It has recently been reported that an alarming three million women across England have not had a smear test for at least three and a half years. More concerning is the news that screening rates are now at their lowest levels for two decades.
There are many reasons for reduced screening rates including embarrassment and lack of awareness but one contributing factor seems to be language barriers.
Dr Laura Marlow from University College London conducted research into cervical cancer screenings and looked at the barriers faced by ethnic minority women.
Dr Marlow found that ethnic minority women felt that there was a lack of awareness about cervical cancer in their community, and several did not recognise the terms ‘cervical screening’ or ‘smear test’. Misconceptions regarding cervical cancer risks were influenced by beliefs around sex outside of marriage and some women felt a diagnosis of cervical cancer might be considered shameful in their community. Some also reported that they would be reluctant to attend their GP surgery for a smear out of embarrassment where there was a possibility they would bump into someone from their community there.
What can be done?
GPs and GP surgeries need to be better equipped to deal with language barriers so women can understand more fully the importance of cervical cancer screening.
When resources are already sparse and consultation times extremely limited, there is no single solution. However, the smallest changes could make a big difference in counteracting these concerning figures.
For example, GPs should consider advising patients to think about bringing a friend or a family member with them to a consultation if their understanding is better and this doesn’t cause embarrassment. In addition, where it is known that there may be a potential language barrier, the GP should consider sending a translated copy of their advice letter. Whilst this would inevitably come at additional cost, it would make consultations and the continuation of that patient’s care much more efficient. Crucially, both patient and GP can then be assured that important details have been fully understood.
Low cost possibilities include providing Cervical Cancer Screening information pamphlets available in a variety of languages and/or holding awareness evenings for community or faith groups or drop in clinics and help lines.
Jo’s Cervical Cancer Trust have produced a film available free of charge to help Black, Asian and Minority Ethnic Women understand the importance of cervical screening and is available in Arabic, Hindi, Urdu, Bengali, Chinese (Mandarin), Tamil and Polish. If nothing else, women from these backgrounds should be made aware of this invaluable resource.
Language barriers between patients and GPs can negatively impact on a patient’s health and result in avoidable injuries which might leave doctors open to potential medical negligence claims.
If a patient is unable to understand the medical advice given, the message of the seriousness of a condition and the treatment involved could be lost in translation meaning the patient either agrees to something they don’t understand or places less importance on it - meaning they don’t seek the treatment needed.
Also, if a patient signs a medical consent form that they don’t truly comprehend and not enough has been done to ensure their full understanding of a proposed procedure, then a potential argument arises that patient has not given their informed consent to any risks or consequences that could arise. Likewise it is very difficult for a doctor to take a full history of the patient’s symptoms in order to give an accurate and safe diagnosis if the patient is finding it difficult to communicate.
Hannah Travis is a senior solicitor in the Complex Injury team at Bolt Burdon Kemp