Getting to the Meat and Bones: Core Elements of Culturally Responsive Group Support for Chinese-Speaking Cancer Patients

Background and Purpose: Chinese-speaking cancer patients in the U.S. face significant linguistic, cultural, and psychosocial barriers to care, resulting in unmet needs for accurate information, emotional support, and accessible services. Existing support group models often overlook the unique cultural values and communication styles of this population, particularly the stigma surrounding cancer, reliance on family-centered decision-making, and preferences for non-disclosure of emotional distress. To address this gap, this qualitative study explored the key components and guiding principles essential to a culturally responsive support group for Chinese-speaking cancer patients.

Methods: We recruited Chinese-speaking cancer patients treated in the U.S., their caregivers, and practitioners (e.g., social workers, nurses, community workers) who have worked with this population through community and social media outreach. The interviews were conducted online or in-person depending on participants’ preference. Interview guides asked questions about unmet needs of Chinese-speaking cancer patients, support services provided/received, factors influencing help-seeking behavior, experiences of cancer support groups (if they have any) and preferences regarding the structure and modality of the group. Interviews were transcribed verbatim and analyzed using Atlas.ti with an inductive thematic analysis approach.

Findings: Sixteen semi-structured interviews were conducted with Chinese-speaking cancer patients (n=5), one caregiver (n=1), and practitioners (n=10); the sample was predominantly female (81.3%) and well-educated (87.5% held a college degree). Five core elements emerged as essential to a culturally responsive support group: (1) trust-building through shared language and cultural understanding, facilitated by bilingual practitioners familiar with Chinese norms surrounding illness, emotional restraint, and family duty; (2) culturally grounded health information delivered in accessible language to address confusion and misinformation; (3) gradual introduction of emotional support via experiential activities or informational sessions, avoiding direct discussions of distress often seen as uncomfortable or inappropriate due to cultural stigma and unfamiliarity with Western psychological concepts; (4) Alignment with family-centered values, supporting patients who prioritize family over self and providing separate support for caregivers to allow space for their distinct emotional and coping challenges; (5) Online format acceptability, which was broadly preferred as it reduced pressure to disclose identity or emotions face-to-face—some participants kept cameras off to preserve privacy. However, this same anonymity created challenges for facilitators in gauging emotional engagement and fostering group cohesion. Despite these barriers, a thoughtfully designed online group with culturally sensitive facilitation was viewed as both feasible and desirable.

Conclusion and Implications: These findings underscore the importance of integrating cultural considerations into psychosocial cancer care. A thoughtfully designed online support group—centered on trust-building, cultural humility, and flexible delivery—can offer meaningful support to Chinese-speaking cancer patients and their caregivers in the U.S. Beyond this population, the identified components offer a culturally grounded framework that can be adapted for other linguistically isolated or immigrant patient groups navigating serious illness.