Page 27 - ASCO Cultural Competency Toolkit

Language Access
Language Barriers, Interpreter Use, Civil Rights Act Barriers
Linguistic competence specifically refers to the “capacity of an organization and its personnel to communicate effectively and convey information in a manner that is easily understood by diverse audiences including persons of Limited English Proficiency (LEP), those who have low literacy skills or are illiterate, and individuals with disabilities.” (Goode and Jones, 2009 ) Language barriers can pose significant challenges when providing patient care. It can hinder patient communication, decrease quality of care, reduce patient and clinician satisfaction, and make it more difficult to maintain patient safety (Shamsi et al, 2020. In fact, language barriers can be one of the biggest obstacles to providing adequate care to those with LEP ( Ali, 2018). Language barriers may also be associated with safety risks (Van Rosse, 2016; Surmond, 2010), increased adverse events (Divi et al, 2007), and reduced treatment compliance. These additional challenges can be especially burdensome on marginalized communities. Language-discordant interactions (people communicating using their second language to healthcare clinicians who are using their first language) between patients and healthcare clinicians can cause additional anxiety and emotional stress during the healthcare exchange (Yue Zhao, 2021). Methods to mitigate language barriers include providing certified interpreter services, employing multilingual staff, and providing linguistically and culturally appropriate written information.
The Civil Rights Act
The Civil Rights Act of 1964 prohibits discrimination based on race, color, religion, sex, or national origin. It was later amended to include gender identity and sexual orientation. Title VI of the Civil Rights Act prohibits any entity or program that receives federal funding from discriminating based on race, color, or national origin. Hence, any entities that receive Federal financial assistance, including Medicare and Medicaid, must take reasonable steps to ensure their services are accessible by persons with Limited English Proficiency (Rosenbaum, 2004). In other words, in federally funded programs, patients who do not speak English are entitled to the same treatment as those who speak English. This is directly applicable to the clinical enterprises of optometry schools and colleges and most optometric practices. The legal requirements of language rights in healthcare can be difficult to navigate. In 2000, Executive Order (EO) 13166, Improving Access to Services for Persons with Limited English Proficiency, was issued reiterating the requirement to provide equal access to LEP persons. Policy guidance was issued by the Department of Health and Human Services’ Office of Civil Rights that was revised and reissued in 2003. Healthcare clinicians that accept federal funds are obligated to provide language access services for their patients (Chen et al, 2007). The extent of an institution's obligation to provide LEP services are based on four factors: “(1) The number or proportion of LEP persons eligible to be served or likely to be encountered by the program or grantee; (2) the frequency with which LEP individuals come in contact with the program; (3) the nature and importance of the program, activity, or service provided by the program to people's lives; and (4) the resources available to the grantee/recipient and costs.” (HHS, 2013) Beyond the legal requirements, it is important to provide medical services in a manner that meets the needs of the patients we serve.
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