tests for several cancers than non-Hispanics. Non-Hispanic women were three times more likely to have had a Pap smear, which screens for cervical cancer, and twice as likely to have had a mammogram compared with Hispanic women. Non-Hispanic men and women over age 50 were nearly twice as likely to have had a sigmoidoscopy to screen for colorectal cancer.
Despite the fact that socioeconomic status was equal among Hispanics and non-Hispanics in the study, two-thirds of health-care providers surveyed believed that the main reason for the disparity in cancer screening rates is socioeconomic.
"This population-based survey and other studies suggest that Hispanics have less knowledge about cancer, tend to avoid the disease and have a more fatalistic attitude toward cancer than non-Hispanics," Thompson said. "These differences in beliefs and attitudes appear to be independent of socioeconomic status."
'Rather not know'
Hispanics were more likely than other community members to believe that they needed to be screened for cancer only if they had symptoms or if cancer runs in their family. Most Hispanics also said they would "rather not know if they had cancer," and more than half believed a diagnosis of cancer was a death sentence.
Hispanics also said that long waiting times at clinics were a problem, while none of the health-care providers or organization representatives said they considered that a barrier to health care. Many health care providers thought lack of transportation made it difficult for Hispanics to get health care, but Hispanics were no more likely than non-Hispanic community members to identify transportation as a problem.
Language and lack of translators were other barriers that health-care providers in the community underestimated. Along with Hispanics, representatives of community organizations were likely to identify it as a problem.
Thompson and colleagues were prompted to initiate the study when their earlier research revealed a lack of routine medical care among area residents.
"We had done a study of one community in the Yakima Valley, and we were struck by the number of people who didn't have regular health care," she said. "So we decided we needed to know what the health-care-provider community and other agencies serving this population thought about Hispanics and health-care access."
Inconsistent ethnic classifications
Overall, cancer incidence among Hispanics tends to be lower than in whites, although, Thompson said, this may be due to other issues, including inconsistencies in classifying individuals by ethnicity. Cancer survival rates are lower, however, generally because Hispanic patients tend to be diagnosed with disease at a more advanced stage.
The key to improving health care for Hispanics may be to identify and address the barriers to care that are not recognized by those who can change them.
"Interventions devised by health-care providers and representatives of community organizations serving Hispanics may be based on perceptions that are inconsistent with the beliefs and practices of Hispanics," Thompson said.
"Health care providers in general don't think of these cultural issues as being important-but they are."