Barriers Beyond Words: Cancer, Culture, and Translation
in a Community of Russian Speakers
Daniel Dohan, PhD
and Marya Levintova, PhD
Institute for Health Policy Studies University of California San Francisco, UCSF Box 0936, San Francisco, CA 94143, USA;
Center, National Institutes of Health, Bethesda, MD, USA.
BACKGROUND: Language and culture relate in com-
plex ways. Addressing this complexity in the context of
language translation is a challenge when caring for
patients with limited English proficiency (LEP).
OBJECTIVE: To examine processes of care related to
language, culture and translation in an LEP population
is the objective of this study.
DESIGN: We used community based participatory re-
search to examine the experiences of Russian-speaking
cancer patients in San Francisco, California. A Russian
Cancer Information Taskforce (RCIT), including commu-
nity-based organizations, local government, and clinics,
participated in all phases of the study.
PARTICIPANTS: A purposeful sample of 74 individuals
were the participants of the study.
APPROACH: The RCIT shaped research themes and
facilitated access to participants. Methods were focus
groups, individual interviews, and participant observa-
tion. RCIT reviewed data and provided guidance in
RESULTS: Four themes emerged. (1) Local Russian-
language resources were seen as inadequate and
relatively unavailable compared to other non-English
languages; (2) a taboo about the word “cancer” led to
language “games” surrounding disclosure; (3) this
taboo, and other dynamics of care, reflected expecta-
tions that Russian speakers derived from experiences in
their countries of origin; (4) using interpreters as
cultural brokers or establishing support groups for
Russian speakers could help address barriers.
CONCLUSIONS: The language barriers experienced by
this LEP population reflect cultural and linguistic
issues. Providers should consider partnering with
trained interpreters to address the intertwining of
language and culture.
KEY WORDS: immigrant health; communication; cancer;
qualitative research; vulnerable populations.
J Gen Intern Med 22(Suppl 2):300–5
© Society of General Internal Medicine 2007
Reflecting the resumption of trans-national migration, the
number of U.S. States residents over the age of 5 who speak
a language other than English at home exceeded 45 million in
the 2000 census.
Addressing the health care needs of LEP
patients requires attention to both language and culture,
which connect in complex ways among diverse patient popula-
Research has documented that differences in lan-
guage and culture can cause breakdowns in provider–patient
communication; that communication may be aided by lan-
guage and cultural concordance between providers and
patients; and that when providers and patients do not share
a common language, well-trained providers and professional
interpretation services provide the best outcomes.
case studies have documented that poor outcomes can result
when the links between language and culture receive insuffi-
cient attention, but these linkages have not yet received
widespread attention in clinical literature.
for continued exploration include how language and culture
together shape the clinical encounter, how the interaction of
language and culture is affected by the presence of a trained
interpreter, and how health care delivery systems can best
meet the challenge of communicating across the linked land-
scapes of language and culture.
The goals of this study were to analyze in a holistic way how
language and culture combine to influence communication in
everyday clinical encounters and to develop strategies for
addressing this issue. To accomplish these goals, we used
qualitative research methods to collect data from a purposeful
sample of individuals (patients, physicians, nurses, inter-
preters, and others) involved in cancer care in a Russian-
speaking émigré community in San Francisco, California. We
focused on cancer care among Russian-speakers because prior
research has suggested that linguistic and cultural factors
combine to negatively impact processes of cancer care, in
general, and among Russian-speaking émigrés in San
Francisco, in particular.
In addition, because Russian-
speakers are generally identified as white, data from this
population may shed light on the dynamics of linguistic and
cultural barriers per se because barriers experienced by
Russian-speakers may not be highly conflated with those
stemming from racial minority status. We selected qualitative
research methods because these methods are appropriate for
documenting processes of care in a holistic way.
Background and Setting
Over 2 million people have immigrated to the United States
from the countries of the former Soviet Union (FSU, including
Russia) since 1954, with main resettlements in California, New