Assessing cultural and linguistic diversity and distress screening completion in gynecologic oncology patients (iCALD)

Abstract

<h3>Objectives:</h3> Optimally caring for oncology patients of culturally and linguistically diverse (CALD) backgrounds poses a unique set of challenges. We aimed to describe CALD gynecologic oncology patient characteristics and distress screening completion in a large, multicultural academic cancer center. <h3>Methods:</h3> This was a retrospective study of patients with a primary gynecologic malignancy treated in the medical, surgical, or radiation oncology and palliative care clinics at Princess Margaret Cancer Centre (PM), Toronto, Canada, from January 1 to December 31, 2019. Data was generated from electronic health records and other databases. Non-English patients were defined as those who listed a primary language on Electronic Patient Records other than English on initial registration. Edmonton Symptom Assessment System-revised (ESAS-r) was available in various languages, and completion rates were assessed and descriptive statistics performed. <h3>Results:</h3> In 2019, there were 19,343 patient visits recorded in gynecologic oncology clinics, and 4684 unique patients (mean visits per patient=4.13). 1656 (8.6%) patient visits were registered as non-English speakers (376 [8.6%] out of 4684 unique patients) comprising more than 40 languages (Figure 1). Most common spoken languages were Mandarin (15.5%), Portuguese (11.6%), Cantonese (10.9%), Spanish (7.8%) and Italian (7.3%). ESAS-r completion rates in the gynecologic oncology clinics were lower in non-English (18.4%) than English (36%; p<0.001) patient visits. Of the most common spoken non-English language populations, ESAS-r completion rates were highest in Spanish patient visits (24%), followed by Mandarin (21.7%), Cantonese (20.6%), Portuguese (17.6%) and Italian (10.8%). <h3>Conclusions:</h3> The PM gynecology clinic sees a significant proportion of patients of CALD backgrounds. Completion rates of ESAS-r are significantly lower amongst patients of CALD backgrounds. These results suggest that linguistic sensitivity in assessing and treating gynecologic cancer patients is paramount. Further research focusing on optimizing care in CALD populations should be considered.