Cultural Competence Can Improve Patient-Reported Outcomes

Digestive Disease Week (DDW) 2019

Miquell Miller, MD


May 31, 2019

Our primary concern during a patient encounter is to address the condition or disease at hand. We have a lot to cover—understanding the patient's symptoms, determining a diagnosis, and discussing the treatment plan. However, a one-size-fits-all approach to patient care can leave many questions unanswered.

It is known that disparities exist in healthcare; minorities, for instance, have worse outcomes for colorectal cancer and heart disease. While efforts, including workplace diversity, have been made to reduce such disparities, the problems have not yet been eradicated.

Miquell Miller, MD

Cultural competence—the ability to understand social backgrounds and how they influence a person's care—is one measure that has been studied and shown to improve communication with patients. Clinicians who display cultural competence make sure to ask important questions during patient interactions in order to identify cultural and social implications that may affect care. We've all seen examples in our practices of how a lack of cultural competence can have an impact on care. A patient who had surgery is subsequently not adhering to the diet plan advised by the surgeon. The patient is losing weight and failing to thrive. The surgeon was not aware that the patient practiced Hinduism and didn't eat meat, so the patient was not getting sufficient protein. If enough questions had been asked and this cultural difference was recognized earlier, a personalized diet plan could have been prescribed with more plant-based nutrition.

Our team conducted an initial study, recently presented at Digestive Disease Week, to see whether improving cultural competence of surgeons and advanced practice providers could be one strategy to reduce disparities in colorectal cancer outcomes. We compared their cultural competence test scores with their Press Ganey patient satisfaction scores. (Press Ganey is a leading provider of patient experience measurement that partners with more than half of US hospitals to help improve clinical and business outcomes.)

This study looked at 36 clinicians, including surgeons, oncologists, gastroenterologists, and advanced practice providers, from a tertiary cancer center. They each completed a validated online survey that measured cultural competency, with a specific emphasis on cultural competency behaviors. Patient-reported outcomes were available for 29 of the 36 clinicians, and their scores were matched with publicly available Press Ganey provider care scores from 1322 patients from 2017 and 2018.

We found that while most had high levels of cultural awareness, there was a difference among them in terms of culturally competent behaviors. Among those who scored high on culturally competent behaviors, patients were more likely to report higher satisfaction in their overall care. Specifically, patients were more likely to say that these clinicians showed concern for their questions and worries and talked to them using words they understood. These results highlight that having good cultural "awareness" may not be enough. Certain behaviors are needed to alleviate cultural barriers for patients. Some of the behaviors noted in the assessment included having resource books and materials to learn about the culture of the families being cared for, doing a cultural assessment of families during clinical encounters, and recognizing barriers to service for different cultures.

We need to incorporate culturally competent behaviors during every patient interaction to help eliminate disparities in care. Cultural competency training should not only address the idea of cultural competence awareness but also provide the skills needed to care for people of all backgrounds.

Follow Medscape on Facebook, Twitter, Instagram, and YouTube