1 in 3 Cancer Care Errors for Migrant Patients
More than 7 million people in Australia were born overseas. Some 5.8 million people report speaking a language other than English at home.
But how well are we looking after culturally and linguistically diverse (CALD) Australians?
In countries around the world, evidence suggests people from CALD backgrounds are at increased risk of harm as a result of the health care they receive when compared to the general population. Common problems include a higher risk of contracting a hospital-acquired infection or medication errors.
People receiving cancer care are at particularly high risk of harm associated with their health care.
In a recent study , we found CALD cancer patients in Australia had roughly a one-in-three risk of something going wrong during their cancer care. This is unacceptably high.
We worked with four cancer services (two in New South Wales and two in Victoria) that provide care to high proportions of people from CALD backgrounds. These four cancer services offer a combination of care to patients in hospitals, clinics and in their homes.
We analysed de-identified medical records of people from CALD backgrounds who received care at any of the four cancer services during 2018. To identify CALD patients, we used information from their medical records including “country of birth”, “preferred language”, “language spoken at home” and “interpreter required”.
We reviewed a total of 628 medical records of CALD cancer patients. We found roughly one in three medical records (212 out of 628) had at least one patient safety event recorded. We defined a patient safety event as any event that could have or did result in harm to the patient as a result of the health care they receive. We also found 44 patient records had three or more safety events recorded over a 12-month period.
Medication-related safety events were common, such as the wrong medication type or dose being given to a patient. Sometimes the patients themselves took the wrong type or dose of a medication or stopped medication all together. We also observed a variety of other patient safety events such as falls, pressure ulcers and infections after surgery.
The number of incidents could even be higher than what we observed. We know from other research that not all patient safety events are documented.
We didn’t have a control group, which is the main limitation of our study. In other words, we didn’t examine medical records of patients from non-CALD backgrounds to compare how common patient safety events were between groups.
But looking at other data suggests the rate of incidents is much higher in CALD patients.
Studies over many years indicate around one in ten patients admitted to hospital experience a safety event.
One study from Norway found cancer patients have a 39% greater risk of experiencing adverse events in hospital when compared to other patients (24.2% compared to 17.4%).
We identified miscommunication as a key factor that put cancer patients from CALD backgrounds at risk.
For example, we observed from one patient’s notes that the patient didn’t take their medication because they were confused by the instructions given by different clinicians. This confusion might have stemmed from language barriers or health literacy issues.
In some medical records, we also saw interpreter requirements were unmet. For example, at the time of admission, assessment for language needs noted an interpreter was not required. However, later notes mentioned the patient had poor English or needed an interpreter.
Also, with the limited availability of interpreters, they’re often reserved for specialist appointments, and not used for “routine” tasks , such as during chemotherapy treatment. This may result in side effects from cancer medications not being properly identified and responded to, potentially leading to patient harm.
To make care safer, patients, their families and the clinicians who care for them should come together so that any solutions developed are practical, relevant, and informed by their combined experiences.
As an example, we developed a tool with consumers from CALD backgrounds and their clinicians that seeks to ensure that when patient medications are changed, there is common understanding between the clinician and the patient of their medication and care instructions. This includes recognising the side effects of the medications and who to contact if they have concerns.
This tool uses images and simple language to support common understanding of medication and care instructions. It takes into account specific cultural expectations and is available in different languages. It’s currently being evaluated in two cancer clinics.
To make cancer care safer for patients from CALD backgrounds, health systems and services will need to support and invest in strategies that are specifically targeted towards people from these backgrounds. This will ensure more equitable health solutions that improve the health of all Australians.
Ashfaq Chauhan’s PhD was funded by Macquarie University Research Excellence Scholarship and Australian Government Research Training Program Scholarship. He receives funding from Medical Research Future Fund.
Melvin Chin has received funding from South Eastern Sydney Local Health District, Cancer Institute NSW, Cancer Australia, National Health and Medical Research Council, AstraZeneca, and Avant Foundation.
Reema Harrison receives funding from Cancer Institute NSW, Medical Research Futures Fund, NHMRC and ARC.
Meron Pitcher does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.