Caring for Patients with Limited English Proficiency

By Teresa Hagan Thomas, PhD, RN - May 18, 2023

Reports estimate that about 145,000 individuals with limited English proficiency (the term used to describe when someone does not speak English or struggles to read, speak, or understand English) are diagnosed with cancer each year in the US. Language concerns are usually one part of a complex interaction of other social determinants that negatively impact patients’ access to and engagement with cancer support systems.

Oncology nurses must learn how to support these individuals throughout the entire cancer experience, from screening to the cancer diagnosis period through treatment and into survivorship. A newly published article by Carl Trube, BSN, RN, and Theresa Yeo, PhD, MPH, ACNP-BC, AOCP®, FAANP, reviewed current issues and policies related to nurses caring for individuals with limited English proficiency to identify with patients’ common concerns and suggest ways to competently and thoughtfully care for the patients.

The authors summarize multiple concerns individuals with limited English proficiency face in addition to their cancer diagnosis and treatment. First, these patients—especially immigrants to the US—are less likely to receive cancer screenings and care. They are also more likely to delay or avoid seeking care out of fear of discrimination, deportation, or incarceration. They are less likely to have a primary care provider or adequate health insurance and more likely to experience language barriers and financial concerns that cause them not to seek or receive health care.

Individuals with limited English proficiency are protected under US law, including the 1964 Civil Rights Act and the Affordable Care Act. Under these laws, health care systems must provide interpretation services and are recommended to have patient education in patients’ native languages. Yet these services are frequently unavailable or underutilized either because health care systems do not provide professional interpretation services, because patients are unaware that these services exist, or because of privacy concerns. Ideally, live interpreters are available to support these patients. If this is not feasible, video or telephone interpreters could be used. While family members, health care staff, and mobile applications (eg, Google Translate) may be used at times, these interpreters are the most likely to present difficulties.

The authors’ recommendations for how to ensure high-quality cancer care to individuals who have limited English proficiency include:

  • Advising patients on how to manage their appointments, including how to access translation services, questions to ask during clinic visits, and how to navigate the cancer clinic.
  • Recognizing cultural differences in how patients with limited English proficiency may be coming to their cancer experience and appreciating differences in familial roles, values, and health concerns.
  • Anticipating patients’ needs so that translation services are available when needed. This includes identifying the best service possible ahead of a patient’s clinic visit and problem solving any logistical or technological issues beforehand.
  • Having health care providers meet with interpreters before and after patient visits. This can ensure that both groups have clear agendas, opportunities to discuss concerns, and build rapport prior to a clinic visit and debrief afterwards.
  • Advocating for health care systems to have live interpretation services that can provide culturally sensitive dialogue. This may require interpreters to have additional training in therapeutic communication regarding delivering difficult or complex medication information.

Oncology nurses are going to be treating more patients for whom English is a challenge. These recommendations are ways to ensure language does prevent any patients from receiving high-quality cancer care.


Patients with limited English proficiency: A challenge for oncology nursing providers