A bridge over cultural divides

Culturally and linguistically appropriate education about colon cancer increases awareness, saves lives underserved by mainstream medicine

Being culturally aware is always important, but new studies indicate that addressing cultural differences in the doctor's office is actually saving lives.

According to a recent study led by researchers at Harborview Medical Center with collaborators from the Public Health Sciences Division, some populations are missing out on screening and early detection for colorectal cancer, which researchers say is the key to survival. Colorectal cancer is the second leading cause of cancer-related deaths, and researchers estimate that it will play a role in ending more than 55,000 lives this year. Evidence shows that early detection is critical in bringing those numbers down, but when a population doesn't understand or utilize the screening process, it does little good.

In a study published in the Sept. 1 issue of the American Cancer Society's journal Cancer, researchers from the Center and University of Washington found that low-income Chinese-speaking patients in the United States were six times more likely to be screened for colorectal cancer when a clinic-based, multilingual health educator provided culturally and linguistically appropriate counseling, educational materials, and screening-test instructions.

"The context and message have to be relevant to the patient," said Dr. Shin-Ping Tu, principal investigator of the study and a visiting investigator with PHS' Cancer Prevention Program. By targeting populations that are traditionally underserved by mainstream medicine, clinicians and educators are able to clear up misunderstandings caused by the cultural divide, she said.

Different health beliefs and cultural values contribute to the confusion. Interviews with patients revealed that many in the community believed colon cancer was caused by a buildup of toxins in the body or constipation, which don't match the biomedical model.

Until a few decades ago, colon cancer was considered a predominantly Western disease afflicting Caucasians, but in recent decades, the rates of colon cancer among foreign-born Asians and Pacific Islanders in the United States have been on the rise.

One study reported that colon-cancer patients in that population were more likely to seek medical attention only after the disease had spread and was more difficult to manage, so reaching affected populations about the importance of screening is critical — and effective.

"Our study shows that culturally and linguistically appropriate education works," Tu said. The study divided participants into two groups. The control group received standard medical care. The other group received counseling from a trilingual and bicultural health educator and multilingual educational materials such as videos and pamphlets, fecal-occult blood testing (FOBT) instructions and three FOBT cards.

Six months after the intervention, researchers found that nearly 70 percent of those in the intervention group had completed FOBT screening; less than 30 percent in the control group had completed the screening. "If we present the message in a way that is meaningful and relevant to the patients, they will follow through," Tu said.

Armed with this knowledge, the team now plans to focus efforts on putting this information to use. While the efforts will be aimed at Asian populations, the team will be looking at different ways to disseminate the intervention to more people as well as exploring funding options.

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