Researchers Explore Unique Attitudes Towards Cancer Care in Asian Populations
Posted in GUMC Stories
FEBRUARY 24, 2014—While there is no one-size-fits-all approach, broadening communication channels between caregivers and patients is an essential component to navigating the different cultural beliefs and attitudes towards the medical system among many people of Asian descent. That’s the finding of cancer specialists at Georgetown Lombardi Comprehensive Cancer Center (new window).
Researchers have come to understand the need to enhance mutual understanding between physicians and patients through education, says Judy Huei-yu Wang, PhD (new window), an associate professor of population sciences at Georgetown Lombardi who studies the influence of culture on cancer care.
“Physicians need to be aware of and sensitive to Asian patients’ culturally based health care views and communication styles, which may be more passive due to a tradition of conformity and respect for authority,” Wang says.
“Likewise, Asian patients need to learn evidence-based practice such as preventive concepts and how to communicate with physicians. For example, they can learn that asking questions, and asking for explanations or further referrals, is a part of patient rights and common practice in mainstream health care,” she adds.
Wang and Aiwu Ruth He, MD (new window), a Georgetown Lombardi oncologist with a large Asian patient practice who specializes in liver and stomach cancers, are working to overcome challenges to boosting cancer screening rates and enrolling patients in clinical trials — a particularly acute issue in the DC area given its large Asian population.
The local population is more than 9 percent Asian, either American-born or immigrants, and growing quickly, while the national average is about 4.8 percent, says Wang.
Emphasis on Self-Care
In Asian communities, self-care through natural approaches such as diet, Chinese medicine and mind-body fitness is widely accepted. Many pharmacies offer composition herbal remedies to treat a variety of diseases, ranging from hypertension to diabetes to infections.
“Due to the emphasis of self-care, many do not think it is necessary to see physicians for semi-annual or annual checkups if they do not have any symptoms. When what the physician discusses does not meet what is believed or read, they tend to shop around for another opinion,” notes He.
Along the same lines, translating educational materials about disease process, evidence-based disease prevention, surveillance, treatment and patient-doctor communication helps encourage patients to take advantage of medical care resources available to them, she adds.
With her cancer patients, He always asks about supplement use, and checks a database to make sure there is no interaction between these agents and cancer drugs.
Cultural Impact on Screening and Clinical Trials
Wang studies the willingness of patients of Asian descent to participate in screening for breast and colorectal cancer, and how physicians communicate with this population.
Educational level often does not have much bearing on how Asians regard both screening and clinical trials, both Wang and He have observed.
“A patient may be highly educated, and may express an understanding of data from clinical trials, yet somehow clinical trials do not become part of the treatment options he or she would consider,” says He.
Many patients lack knowledge about clinical trials and feel uncertain about the effects of the treatment being tested. Also, the informed consent process can be overwhelming for patients given linguistic barriers.
“Implementing cultural expertise to write an understandable informed consent — and training culturally sensitive staff to communicate with patients to make them feel comfortable and earn their trust — may facilitate their participation in clinical trials,” Wang says.
Opening Communication Channels
Language barriers are not the most important issue in cancer screening and survivorship care, the researchers say.
“Our Chinese survivors said that they can request interpreters during medical encounters so that language problems can be overcome,” says Wang. “The problem is communication channels — whether their physician is willing to listen or talk, whether the patient is willing to ask or learn.”
Knowing these challenges, Wang has worked to understand how to improve breast and colorectal cancer screening rates among Chinese Americans. These rates are very low, despite the fact that colorectal cancer is the second leading cause of death among Chinese men and women, and breast cancer mortality rates are on par with colorectal cancer for Chinese women.
She and her colleagues have found ways to encourage Chinese American women to consider breast cancer screening, including encouraging culturally competent communication from the physician, and showing testimonials from breast cancer survivors. They also found success using an 18-minute video that took the form of a soap opera.
“Results show that increasing knowledge through education was able to change fatalistic views of cancer and help women incorporate regular screening into part of their self-care practice,” Wang says.
Increasing Asian participation in clinical trials is important, not just to expand treatment options for individual patients, but also to help identify more effective treatments for this population as a whole, the researchers say.
For example, Asian lung cancer patients are much more likely to have a genetic mutation in a receptor known as EGFR, the knowledge of which predicts good response to anti-EGFR therapy. Including patients of Asian descent into clinical trials provides valuable information as whether certain anticancer therapies will be more or less effective in patients with different ethnic backgrounds.
“Providing educational materials on these types of examples may encourage Asian patients to get involved in clinical trials,” He says.
By Renee Twombly