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Stomach Cancer Screening | How Asian and Latinx Patients Can Self-Advocate

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Stomach Cancer Screening | How Asian and Latinx Patients Can Self-Advocate from Patient Empowerment Network on Vimeo.

How can Asian and Latinx patients self-advocate for gastric cancer screening? Expert Dr. Joo Ha Hwang from Stanford Medicine shares advice for how patients can discuss gastric cancer screening with their provider and how providers should be engaging with patients for better care.

[ACT]IVATION TIP

“…especially if you come from Korea, Japan, where they actually have instituted national screening, with endoscopy, we actually have U.S. guidelines that state that if you come from a country whose guidelines state you should have endoscopy, then you should also have endoscopy, we should be following your home of origins guidelines for you and so, those patients should also have endoscopy.”

See More from [ACT]IVATED Gastric Cancer

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Transcript:

Lisa Hatfield:

So in the United States, we do have many people from the Asian and Hispanic communities who may be at higher risk for gastric cancer, do you suggest that they talk to their provider about getting screened? And how might they phrase that question? Can I get screened for the H. pylorI? So if you had a patient who wanted to be screened or is interested in getting screened, how might they approach their provider in asking for the screening for gastric cancer or H. pylori?

Dr. Joo Ha Hwang:

I think the first step is to get tested for H. pylori, and pretty much, everyone who is, an immigrant to the U.S. is at much higher risk for having H. pylori, in the past, we used to say that the people from Asia, immigrants from Asia had an 80 percent risk of having H. pylori, from Mexico, it was more like around 60 percent, United States, it was in the 20 to 30 percent, it’s probably less than that now.

So worldwide, prevalence of H. pylori is certainly going down but again, providers should know this is something that is taught in medical school, is areas that are, endemic with H. pylori and providers should also know that, H. pylori is a carcinogen, and so if a patient just comes up in and says I’m worried about having H. pylori, I come from a high-risk population, it really shouldn’t be difficult to get tested for H. pylori, furthermore, if they have any symptoms, especially any epigastric pain what we call dyspepsia that should also trigger the provider to go ahead and test for H. pylori, because that’s part of the algorithm. So I think that all of these, it shouldn’t be difficult to engage a provider on that particular issue.

Lisa Hatfield:

So it is okay and appropriate for a patient to approach their provider and ask that question? So I appreciate that.

Dr. Joo Ha Hwang:

I think it’s important and I think that patients need to be their own advocates, because I have heard of instances where providers have been reluctant and in certain systems they’re discouraged from further testing, because it’s a capitated system. I think H. pylori testing is not that difficult, sometimes if patients want endoscopy, it can be, more challenging but again, especially if you come from Korea, Japan, where they actually have instituted national screening, with endoscopy, we actually have U.S. guidelines that state that if you come from a country whose guidelines state you should have endoscopy, then you should also have endoscopy, we should be following your home of origins guidelines for you and so, those patients should also have endoscopy.

But the challenge with that is that they’re going to end up paying for it, because it’s not typically covered by insurance or it’s not fully covered by insurance so you’d probably have to pay a copay, for something like that at this time.

Lisa Hatfield:

I have a friend who’s dealing with her father who lives in Korea, she’s from Korea, has been here about two, five years. He has stomach cancer. So we’ve been having this discussion, and that’s why I thought I’d ask that last question. She said she sometimes is afraid to approach her provider…

Dr. Joo Ha Hwang:

If you’re afraid to approach your provider, you need a different provider.

Lisa Hatfield:

Well, that’s a good suggestion too.

Dr. Joo Ha Hwang:

No, no. We’re supposed to work with you and listen to you and again, I go around and give a lot of talks to patient groups, and I like engaging in these types of activities, because I think the more information patients have, the more that they can talk with their physicians, and oftentimes patients know more than their physicians do, because they’ve done a lot more research. And hopefully you have a physician with some hubris who will listen to the patient and if they don’t know, they’ll kind of look things up, so yeah.

Lisa Hatfield:

Yeah. I appreciate that, thank you.

Dr. Joo Ha Hwang:

My pleasure.

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What Multi-Language Technology Innovations Are Available for Cancer Patients and Families?

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What Multi-Language Technology Innovations Are Available for Cancer Patients and Families? from Patient Empowerment Network on Vimeo.

What are available innovations for chronic lymphocytic leukemia (CLL) patients who speak languages besides English? Dr. Kathy Kim and Dr. Farrukh Awan share their perspectives on interpreter services and multi-language technology innovations for patients who need Spanish, Vietnamese, Korean, Chinese, and other languages for improving their CLL knowledge and care.

See More from Best CLL Care No Matter Where You Live

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Transcript:

Dr. Awan:

Another issue that we have seen is that some of our patients and we live in a town that has a substantial percentage of Hispanic-speaking or Spanish-speaking people, so we actually have access to a lot of resources and a lot of options for those patients, but there might be some limitations in people who don’t necessarily speak English as the first language, so what kind of tools do we have for those people, what kind of resources can they access to? So, Dr. Kim, anything for those patients?

Dr. Kim:

Yes, and we have really made an effort in our own research to any of the resources that we provide, the mobile applications that we use are available in multiple languages, and I will say Spanish is the most common one that we are able to support. Of course, there are many, many languages spoken in the United States, beyond English and Spanish that we do, we are challenged when we try to find other resources or applications that can be in Chinese and Korean and in other languages. It’s really challenging. So, in our own work, we have developed applications, and this is in research, so these are not things that are necessarily available in practice. We have developed applications for example, for care coordination for patients undergoing chemotherapy or to support shared decision-making at the beginning of your cancer journey between a patient and their family and a clinician, and when we develop those applications, as I said, we, obviously, I don’t speak Spanish, I only speak English, so I’m limited as to what I can develop. I can develop it in English, but then we always try to co-design it with clinicians who speak that language and with patients, so we do a lot of co-design with patients so that when we create it we’re making sure that it seems appropriate when it’s produced in other languages, and then we always test it with people who are native speakers in that language as well, so that’s one.

So many of the educational resources, our website information, our mobile applications, there is no reason why we can’t have those available in multiple languages. I think it is more challenging when you’re trying to build a relationship with a provider, with your doctor or with your nurse, or nurse practitioner and the patient don’t speak the same language, and then we have to rely on interpreter services. And I will say that that has not quite made the leap that we’d hoped with telehealth, to integrate an interpreter into your telehealth visit is quite challenging, and I’ve heard of doctors and patients being on a televisit and then the doctor calls the interpreter on their cell phone and tries to put that speaker up to the speaker on the computer, and that it’s not the best experience for anybody. So, that is an area that we would really like to work on, how do you have interpreter services really integrated into telehealth so it’s smooth for everybody.

Dr. Awan:

And let me share my experience, just this week, actually, on Monday, I was in clinic and we frequently have patients who speak Spanish, and we have in-person Spanish interpreters that are readily available, so one of my patients was a Spanish speaker, so I had the interpreter in the room with me, so that interaction went really well, the patient’s daughter was also obviously able to interpret some of that, so it was a fairly easy conversation, we explained, we talked about treatment options and what the plan is, so that went really well, My next patient was a Vietnamese speaking patient, so we don’t have those in person, so my nurse got me this iPad, which was on a mount, it’s like a dolly that can go from room to room, and I

turned it on and I was expecting some issues and they basically had a screen for me saying what language do you want, and I said Vietnamese, and then literally 30 seconds I was connected to a Vietnamese speaking interpreter, and they were able to see me, see the patient and the patient was able to see them. So, it was almost like having an interpreter in the room.

I think it always helps to have an interpreter in the room, in the event that you have to explain certain medical terminology, so my experience with this one application that our hospital subscribes to was very, very good.

I also found out that actually there are certain apps that if I want to print out a certain form or a certain patient education material and give it to the patient, okay, fine, this is the treatment you’re getting, these are the side effects, this is what to expect, there are options for translating it because they are already translated. You just hit the language you want, and that prints out the material in that language and you can give it to the patient to read, and I feel that that was a good resource to have. Similarly, being involved in multiple clinical trials, I feel that that is sometimes challenging option for a lot of patients, but I just wanna reassure everyone that all you have to do is ask. You can ask for a form in a specific language and it’s my responsibility, it’s my job to make sure that that translation is available to you so you can read it in your own language, and that is a service that is provided routinely by our cancer center, and I’m sure by a lot of other major academic centers and cancer centers in the country.