Readiness to treat Latino patients in cancer care: A qualitative study of medical and nursing students

The southeastern United States has recently experienced an unprecedented influx of Latino immigrants. Well-documented disparities in cancer diagnosis and death rates exist between Latinos and other ethnic groups. Late diagnosis, underutilization of screening techniques, delayed treatment and decreased follow-ups could contribute to these disparities. Disparities may be related to discrimination and stereotyping of Latino patients as well as lack of cultural knowledge regarding Latino patients. Examining medical and nursing students' current attitudes, perceptions and beliefs toward Latino patients in cancer care settings will assist medical and nursing education programs training future health service providers. To develop an instrument to assess attitudes and perceptions, focus groups were conducted with 28 students from 7 different medical and nursing programs in South Carolina and Georgia. Students provided important feedback on a survey of nursing and medical students' readiness to treat Latino patients. Participants reviewed survey items and response options, related to their experiences, beliefs, and attitudes regarding Latino patients. Investigators independently completed the open coding process. Data were transcribed, coded, and analyzed using the program NVIVO. Through a process of constant comparison, emerging themes were identified. These themes were compared to the conceptual model for construct validity and classified into categories related to item and response option improvement. In the final step, survey administration protocols and the survey were revised based on findings from the focus groups to more accurately reflect constructs and to improve the validity of the instrument. Based on focus group data, the questionnaire was narrowed and refined and pre-tested with medical and nursing students. Data collected included social and demographic characteristics (including gender and ethnicity of providers), attitudes toward Latinos, knowledge of the Latino population in South Carolina/Georgia, knowledge of cancer risk of Latinos, cultural and ethnic knowledge, experience with Latinos, comfort with Latino patients, Spanish language proficiency and training experiences with Latinos, as well as confidence and cultural competency measures. Relatively low levels of knowledge regarding Latinos and low levels of cultural competence in cancer care settings emerged as common themes. These findings will be used to update the survey instrument that will be administered to a larger sample of 946 medical and nursing students via electronic format. Results will be provided to respective training programs, with the ultimate goal of identifying educational gaps in cultural competency training in medical education and designing interventions to address those gaps and improve cancer disparities outcomes.