Oncology nursing bias contributes to health care inequity. There are many forms of bias, and language bias is often not the first that comes to mind. Language prejudice and discrimination can be a form of racism and ethnic disparity. To combat language bias in cancer care, oncology nurses must be aware of potential individual and institutional prejudice.
What Is Language Bias?
Language bias is an aspect of implicit bias that refers to prejudice against people who do not speak the same language as you or who do not speak the majority or official language in your region. This bias is implicit, and you might not notice that you have it. However, individual language bias can lead to language-based inequity in health care.
Patients with limited English proficiency (LEP) consistently receive lower-quality care than patients proficient in English. The AMA Journal of Ethics suggests this is because of “obvious communication barriers but also may reflect cultural differences, clinician biases, and ineffective systems (ie, structural barriers).”
How Can Language Bias Affect Cancer Care?
A cancer diagnosis is scary for any individual, but it can be particularly overwhelming if patients are not receiving the diagnosis or care in their native language. In addition, a diagnosis comes with so much uncertainty and information: biopsies, scans, test results, information about the specific disease, treatment options, clinical trials, and more. As a result, patients can quickly become confused and overwhelmed.
Common teaching tools, such as take-home pamphlets or drug sheets, may not be available in the patients’ native language, limiting their usefulness for patients with LEP. In addition, many tools are written at a high reading level and do not meet the needs of patients with low health literacy. As a result, patients can experience information overload that affects their ability to deal with their cancer diagnosis. The lack of appropriate resources for these patients is a form of institutional bias. Allowing value statements or stigmatizing language (eg, “substance abuser” instead of “history of substance abuse disorder”) in medical records is another form of language bias.
What Are 5 Ways to Help Combat Language Bias?
Oncology nurses must work to identify language bias in themselves and their institution to combat inequity in cancer care. Below are 5 tips to mitigate language bias.
- Slow down
If your patient has difficulty understanding you, consider slightly slowing down your speech. However, don’t slow down so much that it becomes difficult to remember the first part of the sentence or over-enunciate your words. If you’ve studied a foreign language, remember how your teacher spoke: a steady pace with clearly enunciated words. Mimic this speaking style for your LEP patients. Face patients when talking to them and remain still. It can be difficult for patients to understand if you move around the room or make additional noise.
- Use alternate phrases
Patients who have LEP may be able to understand some phrases better than others. This difference occurs because the structure of some words may be more like their native language (or may be less complex), or they are words used more frequently in their vocabulary. Consider the following examples:
“Let me know if you are experiencing any discomfort” vs “Tell me if you feel any pain.”
“This medicine may cause drowsiness” vs “You may feel sleepy after taking this drug.”
An easy guideline for health literacy is if the word has 3 or more syllables, try to find a different one. In the examples above, “pain” is used for “discomfort,” “sleepy” replaces “drowsiness,” and the more straightforward word “drug” is a substitute for “medicine.”
- Speak directly to the patient
When using an interpreter (either professional or ad hoc), it can be tempting to look at the interpreter while speaking. For example, if a patient’s daughter is interpreting for her mother, look at the mother. Not looking at the patient can be construed as rude or disrespectful or may make them feel unimportant. Likewise, speak to the patients, not the interpreters. You can look at the interpreters while they are speaking to you but direct your conversation toward your patients.
- Don’t make assumptions
When working with patients with LEP, it is essential not to make assumptions based on their language use. One of the more prevalent assumptions about patients with LEP is that they are less intelligent. Learn about your patient’s education, background, former job, and current job. Many nurses know of physicians or professors from other countries where English is not their first language, who are brilliant but may struggle with English, and without knowing their background, you are missing their story. You may feel tempted to omit or over-simplify information that you think is too complicated for the patient. Nurses must evaluate their communication to ensure they are not making assumptions about their LEP patients.
- Ask if you don’t understand
Patients who have LEP usually have an accent when speaking English. As a result, their speech may be difficult to understand, especially if this is one of your first interactions. It is okay to ask patients to repeat themselves if you do not understand. To prevent frustration, however, instead of asking, “Could you repeat that?” consider something like “I think I heard you say [XYZ]. Is that correct?” or “I got a little lost after you said [XYZ]. Could you start from there?” This type of dialogue can mitigate some of the patients’ frustration from repeating themselves while also demonstrating that you were listening to them.
Language bias is a potent but often overlooked form of implicit bias. Your words or the words of others may stigmatize a patient verbally or when writing or reading medical records. Therefore, oncology nurses must increase their awareness of potential language bias and implement strategies to combat it.
References
Understanding Implicit Bias and Its Impact on Oncology Care
Language Proficiency and Adverse Events in US Hospitals: A Pilot Study
Language-Based Inequity in Health Care: Who Is the “Poor Historian”?
Physician Use of Stigmatizing Language in Patient Medical Records
