The patient-reported Clinicians' Cultural Sensitivity Survey: a field test among older Latino primary care patients.

BACKGROUND: Patient-reported measures of clinicians' cultural sensitivity are important to assess comprehensively quality of care among ethnically diverse patients and may help address persistent health inequities. OBJECTIVE: Create a patient-reported, multidimensional survey of clinicians' cultural sensitivity to cultural factors affecting quality of care. DESIGN: Using a comprehensive conceptual framework, items were written and field-tested in a cross-sectional telephone survey. Multitrait scaling and factor analyses were used to develop measures. SETTING AND PARTICIPANTS: Latino patients age ≥50 from primary care practices in California. MAIN VARIABLES STUDIED: Thirty-five items hypothesized to assess clinicians' sensitivity. MAIN OUTCOMES MEASURES: Validity and reliability of cultural sensitivity measures. RESULTS: Twenty-nine of 35 items measuring 14 constructs were retained. Eleven measures assessed sensitivity issues relevant to all participants: complementary and alternative medicine, mind-body connections, causal attributions, preventive care, family involvement, modesty, prescription medications, spirituality, physician discrimination due to education, physician discrimination due to race/ethnicity and staff discrimination due to race/ethnicity. Three measures were group specific: two to limited English proficient patients (sensitivity to language needs and discrimination due to language) and one to immigrants (sensitivity to immigrant status). Twelve multi-item scales demonstrated adequate reliability (alpha ≥0.68 except for Spanish discrimination due to education) and evidence of construct validity (item-scale correlations for all scales >0.40 except for sensitivity to immigrant status). Two single-item measures demonstrated sufficient construct validity to retain for further development. DISCUSSION AND CONCLUSIONS: The Clinicians' Cultural Sensitivity Survey can be used to assess the quality of care of older Latino patients.

What RNs Can Do to Improve the Health of Their Communities.

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Aberrant crypt foci in patients with a positive family history of sporadic colorectal cancer.

Early detection is crucial in the prevention of colorectal cancer (CRC) deaths. The earliest detectable neoplastic lesion in the colon is the aberrant crypt foci (ACF). A major question is whether ACF are precursors of CRC, and thus, early biomarkers for CRC risk. If so, we hypothesized that the number of ACF would be higher in patients who had a family history of CRC compared to patients without. We counted ACF in the distal 20cm of colon/rectum during 103 colonoscopic examinations using a prototype Close Focus Colonoscope (Olympus Corp.) with methylene blue chromendoscopy. Each patient was asked whether they had a family history of CRC in a first degree relative, or a personal history of CRC or adenoma. Patients answering 'no' to these questions (n=17) had a mean number of ACF of 4.4; the mean was significantly higher in the patients with a positive family history of CRC (9.0, p<0.01; n=43) or a personal history of advanced adenoma (7.5, p<0.05; n=34).