This is an application for a K-07 award for Dr. Lisa Diamond, a clinician-investigator in the Immigrant Health and Cancer Disparities Service at Memorial Sloan-Kettering Cancer Center. The applicant's long-term career goal is to contribute to the policy recommendations needed to eliminate healthcare disparities for cancer patients with limited English proficiency (LEP). Her research is aimed at understanding how clinician non- English language proficiency influences quality of care and outcomes for cancer patients with LEP. The work described in this proposal represents the first evidence-based approach to inform guidelines for the care of cancer patients with LEP. Dr. Diamond's background in health services research, using both quantitative and qualitative methods, through the Robert Wood Johnson Clinical Scholars Program positions her well to accomplish this. Through the proposed career development activities she seeks to gain additional skills towards achieving independence as a scientific investigator with a program of training in large database analysis and its relationship to policy formation, dissemination and implementation research, and the Roter Interaction Analysis System (RIAS), a widely used rigorous method of coding medical interactions. True language concordance occurs when clinicians are fluent in the language that their patient speaks and reduces disparities among LEP patients. Partial language concordance may adversely impact the quality of cancer care provided to LEP patients. The applicant's research agenda is to gather the evidence to inform national and local standards for the appropriate use of non-English language skills by clinicians. Without standards, LEP cancer patients have the potential to misunderstand diagnoses and treatment recommendations, leading to treatment non- adherence. Dr. Diamond proposes to accomplish this through the three aims in this career development award. First, she will identify the content of any existing policies on clinician use of non-English language skills and interpreters at hospitals that frequently serve cancer patients and to determine the factors associated with having such a policy. This will be accomplished by surveying the NCI-designated Cancer Centers nationally, the NCI Community Oncology Research Program sites, and minority-serving hospitals in New York City (NYC). Second, she will test the feasibility of using the RIAS across different languages to describe the nature of communication between clinicians and LEP cancer patients presenting for an initial visit at three minority- serving hospitals in NYC. Third, she will assess the impact of clinician non-English language proficiency, non- English language use, and interpreter use on completion of cancer treatment, quality of life, depression, and stress among a population of LEP cancer patients at the same 3 hospitals participating in Aim 2. Through the proposed career development and research activities, the applicant seeks to acquire new skills and knowledge that will complement her existing research abilities in order to improve cancer care to patients with LEP.
Since many clinicians who provide language concordant care are not native speakers of their patients' languages, studies are needed to help understand the impact of clinician non-English language proficiency on quality of cancer care for patients with limited English proficiency (LEP). There are no national or state guide- lines to direct a clinician's decision to use his/her non-English language skills or a professional interpreter with LEP patients. It is critical to gather the evidence for standards addressing when it is acceptable to use one's own non-English language skills with LEP cancer patients and when professional interpreters are essential.