To accomplish these goals, we used qualitative research methods to collect data from a purposeful sample of individuals (patients, physicians, nurses, interpreters, and others) involved in cancer care in a Russian-speaking émigré community in San Francisco, California. 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. 13 – 16 Key questions 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 landscapes of language and culture. 7 – 12 Several case studies have documented that poor outcomes can result when the links between language and culture receive insufficient attention, but these linkages have not yet received widespread attention in clinical literature.

3 – 6 Research has documented that differences in language and culture can cause breakdowns in provider–patient communication that communication may be aided by language 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. 1, 2 Addressing the health care needs of LEP patients requires attention to both language and culture, which connect in complex ways among diverse patient populations. States residents over the age of 5 who speak a language other than English at home exceeded 45 million in the 2000 census. Reflecting the resumption of trans-national migration, the number of U.S.

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