Identifying Barriers to Care for Hispanic Patients with Thyroid Cancer

Study finds that language is not a major barrier to access to thyroid cancer care for Hispanic patients at a large urban hospital with ample interpretation services and a robust community network.

Incidence across all tumor sizes of differentiated thyroid cancer has more than tripled in the US over the last decade. Moreover, a previous study found that patients in Bellevue Hospital Center—New York City's flagship public hospital, where 98% of patients are uninsured or enrolled in government insurance plans—presented with significantly more advanced stage of differentiated thyroid cancer than those at the private, adjacent university hospital NYU Langone Medical Center, in New York, NY.

Based on that information, focus groups and key informant interviews conducted in Spanish by Alexandra H. León-Guerrero and colleagues from the Department of Surgery at NYU Langone Medical Center examined access to care and knowledge of diagnosis and treatment among adult primarily Spanish-speaking patients receiving treatment for differentiated thyroid carcinoma at Bellevue Hospital Center. The team of researchers concluded that patient education and a culturally sensitive approach are important to optimize care in this demographic, emphasizing the importance of targeted education and a culturally-focused approach towards care.

The results of these focus groups were presented at the 83rd Annual Meeting of the American Thyroid Association, in San Juan, Puerto Rico, on October 18, 2013.

According to Navim D. Bhatia, a member of the research team, between 2007 and 2012, Hispanic patients were the second largest ethnic population (37%) with differentiated thyroid cancer at Bellevue Hospital Center (the first group was Asians at 49%). The research team aimed to evaluate Hispanic patients’ with differentiated thyroid cancer understanding of disease mechanism and available health care resources, and to identify potential barriers to care. As a secondary objective, the team would apply those results toward increasing patient knowledge and removing barriers to enhance care and to identify patients at an earlier stage of disease.

Sixteen out of 50 eligible patients participated in the study. While all expressed a preference for Spanish when discussing medical care, no patient found language to be a barrier and all reported unimpeded access to primary care, although communication depended on ready availability of interpreting services and community networks serving as an important information source of public health services.

The majority of patients (62.5%) reported limited to no knowledge of thyroid cancer prior to diagnosis. However, the interviews reflected that Hispanics promote a culture of openness among community members toward discussing health care issues. Differentiated thyroid cancer was most commonly diagnosed in this patient population following presentation with a self-reported nodule or symptoms associated with hypo/hyperthyroidism, which prompted further work-up. A small minority of patients was diagnosed initially on imaging. Thirty-seven percent of participants expressed a belief in the value of alternative medicine as a complementary modality, but it did not contribute to delays in diagnosis.