Perceptions of patient-provider communication by language concordance status: A qualitative study of spanish-speaking women receiving breast and cervical cancer-related care in safety net clinics

Underutilization of breast and cervical cancer screening among low-income ethnic minority women has been tied to language barriers, which present further challenges to follow-up care and treatment. Language concordance and quality interpretation have been shown to enhance patient-provider communication among patients with limited English proficiency. To explore patient perceptions of patient-provider communication among Spanish-speakers receiving breast or cervical cancer-related care at safety net clinics, we qualitatively examined communication barriers and facilitators according to patient-provider language concordance status. Participants were interviewed after receiving an abnormal breast or cervical cancer screening test or cancer diagnosis. Interviews were coded and analyzed by language concordance status. Of 37 participants, 27% (n = 10) were Spanish-concordant; 38% (n = 14) were Spanish-discordant, requiring an interpreter; and 35% (n = 13) were Spanish mixed-concordant, experiencing both types of communication throughout the care continuum. Appreciation for language support resources was a common theme among all groups. Spanish-concordant and Spanish-discordant participants perceived patient-provider communication positively, emphasizing facilitators. Mixed-concordant participants' perceptions depended on whether communication was language-concordant or –discordant; barriers were reported only in the context of language-discordant communication. Mixed concordant participants reported the majority of communication barriers among all participants and strongly preferred Spanish-speaking providers. Efforts should be directed toward exploring the prevalence of mixed language concordance and its impact on real and perceived patient-provider communication. Our findings posit that providing consistent language concordance or interpretation, respectively, may be associated with improved health communication experiences in breast and cervical cancer-related care for low-income Spanish-speaking women.