How Northwestern Medicine Is Bringing Culturally Sensitive Care to the Community
Personalized patient care means not only customized medical treatments, but also a care team that recognizes how cultural differences affect patients. The relationship between physician and patient forms the foundation of the patient’s experience, and the more complex the treatment, the more vital the relationship. Many things can contribute to a good relationship, but communication and understanding both top the list, particularly when it comes to values, beliefs and traditions.
More and more, care teams are being trained to treat patients of diverse cultural backgrounds and healthcare providers are developing what are called culturally sensitive programs, which treat patients with specific attention to their cultural preferences. And the impact extends beyond comfort: The Centers for Disease Control consistently reports health disparities across demographics; education and awareness of the causes and concerns can improve diagnosis and treatment.
Non-white populations are often disadvantaged by lower quality of care, more difficult access to care and worse outcomes. Provider biases, poor provider-patient communication and health literacy also disproportionately affect minorities.
The Hispanic Transplant Program
The Hispanic population is one of the fastest growing in the United States and is expected to represent one in three Americans by 2050. However, they also face higher risks of diabetes, hypertension and heart disease, which can result in an increased risk of organ failure. Nineteen percent of waiting list candidates are Hispanic. Furthermore, 75 percent of Hispanic people would prefer to receive treatment in Spanish. And for many providers, the best they can offer is an interpreter.
Juan Carlos Caicedo, MD, a transplant surgeon at Northwestern Memorial Hospital, wanted to do more. Starting in 2006, anyone who arrived at the hospital with kidney or liver problems and preferred to be treated in Spanish was directed to Dr. Caicedo, the director of the first-of-its-kind Hispanic Transplant Program.
“I realized there was a big Hispanic community that was not receiving the attention it needed,” says Dr. Caicedo, who is also an associate professor of surgery at Northwestern University Feinberg School of Medicine. “For the thousands of Hispanics on the organ transplant waiting list, the language and cultural barriers to staying alive appeared insurmountable.”
The Hispanic Transplant Program is dedicated to making Spanish-speaking patients and their families feel more comfortable during the transplant process. Dr. Caicedo describes the team as both bilingual and bicultural, meaning they can not only communicate with their patients, but also understand and relate to them on a cultural level as well.
One way this manifests itself is through the educational group sessions the program utilizes to explain treatment options to the patient and their family, honoring the preference of many Hispanic patients to include family members, particularly elders, in their care decisions.
And for many patients, such attention to culture makes a big difference. Receiving care from someone who represents and can relate to you encourages connection and commitment on a different level.
Navigators Impacting Follow-Up Care
Culturally sensitive care extends outside the hospital, too. Patient navigators, who help make appointments, provide interpreter services, suggest local services and offer emotional support, also have a real impact on the health outcomes of at-risk communities.
A Northwestern Medicine study, led by Melissa Simon, MD, the George H. Gardner, MD, Professor of Clinical Gynecology at Northwestern University Feinberg School of Medicine, looked at the effect community navigators had on follow-up care after an abnormal breast or cervical cancer screening result for uninsured Spanish-speaking women in DuPage County. They reported significantly lower income, lower health literacy, less confidence self-managing health and more distrust of the healthcare system. Though these barriers put them at a higher risk for stalled follow-up care, patients in the navigation study did not have longer follow-up times than their English-speaking counterparts.
The DuPage County research was part of an ongoing series of studies focusing on patient navigation and barriers to care across a variety of populations in the Chicagoland area, including Chinatown and South Side neighborhoods, led by Dr. Simon.
“Women come here from other countries, sometimes as refugees with no family or resources, and they need treatment,” says Nadia Hajjar, a patient navigator and project coordinator. “As a navigator, you become their everything. I’m so proud to be part of this team and I hope we can do more projects – not just for cancer, but for diabetes, heart disease and all the other issues people are facing.”
Reducing inequality in care and outcomes is a major goal of public health. Programs that support culturally sensitive care and navigator outreach are just some of the ways that the healthcare community can work to improve the health and wellbeing of disadvantaged groups. In addition, the CDC releases recommendations, most recently in February 2016, for specific condition- or group-related strategies.