Deaf Patients Face a Communication Crisis in Cancer Care, Landmark Review Finds

For the estimated 70 million people worldwide who identify as culturally Deaf, and the hundreds of millions more who are deaf or hard of hearing, a cancer diagnosis arrives with a second, quieter burden: a healthcare system that often cannot talk to them. A new scoping review published in Supportive Care in Cancer has systematically mapped, for the first time, the communication barriers that d/Deaf patients encounter across the cancer care pathway, and the picture it paints is stark. Drawing on every study the researchers could find, the review identified just nine papers that directly examined the experiences of d/Deaf people with cancer, a number so small that it constitutes a finding in itself. Despite decades of progress in oncology communication research, the evidence base for this population remains thin, fragmented and heavily skewed toward a single cancer type.

The review, conducted by researchers at the Sussex Health Outcomes Research and Education in Cancer group at Brighton and Sussex Medical School, followed the Joanna Briggs Institute methodology for scoping reviews. The team searched five major databases, PsycInfo, PubMed, Embase, CINAHL and Scopus, alongside grey literature sources including theses, conference abstracts and cancer charity publications, with no date restrictions. After removing 1,301 duplicates from an initial haul of 3,314 records and screening nearly 2,000 titles and abstracts, only five studies survived full-text review. Four more emerged from grey literature and citation searching, bringing the total to nine, two of which reported on the same sample. Seven were qualitative, one quantitative and one mixed-methods, conducted between 2009 and 2024 in the United States, Israel and Germany.

That scarcity of evidence is itself diagnostic. Eight of the nine studies focused on patients, five of them specifically on women with breast cancer, a condition supported by comparatively well-resourced care pathways. Only one study examined the perspective of healthcare professionals, and none at all explored the experiences of communication support professionals, the sign language interpreters, lip speakers and notetakers who mediate between d/Deaf patients and hearing clinicians. The researchers registered their protocol on the Open Science Framework and used the PCC framework, defining population, concept and context, to structure their questions around patient experiences, professional educational needs and the role of interpreters in cancer settings.

Thematic analysis of the included studies revealed three overarching domains of barriers: system-level, interpersonal and patient-level factors. At the system level, the most persistent problem was the simple absence of interpreters during consultations, including conversations in which a cancer diagnosis was being delivered. Patients described feelings of loneliness, isolation and frustration when left to decipher complex medical information without linguistic support. Even when interpreters were present, quality varied alarmingly. In one account, a discussion of high medical risk was rendered into American Sign Language as a phrase translating roughly as dangerous, dead, can, a misinterpretation the patient said directly altered their treatment decisions. Poorly designed consultation rooms that blocked sightlines to the interpreter, and patient portals that offered no way to request interpreting services, compounded the failures.

The interpersonal domain was equally troubling. Patients repeatedly reported that clinicians had limited understanding of d/Deaf culture and communication needs, falling back on lipreading or written notes, methods the review notes are often ineffective. Some healthcare professionals displayed impatience or reluctance to adapt, and a few held outright misconceptions, assuming that a patient who could lipread needed no interpreter, or that d/Deaf patients were illiterate. In one documented case, such an assumption nearly led to a patient being excluded from a clinical trial. In a survey embedded in one of the included studies, 87 percent of d/Deaf patients said clinicians spoke too quickly, 43 percent reported that eye contact was not maintained, and 85 percent said face masks obscured the facial expressions that carry so much meaning in signed and lipread communication.

The consequences of these failures are measurable and serious. Evidence cited in the review shows that 64 percent of d/Deaf patients with prostate cancer are diagnosed at an advanced or metastatic stage, compared with 13 percent in the general population. Half of d/Deaf men surveyed lacked basic knowledge of prostate cancer, and 37 percent reported receiving no information about early detection or prevention. Among d/Deaf women, 35.8 percent held misconceptions about the purpose of mammograms. A large English study of more than 473,000 women found that those with recognised disabilities, including d/Deaf women, were significantly less likely to participate in breast cancer screening, with a relative risk of 0.64, and in bowel cancer screening, with a relative risk of 0.75.

At the patient level, the review documented gaps in health literacy that flow directly from inaccessible communication. Some breast cancer survivors interviewed in the included studies lacked a clear understanding of what cancer actually was and were uncertain about the procedures and medications they had received. Seventy-two percent of d/Deaf patients in one survey struggled to understand verbal instructions about medication and examinations. Over a third reported difficulty grasping the full scope of their treatment and making informed decisions during consent conversations. Beyond comprehension, the review found emotional consequences: distrust of clinicians, disengagement and avoidance of care. One patient told researchers they had become their own doctor, doing their own research because they no longer believed what clinicians told them.

The single study examining healthcare professionals offered a counterpoint of cautious optimism. Clinicians who worked with interpreter teams reported improved communication and better patient assessment, and one described the sobering discovery that a patient had no idea they had cancer until a consultation was finally conducted through an interpreter in American Sign Language. The review also highlights the potential of Certified Deaf Interpreters, deaf professionals whose cultural knowledge and lived experience allow them to work alongside hearing interpreters using gestures, mime and visual props, particularly in complex medical appointments. Yet the authors note that such specialists were entirely absent from the literature they reviewed, and that many d/Deaf patients have no access to any interpreter, or are assisted by someone without adequate medical training.

The review’s authors are careful about the limits of their evidence. The included studies were small, largely exploratory and disproportionately focused on breast cancer in the United States, which accounted for 78 percent of the literature. All were published in English, and deaf community members were rarely involved in designing or interpreting the underlying research. Even so, the converging picture supports concrete interventions: reliable access to qualified medical interpreters, visually based educational materials in sign language, and deaf awareness training for healthcare staff. Educational programs delivered in sign language have already improved knowledge of prostate, breast and cervical cancer screening, with retention lasting up to two months, and cultural competency programs such as the Deaf Strong Hospital exercise have measurably improved medical students’ communication. Targeted cancer-specific training for medical interpreters has been associated with a 23 percent improvement in cancer knowledge, a model the authors argue should be extended to communication support professionals, whose educational needs a survey now underway aims to define.

What makes this review resonate beyond oncology is its alignment with the social model of disability, which locates the problem not in deafness itself but in systems that fail to accommodate it. The barriers documented here, missing interpreters, rushed speech, obscured faces, inaccessible portals, are all artifacts of design and policy, not of biology. As cancer diagnosis and treatment grow more complex, the communication demands placed on every patient increase, and for d/Deaf patients the margin for misunderstanding narrows to nothing. The review’s nine studies may be a small foundation, but they point in a clear direction: equitable cancer care for d/Deaf people is not a question of new medical technology, but of whether the healthcare system is finally willing to learn their language.

Subject of Research: Communication barriers experienced by d/Deaf patients in cancer care

Article Title: Communication barriers for d/Deaf people with cancer: a scoping review

Article References: Wogan, N., Habibi, R., Fallowfield, L., & Harder, H. (2026). Communication barriers for d/Deaf people with cancer: a scoping review. Supportive Care in Cancer, 34(10), Article 950. https://doi.org/10.1007/s00520-026-11202-y

Image Credits: AI Generated

DOI: 10.1007/s00520-026-11202-y

Keywords: d/Deaf, cancer care, communication barriers, sign language interpreters, health literacy, scoping review, health inequalities, oncology, deaf awareness training, patient-provider communication, supportive care, health services research