How to Increase Cultural Competence Among Oncology Surgeons? Diversity Training

Jan 19, 2016

By Shira Klapper, Senior Writer/Editor

A study in the Journal of Oncology Practice (JOP), measured the level of cultural competence among surgeons from six hospitals in the Puget Sound region of Washington State, home to a large population of American Indians and Alaska Natives. According to the study, culturally congruent care is characterized by an alignment between patients’ needs, preferences, and expectations on one side and clinicians’ knowledge, attitudes, and skills on the other. The study, “Assessing Cultural Competence Among Oncology Surgeons,” was published in the January 2016 issue of JOP.

To measure levels of cultural competence, the study sent out Cultural Competence Assessments (CCAs) to 495 surgeons from several specialties, including oncology. The CCA assesses several characteristics associated with cultural competence, including cultural awareness and sensitivity, culturally competent behaviors, and diversity experience. Respondents use a five-point Likert scale to rate how strongly they agree with statements such as: “I believe that everyone should be treated with respect no matter what their cultural heritage.”

Two hundred fifty-three surgeons (or 51% of all those contacted) completed the CCA. The data showed that 71% of surgeons encountered patients from six or more racial groups and that 58% completed cultural diversity training. The study also found that surgeons who received diversity training scored significantly higher on the CCA, compared to those who did not receive training; in fact, participating in diversity training was the variable most significantly associated with higher scores. To control for the possibility that surgeons filled out the survey with an eye towards filling out the “right” answers, all respondents filled out the Marlowe-Crowne Social Desirability Scale, which assesses whether respondents are responding truthfully or are answering a survey in a way they believe will reflect well upon them.

Cultural competence a factor in health disparities

Cultural congruence in oncology is important in light of data showing that racial and ethnic minorities die of cancer at a much higher rate than people in majority groups. According to some studies, one explanation for this health disparity is the fact that racial and ethnic minorities are more likely delay, and even decline, treatment—and that they do so because of a perception that health providers may not be culturally sensitive.

Scores exceeded expectations

According to the study’s first author, Ardith Z. Doorenbos, PhD, RN, FAAN, a Nursing Professor at the University of Washington, in Seattle, the researchers were “thrilled” with the results.

“No one had really measured cultural competence among surgeons before, so it really was an unknown going into this,” said Dr. Doorenbos. “The results were better than what we expected. We were excited that, one, we had a survey response rate of over 50% from providers at six different hospitals, and that two, we found out surgical providers do see a very diverse patient population, with 71% of our respondents encountering patients from six or more racial or ethnic groups.”

Dr. Doorenbos added that having strong skills in cultural competence is important all over the United States, and especially so in a city such as Seattle, which serves as a point of entry for many immigrants. The University of Washington’s associated hospitals alone have translators available for 45 different languages.

A compelling argument for diversity training

The researchers were also pleased with the finding showing that surgeons who undergo diversity training score higher in cultural competence than those who do not. Dr. Doorenbos said this finding might inspire hospital management to take a strong stand on cultural diversity training.

“This was a phenomenal finding for doctors, but also for hospital administrators who might look at this article and think, ‘an investment in cultural diversity training makes a difference and will help give every patient we encounter the best quality care possible.’”


Ardith Z. Doorenbos, PhD, RN, FAAN, is a Professor of Biobehavioral Nursing and Health Systems and an Adjunct Professor of Global Health in the Department of Global Health at University of Washington, in Seattle.

Abstract of the original JOP article.

PDF of the original JOP article.

Doorenbos AZ, Morris AM, Haozous EA, et al. Assessing cultural competence among surgeons. J Oncol Pract. 2016;12:61-62.

The Exclusive Coverage series on highlights selected research from JCO, JGO, and JOP, with additional perspective provided by the lead or corresponding author.

@ 2016 American Society of Clinical Oncology

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