Communicating without a Shared Language: A Qualitative Study of Language Barriers in Language-Discordant Cancer Communication

Journal of health communication, 29(3), 187–199.- 2024

We use language to achieve understanding, and language barriers can have major health consequences for patients with serious illness. While ethnic minorities are more likely to experience social inequalities in health and health care, communicative processes in language-discordant cancer care remain unexplored. This study aimed to investigate communication between patients with cancer and limited Danish proficiency and oncology clinicians, with special emphasis on how linguistic barriers influenced patient involvement and decision-making. 18 participant observations of clinical encounters were conducted. Field notes and transcriptions of audio recordings were analyzed, and three themes were identified: Miscommunication and uncertainty as a basic linguistic condition; Impact of time on patient involvement; Unequally divided roles and (mis)communication responsibilities. The results showed that professional interpreting could not eradicate miscommunication but was crucial for achieving understanding. Organizational factors related to time and professional interpreting limited patient involvement. Without professional interpreting, patients’ relatives were assigned massive communication responsibilities. When no Danish-speaking relatives partook, clinicians’ ethical dilemmas further increased as did patient safety risks. Language barriers have consequences for everyone who engages in health communication, and the generated knowledge about how linguistic inequality manifests itself in clinical practice can be used to reduce social inequalities in health and health care.

Read the article – Communicating without a Shared Language: A Qualitative Study of Language Barriers in Language-Discordant Cancer Communication

The Lancet Commission on prostate cancer: planning for the surge in cases

Key messages

• •We project that the number of new cases of prostate cancer annually will rise from 1·4 million in 2020 to 2·9 million by 2040. Changing age structures and improving life expectancy are predicted to drive big increases in the disease.
• •The projected rise in prostate cancer cases cannot be prevented by lifestyle changes or public health interventions.
• •Late diagnosis of prostate cancer is widespread worldwide but especially in LMICs, where late diagnosis is the norm. The only way to mitigate the harm caused by rising case numbers is to urgently set up systems for earlier diagnosis in LMICs. Trials of screening are urgently needed in LMICs to better inform ways to improve early diagnosis.
• •Early diagnosis systems will need to incorporate novel mixes of personnel and integrate the growing power of artificial intelligence to aid interpretation of scans and biopsy samples.
• •As the rise in prostate cancer is likely to be mirrored by rises in other conditions such as diabetes and heart disease, early diagnosis programmes should focus not just on prostate cancer but on men’s health more broadly.
• •Outreach programmes are needed that harness the broad global availability of smartphones as tools for education about prostate cancer (using both social media and traditional media), as are programmes that assist people with navigation of health-care systems.
• •Most prostate cancer research has disproportionally focused on men of European origin, despite rates of prostate cancer being twice as high in men of African heritage. Better understanding of drivers of ethnic differences in prevalence of the disease is a key research priority.
• •Treatment of advanced prostate cancer remains a problem, and affordable therapies are available but are unevenly distributed. Consistent use of these therapies is a cost-effective way to reduce harm from prostate cancer.
• •There remains a shortage of specialist surgeons and radiotherapy equipment in LMICs, and addressing this shortage is key to improving prostate cancer care globally.

Further information – The Lancet Commission on prostate cancer: planning for the surge in cases

Guidelines for the prevention, diagnosis, care and treatment for people with chronic hepatitis B infection – WHO

WHO – 29th March 2024

Hepatitis B (HBV) infection is a major public health problem and cause of chronic liver disease. 

The 2024 HBV guidelines provide updated evidence-informed recommendations on key priority topics. These include expanded and simplified treatment criteria for adults but now also for adolescents; expanded eligibility for antiviral prophylaxis for pregnant women to prevent mother-to-child transmission of HBV; improving HBV diagnostics through use of point-of-care HBV DNA viral load and reflex approaches to HBV DNA testing; who to test and how to test for HDV infection; and approaches to promote delivery of high-quality HBV services, including strategies to promote adherence to long-term antiviral therapy and retention in care.

The 2024 guidelines include 11 updated chapters with new recommendations and also update existing chapters without new recommendations, such as those on treatment monitoring and surveillance for liver cancer.

Guidelines for the prevention, diagnosis, care and treatment for people with chronic hepatitis B infection

Implementing a timed HPB cancer diagnostic pathway

NHS England – 25th March 2024

Best practice timed pathways support the ongoing improvement effort to shorten diagnosis pathways, reduce variation, improve experience of care, and meet the Faster Diagnosis Standard (FDS).

The 28-day Faster Diagnosis Standard remains the single standard by which the speed of diagnosis of cancer will be measured under Cancer Waiting Times. However, some types of cancer are particularly aggressive, and particular effort should be made to diagnose them even faster than the headline target. Many hepato-pancreatic biliary (HPB) cancers fall into this category, and the pathways in this document, which set out the sequence of events that would be required to complete the diagnostic process wherever possible within 21 days are reflective of that.

This HPB pathway is part of a series, which includes the oesophago-gastric pathway and completes the pathways that cover upper gastrointestinal cancers, published since April 2018.

Implementing a timed HPB cancer diagnostic pathway

Implementing a timed HPB cancer diagnostic pathway – audit tool

Bowel Cancer Screening: Annual Report 2021 to 2022

Office for Health Improvement and Disparities (OHID); 2024.

Data report for the Bowel Screening Programme (BCSP) screening which focuses on programme performance in England during the screening year 2021 to 2022 (1 April 2021 to 31 March 2022) compared to the national bowel cancer screening programme standards. It also includes trend data from previous years where this is available

Bowel Cancer Screening: Annual Report 2021 to 2022.

MRI screening for prostate cancer shows promise.

National Institute for Health and Care Research (NIHR); 2024.

In the UK, more than 52,000 men are diagnosed with prostate cancer each year. A screening programme would need to detect serious cancers, while not picking up slow-growing, low-risk prostate cancers. The existing PSA blood test alone is not accurate enough. MRI and ultrasound tests can also detect prostate cancer and could give more reliable results. This study compared the benefits and risks of MRI, ultrasound and blood tests for prostate cancer screening

Further information – MRI screening for prostate cancer shows promise.

Background information – Eldred-Evans D, and others. Population-Based Prostate Cancer Screening With Magnetic Resonance Imaging or Ultrasonography. JAMA Oncology 2021; 7: 395 – 402.

Reimagining rehabilitation for adults with brain tumours: a roadmap

Tessa Jowell Brain Cancer Mission – 2024

Developed in collaboration with health communications agency Costello Medical, this report sets out a roadmap of actionable and impactful recommendations that aim to improve rehabilitation for adults with brain tumours. Key recommendations were to: build the evidence base that quantifies patient need for rehabilitation by providing funding/infrastructure for allied health professional-led research; develop clinical consensus recommendations on rehabilitation to inform guidelines for adults with brain tumours; and raise awareness of the benefits of rehabilitation for adults with brain tumours among all stakeholder groups.

Reimagining rehabilitation for adults with brain tumours: a roadmap

25 year trends in cancer incidence and mortality among adults aged 35-69 years in the UK, 1993-2018: retrospective secondary analysis

BMJ 2024;384:e076962

Cancer mortality had a substantial reduction during the past 25 years in both men and women aged 35-69 years. This decline is likely a reflection of the successes in cancer prevention (eg, smoking prevention policies and cessation programmes), earlier detection (eg, screening programmes) and improved diagnostic tests, and more effective treatment. By contrast, increased prevalence of non-smoking risk factors are the likely cause of the observed increased incidence for a small number of specific cancers. This analysis also provides a benchmark for the following decade, which will include the impact of covid-19 on cancer incidence and outcomes.

Read the article – 25 year trends in cancer incidence and mortality among adults aged 35-69 years in the UK, 1993-2018: retrospective secondary analysis

Breast cancer now added to summary guide supporting the NHS 28-day cancer diagnosis standard – GIRFT

GIRFT – 8th March 2024

A new section on breast cancer has been added to GIRFT’s summary guidance supporting NHS clinicians to better meet the Faster Diagnosis Standard (FDS) for cancer.

In 2023, Getting It Right First Time (GIRFT) and NHS England’s Cancer Programme worked in partnership to produce concise guidance for Best practice timed diagnostic cancer pathways, outlining how cancer alliances and local organisations can implement NHSE’s best practice timed diagnostic pathways for cancer. The summary guidance includes advice for all stages of a cancer diagnosis, from early identification of patients to onward referral, as well as useful insights from the relevant GIRFT national clinical leads and links to best practice case studies.

The first iteration included colorectal cancer, prostate cancer and skin cancer. Guidance for breast cancer has now been added following the publication of NHSE Cancer Programme’s breast pathway.

Further information – Best Practice Timed Diagnostic Cancer pathways

Referrals into the very high risk breast screening programme

NHS England – 5th March 2024

Letter from Steve Russell, Dr Amanda Doyle OBE and Professor Stephen Powis. NHS England recently advised breast screening services about the delayed referrals of some women who are eligible to be screened within the very high risk (VHR) NHS Breast Screening Programme. This letter contains further information and sets out some important next steps on this.

Action required: Referrals into the very high risk breast screening programme

Very high risk breast screening for some women following chest radiotherapy for Hodgkin lymphoma