Healthcare providers increasingly care for patients with Limited English Proficiency (LEP). There is limited research evaluating healthcare provider utilization practices, attitudes, perceived benefits and barriers regarding the use of medical interpreters in end of life (EOL) and goals of care (GOC) conversations.
Objectives:
To elicit healthcare providers’ opinions of the role, factors that impact decisions to use medical interpreters and perceived utility of using medical interpreters when conducting EOL and GOC conversations with LEP patients and their families.
Design:
Cross-sectional survey of internal medicine trainees and attending physicians from a U.S. medical center.
Results:
A total of 117 surveys were collected with a response rate of 51%. In-person medical interpreters received higher ratings with regard to their helpfulness compared to telephone medical interpreters during EOL and GOC conversations. Being an attending physician and having received training in the use of a medical interpreter predicted higher composite scores reflecting greater awareness of the roles of medical interpreters and endorsement of best communication practices. In-person interpreters were viewed by a subset of participants as “standard of care” during EOL and GOC conversations.
Conclusion:
Having more years in practice and receiving training in the use of medical interpreters correlated with more favorable attitudes toward the role of medical interpreters and positive communication practices. Incorporating early training in the use of medical interpreters could help enhance communication practices and outcomes during EOL and GOC conversations with LEP patients.
Hasnain-WyniaRYonekJPierceDKangRGreisingCH. Hospital language services for patients with limited English proficiency: results from national survey. Health Research and Educational Trust (HRET). 2006.
4.
TairaBRKimKModyN.Hospital and health system–level interventions to improve care for limited English proficiency patients: a systematic review. Jt Comm J Qual Patient Saf. 2019;45(6):446–458.
5.
Guidance of the National CLAS Standards. United States Department of Health and Human Services: Office of Minority Health website. Published October 2, 2018. Accessed December 16, 2020.https://minorityhealth.hhs.gov/omh/browse.aspx?lvl=2&lvlid=53
6.
CarrasquilloOOravEJBrennanTABurstinHR. Impact of language barriers on patient satisfaction in an emergency department. J Gen Intern Med. 1999;14(2):82–87.
7.
AbbeMSimonCAngiolilloARuccioneKKodishED. A survey of language barriers from the perspective of pediatric oncologists, interpreters, and parents. Pediatr Blood Cancer. 2006;47(6):819–824.
8.
DiviCKossRGSchmaltzSPLoebJM. Language proficiency and adverse events in U.S. hospitals: a pilot study. Int J Qual Health Care. 2007;19(2):60–67.
9.
LindholmMHargravesJLFergusonWJReedG. Professional language interpretation and inpatient length of stay and readmission rates. J Gen Intern Med. 2012;27(10):1294–1299.
10.
Espinoza SuarezNRUrtechoMNyquistCA, et al.Consequences of suboptimal communication for patients with limited English proficiency in the intensive care unit and suggestions for a way forward: a qualitative study of healthcare team perceptions. J Crit Care. 2021;61:247–251.
11.
SuurmondJLieveldAvan de WeteringMvan MeeterenAYNS. Towards culturally competent pediatric oncology care. A qualitative study from the perspective of care providers. Eur J Cancer Care. 2017;26(6):e12680.
12.
FloresG. The impact of medical interpreter services on the quality of health care: a systematic review. Med Care Res Rev. 2005;62(3):255–299.
13.
KarlinerLSJacobsEAChenAHMuthaS. Do professional interpreters improve clinical care for patients with limited English proficiency? A systematic review of the literature. Health Serv Res. 2007;42(2):727–754.
14.
SchenkerYFernandezAKerrKO’RiordanDPantilatSZ. Interpretation for discussions about end-of-life issues: results from a national survey of health care interpreters. J Palliat Med. 2012;15(9):1019–1026.
15.
BarwiseAYeowMEPartainDK. The premise and development of check in-check-in for exchange of clinical and key information to enhance palliative care discussions for patients with limited English proficiency[published December 9, 2020]. Am J Hosp Palliat Care. 2020:1049909120979982.
16.
FloresGLawsMBMayoSJ, et al.Errors in medical interpretation and their potential clinical consequences in pediatric encounters. Pediatrics. 2003;111(1):6–14.
17.
SandlerRMyersLSpringgateB. Resident physicians’ opinions and behaviors regarding the use of interpreters in New Orleans. South Med J. 2014;107(11):698–702.
18.
GrayBStanleyJStubbeMHilderJ. Communication difficulties with limited English proficiency patients: clinician perceptions of clinical risk and patterns of use of interpreters. N Z Med J. 2011;124(1342):23–38.
19.
SchenkerYPérez-StableEJNickleachDKarlinerLS. Patterns of interpreter use for hospitalized patients with limited English proficiency. J Gen Intern Med. 2011;26(7):712–717.
20.
DiamondLCSchenkerYCurryLBradleyEHFernandezA.Getting by: underuse of interpreters by resident physicians. J Gen Intern Med. 2009;24(2):256–262.
21.
LópezLRodriguezFHuertaDSoukupJHicksL. Use of interpreters by physicians for hospitalized limited English proficient patients and its impact on patient outcomes. J Gen Intern Med. 2015;30(6):783–789.
22.
RoseDETisnadoDMMalinJL, et al.Use of interpreters by physicians treating limited English proficient women with breast cancer: results from the provider survey of the Los Angeles Women’s Health Study. Health Serv Res. 2010;45(1):172–194.
23.
RandhawaGOwensAFitchesRKhanZ. Communication in the development of culturally competent palliative care services in the UK: a case study. Int J Palliat Nurs. 2003;9(1):24–31.
24.
ChanAWoodruffRK. Comparison of palliative care needs of English-and non-English-speaking patients. J Palliat Care. 1999;15(1):26–30.
25.
DaviesBControNLarsonJWidgerK. Culturally-sensitive information-sharing in pediatric palliative care. Pediatrics. 2010;125(4): e859–e865.
26.
SpruytO. Community-based palliative care for Bangladeshi patients in East London. Accounts of bereaved carers. Palliat Med. 1999;13(2):119–129.
27.
SilvaMDGenoffMZaballaA, et al.Interpreting at the end of life: a systematic review of the impact of interpreters on the delivery of palliative care services to cancer patients with limited English proficiency. J Pain Symptom Manage. 2016;51(3):569–580.
28.
KaiJBeavanJFaullC. Challenges of mediated communication, disclosure and patient autonomy in cross-cultural cancer care. Br J Cancer. 2011;105(7):918–924.
29.
RosenbergELeanzaYSellerR.Doctor-patient communication in primary care with an interpreter: physician perceptions of professional and family interpreters. Patient Educ Couns. 2007;67(3):286–292.
30.
HsiehEHongSJ. Not all are desired: providers’ views on interpreters’ emotional support for patients. Patient Educ Couns. 2010;81(2):192–197.
31.
HsiehE. Not just “getting by”: factors influencing providers’ choice of interpreters. J Gen Intern Med. 2015;30(1):75–82.
32.
MayoRParkerVGSherrillWW, et al.Cutting corners: provider perceptions of interpretation services and factors related to use of an Ad Hoc Interpreter. Hisp Health Care Int. 2016;14(2):73–80.
33.
BarwiseAKNyquistCAEspinoza SuarezNR, et al.End-of-life decision-making for ICU patients with limited English proficiency: a qualitative study of healthcare team insights. Crit Care Med. 2019;47(10):1380–1387.
34.
GreenAJerzmanowskaNGreenMLobbEA. “Death is difficult in any language”: a qualitative study of palliative care professionals’ experiences when providing end-of-life care to patients from culturally and linguistically diverse backgrounds. Palliat Med. 2018;32(8):1419–1427.
35.
HarrisPATaylorRThielkeR, et al.Research electronic data capture (REDCap)—a metadata-driven methodology and workflow process for providing translational research informatics support. J Biomed Inform. 2009;42(2):377–381.
36.
HarrisPATaylorRMinorBL, et al.The REDCap consortium: building an international community of software platform partners. J Biomed Inform. 2019;95:103208.
SuarezNREUrtechoMJubranS, et al.The roles of medical interpreters in intensive care unit communication: a qualitative study. Patient Educ Couns. 2020;25:S0738–3991(20)30553–X.
39.
NorrisWMWenrichMDNielsenEL, et al.Communication about end-of-life care between language-discordant patients and clinicians: insights from medical interpreters. J Palliat Med. 2005;8(5):1016–1024.
40.
RhodesMGFletcherKEBlumenfeld-KoucherFJacobsEA. Spanish medical interpreters’ management of challenges in end of life discussions. Patient Educ Couns. 2021;S0738–3991(21)00045–8.
41.
BoylenSCherianSGillFJLeslieGDWilsonS. Impact of professional interpreters on outcomes for hospitalized children from migrant and refugee families with limited English proficiency: a systematic review. JBI Evid Synth. 2020;18(7):1360–1388.
42.
KushalnagarPPaludnevicieneRKushalnagarR. Video remote interpreting technology in health care: cross-sectional study of deaf patients’ experiences. JMIR Rehabil Assist Technol. 2019;6(1): e13233.
43.
JosephCGarrubaMMelderA.Patient satisfaction of telephone or video interpreter services compared with in-person services: a systematic review. Aust Health Rev. 2018;42(2):168–177.
44.
PriceELPérez-StableEJNickleachDLópezMKarlinerLS. Interpreter perspectives of in-person, telephonic, and videoconferencing medical interpretation in clinical encounters. Patient Educ Couns. 2012;87(2):226–232.
45.
LocatisCWilliamsonDGould-KablerC, et al.Comparing in-person, video, and telephonic medical interpretation. J Gen Intern Med. 2010;25(4):345–350.
46.
GarciaEARoyLCOkadaPJPerkinsSDWiebeRA. A comparison of the influence of hospital-trained, ad hoc, and telephone interpreters on perceived satisfaction of limited English-proficient parents presenting to a pediatric emergency department. Pediatr Emerg Care. 2004;20(6):373–378.
47.
FanWYanZ.Factors affecting response rates of the web survey: a systematic review. Comput Human Behav. 2010;26(2):132–139.
48.
CunninghamCTQuanHHemmelgarnB, et al.Exploring physician specialist response rates to web-based surveys. BMC Med Res Methodol. 2015;15:32.
49.
HamaiTNagataANishikawaH. The need for medical interpreters: a questionnaire survey of municipal hospitals in Japan. Nihon Koshu Eisei Zasshi. 2017;64(11):672–683.
50.
AudibertCGlassDJohnsonTP. Method and transparency of online physician surveys: an overview survey methods: insights from the field. Published May 3, 2020. Accessed February 18, 2021. https://surveyinsights.org/?p=12496
Supplementary Material
Please find the following supplemental material available below.
For Open Access articles published under a Creative Commons License, all supplemental material carries the same license as the article it is associated with.
For non-Open Access articles published, all supplemental material carries a non-exclusive license, and permission requests for re-use of supplemental material or any part of supplemental material shall be sent directly to the copyright owner as specified in the copyright notice associated with the article.
