Barriers Encountered by Patients While Making Cancer Care Clinic Appointments

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In 2001, the Institute of Medicine released a report, Crossing the Quality Chasm, which noted that “timely access to care” was one of the six areas that define quality healthcare.¹

Within the United States, history has shown that there is known association between access to cancer care and improved health outcomes; however, on the other side of the coin, it has also been determined that cancer disparities are related to difference access to cancer care services.²

A cross-sectional audit study published in JAMA Network Open² sought to determine what exactly patients experience when scheduling appointments at a new cancer care clinic.

Between Nov. 15, 2021, and March 31, 2023, investigators conducted an audit study that consisted of 479 clinic telephone numbers that were shared by hospital general information employees at 143 hospitals located across 12 states in the US that have varying proportions of residents with limited English proficiency (LEP), including Arizona, California, Florida, Illinois, Massachusetts, Michigan, Missouri, New Jersey, New York, Oregon, Pennsylvania, and Texas.

With the help of identical scripts, trained research staffed were assigned a role of either English-speaking, Mandarin-speaking, or Spanish-speaking patients, and were directed to call a telephone number for a clinic that treats colon, lung, or thyroid cancer—three types of cancer types that immensely affect Asian and Hispanic populations—to ask to make a new clinic appointment, which was done during standard business hours (Monday through Friday from 8 am to 5 pm. The data analysis occurred from June to September 2023.

Of the 985 total calls, they were divided in the following manner: 399 English calls; 284 Mandarin calls; and 302 Spanish calls, with simulated patient callers accessing cancer care in 409 calls (41.5%). There were also differences were according to the language, as simulated English-speaking patient callers were reportedly more likely to access cancer care compared to simulated Mandarin-speaking and Spanish-speaking patient callers (English, 245 calls [61.4%]; Mandarin, 54 calls [19.0%]; Spanish, 110 calls [36.4%]; P < .001).

Almost half of the total calls ended due to language barriers (291 of 586 Mandarin or Spanish calls [49.7%]), while workflow barriers represented 239 of 985 calls [24.3%]). When compared alongside English-speaking simulated patient callers, the chances of accessing cancer care were lower for Mandarin-speaking simulated patient callers (adjusted odds ratio [aOR], 0.13; 95% confidence interval (CI), 0.09-0.19) and Spanish-speaking simulated patient callers (aOR, 0.34; 95% CI, 0.25-0.46). Compared with contacting clinics affiliated with teaching hospitals, callers also had lower chances of accessing cancer care when contacting clinics that were associated with non-teaching hospitals (aOR, 0.53; 95% CI, 0.40-0.70).

As a result, the investigators concluded that, “Our study provides actionable insight into existing linguistic and workflow barriers that patient callers may encounter when attempting to access a new clinic appointment for cancer care. Thus, there is a need for intervention to reduce these communication barriers and optimize the clinic appointment scheduling workflow. 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.”

References

1. Institute of Medicine. Crossing the Quality Chasm: A New Health System for the 21st Century. National Academies Press; 2001.

2. Chen DW, Banerjee M, Gay B, et al. Access to New Clinic Appointments for Patients With Cancer. JAMA Netw Open. 2024;7(6):e2415587. doi:10.1001/jamanetworkopen.2024.15587