Good provider, good patient: changing behaviors to eliminate disparities in healthcare.

We examined the relationship between cross-cultural provider-patient interactions and health outcomes through a literature review. Results were presented in the form of guiding principles to an expert panel of health care administrators, medical practitioners, and medical care providers. This expert panel met at the workshop "Changing Patient Behavior" during a conference convened by the office of Minority Health, US Department of Health and Human Services, February 17-18, 2000. The panel reviewed the themes and formulated suggestions for program and policy change. Six principles were identified: (1) Physicians should acknowledge that patients may be actively involved in health maintenance long before they seek medical care. (2) Patients should be empowered to be active participants in their medical care. (3) Providers should critically evaluate their own assumptions and underlying values about what constitutes a "good" patient and consider how these assumptions and values affect their communication strategies. (4) The patient's behavior change in the medical interaction should result from a process of negotiation between provider and patient. (5) The medical system should focus on community empowerment in addition to individual empowerment. (6) Accessible and understandable health outcome data will empower the community to participate in the elimination of health disparities

VITAL: Virtual Interpreting Training and Learning

This paper describes a distance learning solution for the training of medical interpreters: the Virtual Interpreting Training and Learning (VITAL) Program. VITAL was developed to offer an effective, efficient, and scalable learning alternative to conventional models. The main objective of VITAL is to increase the pool of trained medical interpreters, while providing the same quality of training as in-person programs. Currently, VITAL is used in training bilingual (i.e., English and Spanish) individuals to perform as medical interpreters. An expanded pool of trained medical interpreters will ultimately lead to enhanced communication between providers and their patients and reduce the occurrence of medical errors

Identifying human papillomavirus vaccination practices among primary care providers of minority, low-income and immigrant patient populations.

Objective: Minority populations in the United States are disproportionally affected by human papillomavirus (HPV) infection and HPV-related cancer. We sought to understand physician practices, knowledge and beliefs that affect utilization of the HPV vaccine in primary care settings serving large minority populations in areas with increased rates of HPV-related cancer.Study Design: Cross-sectional survey of randomly selected primary care providers, including pediatricians, family practice physicians and internists, serving large minority populations in Brooklyn, N.Y. and in areas with higher than average cervical cancer rates.Results: Of 156 physicians randomly selected, 121 eligible providers responded to the survey; 64% were pediatricians, 19% were internists and 17% were family practitioners. Thirty-four percent of respondents reported that they routinely offered HPV vaccine to their eligible patients. Seventy percent of physicians reported that the lack of preventive care visits for patients in the eligible age group limited their ability to recommend the HPV vaccine and 70% of those who reported this barrier do not routinely recommend HPV vaccine. The lack of time to educate parents about the HPV vaccine and cost of the vaccine to their patients were two commonly reported barriers that affected whether providers offered the vaccine.Conclusions: Our study found that the majority of providers serving the highest risk populations for HPV infection and HPV-related cancers are not routinely recommending the HPV vaccine to their patients. Reasons for providers' failure to recommend the HPV vaccine routinely are identified and possible areas for targeted interventions to increase HPV vaccination rates are discussed.AMSUNY DownstateCommunity Health SciencesN/

Drivers of Job Loss Among Chinese Breast Cancer Survivors: A Qualitative Analysis

Purpose: This study aimed to understand the reasons for the high risk of job loss previously identified among foreign-born Chinese breast cancer survivors in the US. Qualitative interviews were conducted to explore challenges leading to job loss during/after treatment and to help identify potential interventions to promote job retention and re-employment. Patients and Methods: The research team conducted semi-structured interviews with foreign-born Chinese breast cancer survivors in New York City. A total of twelve participants, previously enrolled in the Breast Cancer and the Workforce study, were interviewed between February and November 2018. Purposive sampling was used to identify participants diverse across job type and work history. Thematic content analysis was conducted on translated interview transcripts. Results: Since diagnosis, 8/12 participants had experienced job loss (6/6 in service/production, 1/5 retail/administrative, and 1/1 professional/managerial). Many described being unable to work due to treatment side-effects, inflexible schedules, and a perception that work accommodations were unavailable. Only one participant who had lost her job went on to secure stable re-employment. Conclusions: Job type, language barriers, and cultural attitudes towards work accommodations contributed to a high job-loss rate in this population. Those who remained employed had received work accommodations. Lack of awareness or belief in obtaining accommodations was a critical factor in job loss. Implications for Cancer Survivors: These findings highlight the necessity of advocacy for work accommodations for cancer patients and culturally competent care. Addressing these issues could improve job retention and financial stability for breast cancer survivors, particularly among immigrant and minority groups

The Impact of Medical Interpretation Method on Time and Errors

Background: Twenty-two million Americans have limited English proficiency. Interpreting for limited English proficient patients is intended to enhance communication and delivery of quality medical care. Objective: Little is known about the impact of various interpreting methods on interpreting speed and errors. This investigation addresses this important gap. Design: Four scripted clinical encounters were used to enable the comparison of equivalent clinical content. These scripts were run across four interpreting methods, including remote simultaneous, remote consecutive, proximate consecutive, and proximate ad hoc interpreting. The first 3 methods utilized professional, trained interpreters, whereas the ad hoc method utilized untrained staff. Measurements: Audiotaped transcripts of the encounters were coded, using a prespecified algorithm to determine medical error and linguistic error, by coders blinded to the interpreting method. Encounters were also timed. Results: Remote simultaneous medical interpreting (RSMI) encounters averaged 12.72 vs 18.24 minutes for the next fastest mode (proximate ad hoc) (p = 0.002). There were 12 times more medical errors of moderate or greater clinical significance among utterances in non-RSMI encounters compared to RSMI encounters (p = 0.0002). Conclusions: Whereas limited by the small number of interpreters involved, our study found that RSMI resulted in fewer medical errors and was faster than non-RSMI methods of interpreting

VITAL: Virtual Interpreting Training and Learning

This paper describes a distance learning solution for the training of medical interpreters: the Virtual Interpreting Training and Learning (VITAL) Program. VITAL was developed to offer an effective, efficient, and scalable learning alternative to conventional models. The main objective of VITAL is to increase the pool of trained medical interpreters, while providing the same quality of training as in-person programs. Currently, VITAL is used in training bilingual (i.e., English and Spanish) individuals to perform as medical interpreters. An expanded pool of trained medical interpreters will ultimately lead to enhanced communication between providers and their patients and reduce the occurrence of medical errors