Stanford University School of Medicine and Stanford Cancer Institute, Stanford, CA.
Quantitative Sciences Unit, Stanford University School of Medicine, Stanford, CA.
JCO Oncol Pract. 2021 Dec;17(12):e1837-e1845. doi: 10.1200/OP.20.01093. Epub 2021 Apr 12.
Race and ethnicity have been shown to affect quality of cancer care, and patients with low English proficiency (LEP) have increased risk for serious adverse events. We sought to assess the impact of primary language on health care engagement as indicated by clinical trial screening and engagement, use of genetic counseling, and communication via an electronic patient portal.
Clinical and demographic data on patients with breast cancer diagnosed and treated from 2013 to 2018 within the Stanford University Health Care system were compiled via linkage of electronic health records, an internal clinical trial database, and the California Cancer Registry. Logistic and linear regression models were used to evaluate for association of clinical trial engagement and patient portal message rates with primary language group.
Patients with LEP had significantly lower rates of clinical trial engagement compared with their English-speaking counterparts (adjusted odds ratio [OR], 0.29; 95% CI, 0.16 to 0.51). Use of genetic counseling was similar between language groups. Rates of patient portal messaging did not differ between English-speaking and LEP groups on multivariable analysis; however, patients with LEP were less likely to have a portal account (adjusted OR, 0.89; 95% CI, 0.83 to 0.96). Among LEP subgroups, Spanish speakers were significantly less likely to engage with the patient portal compared with English speakers (estimated difference in monthly rate: OR, 0.43; 95% CI, 0.24 to 0.77).
We found that patients with LEP had lower rates of clinical trial engagement and odds of electronic patient portal enrollment. Interventions designed to overcome language and cultural barriers are essential to optimize the experience of patients with LEP.
种族和民族已被证明会影响癌症治疗的质量，而英语水平较低（LEP）的患者发生严重不良事件的风险增加。我们旨在评估主要语言对临床研究筛选和参与、遗传咨询的使用以及通过电子患者门户进行沟通等医疗保健参与的影响。
通过电子健康记录、内部临床试验数据库和加利福尼亚癌症登记处的链接，汇编了 2013 年至 2018 年期间在斯坦福大学医疗保健系统内诊断和治疗的乳腺癌患者的临床和人口统计学数据。使用逻辑和线性回归模型评估临床试验参与率和患者门户消息率与主要语言组之间的关联。
与讲英语的患者相比，LEP 患者的临床试验参与率明显较低（调整后的优势比 [OR]，0.29；95%置信区间，0.16 至 0.51）。语言组之间遗传咨询的使用情况相似。在多变量分析中，讲英语和 LEP 组之间患者门户消息的比率没有差异；然而，LEP 患者建立门户账户的可能性较低（调整后的 OR，0.89；95%置信区间，0.83 至 0.96）。在 LEP 亚组中，与讲英语的患者相比，西班牙语患者使用患者门户的可能性明显较低（估计每月差异率：OR，0.43；95%置信区间，0.24 至 0.77）。
我们发现 LEP 患者的临床试验参与率和电子患者门户注册的可能性较低。旨在克服语言和文化障碍的干预措施对于优化 LEP 患者的体验至关重要。
