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Hamai T, Nagata A, Ono N, Nishikawa H, Higashino S. Evaluating a conceptual framework for quality assessment of medical interpretation. PATIENT EDUCATION AND COUNSELING 2024; 123:108233. [PMID: 38447476 DOI: 10.1016/j.pec.2024.108233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Revised: 02/19/2024] [Accepted: 02/28/2024] [Indexed: 03/08/2024]
Abstract
OBJECTIVE We aimed to evaluate a proposed conceptual framework for quality assessment of medical interpretation using actual data from clinical settings. METHODS A mixed methods approach was used. Routine outpatient encounters involving Portuguese-speaking Brazilian patients, Japanese physicians, and hospital-provided and ad hoc interpreters were digitally recorded and transcribed. A questionnaire survey examining participants' satisfaction was conducted; 111 and 13 encounters by hospital-provided and ad hoc interpreters, respectively, were recorded. Segments of consecutively interpreted utterances were coded as "altered," whereby the interpreter changed the meaning of the source utterance, or "unaltered (accurate)." Frequency and type of alteration were analyzed. The effect of positive interpretation alterations on physician-patient interactions was qualitatively described. RESULTS Interpretation accuracy was significantly higher for hospital-provided interpreters, but was not associated with overall patient satisfaction. Overall physician satisfaction was associated with accurate interpretation, clinically negative altered interpretations, and positive voluntary interventions (p < 0.05). Positive alterations promoted patient, physician, and interpreter interactions, which helped to achieve clinical outcomes. CONCLUSION A new conceptual framework for quality assessment of medical interpretation was developed for clinical settings. Healthcare provider satisfaction can provide a measure of interpretation alterations. PRACTICE IMPLICATIONS Healthcare providers can effectively use the conceptual framework to improve medical interpretation and collaboration with healthcare interpreters.
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Affiliation(s)
- Taeko Hamai
- School of Nursing, University of Shizuoka, Shizuoka, Japan.
| | - Ayako Nagata
- College of Nursing and Nutrition, Shukutoku University, Chiba, Japan
| | - Naoko Ono
- Faculty of International Liberal Arts, Juntendo University, Tokyo, Japan
| | | | - Sadanori Higashino
- School of Management and Information, University of Shizuoka, Shizuoka, Japan
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Brune C, Liljas A. "You treat what you have to treat, and you don't care as much if they understand or if they feel good about it": Communication barriers and perceptions of moral distress among doctors in emergency departments. Medicine (Baltimore) 2023; 102:e36610. [PMID: 38115277 PMCID: PMC10727579 DOI: 10.1097/md.0000000000036610] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Revised: 11/16/2023] [Accepted: 11/21/2023] [Indexed: 12/21/2023] Open
Abstract
Doctors facing communication barriers when assessing patients in emergency departments (ED) is a frequent phenomenon, as the global prevalence of dementia and migration have increased. This study aims to explore how communication barriers influence moral distress as perceived by medical doctors working at emergency departments. Twelve doctors at 2 different EDs in Stockholm, Sweden, participated. Answers on communication barriers were collected from an interview guide on moral distress. Informants' responses were analyzed using qualitative thematic analysis. The results suggest that doctors experience moral distress when assessing patients with communication barriers due to an inability to mediate calm and safety and understand their patients, and due an increased need of resources and difficulties in obtaining consent before conducting examinations or interventions. In conclusion, communication barriers can be a cause of moral distress, which should be considered when developing tools and methods to mitigate and manage moral distress.
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Affiliation(s)
- Clara Brune
- Karolinska Institutet, Department of Global Public Health, Stockholm, Sweden
| | - Ann Liljas
- Karolinska Institutet, Department of Global Public Health, Stockholm, Sweden
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Chhabra N, Christian E, Seseri V, George F, Rizvanolli L. Association of Patient English Proficiency and Diagnostic Imaging Acquisition in Emergency Department Patients with Abdominal Symptoms. J Emerg Med 2023; 65:e172-e179. [PMID: 37635035 DOI: 10.1016/j.jemermed.2023.05.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Revised: 04/20/2023] [Accepted: 05/26/2023] [Indexed: 08/29/2023]
Abstract
BACKGROUND Patients with limited English proficiency (LEP) are at risk for communication barriers during medical care in the United States compared with English-proficient (EP) patients. It is unknown how EP affects the utilization of advanced diagnostic imaging (ADI) in the emergency department (ED). OBJECTIVE The aim of this study was to compare the acquisition and findings of ADI in EP and LEP patients with abdominal symptoms. METHODS We conducted a retrospective analysis of adult ED patients from January 2015 to January 2016. Patients were divided into EP and LEP cohorts. Logistic regression models incorporated language proficiency, interpretation method, and demographic characteristics. We determined crude and adjusted odds ratios (ORs) for the acquisition of ADI, defined as either computed tomography or ultrasound, and the proportion with actionable findings. RESULTS In 3324 encounters (2134 EP; 1190 LEP), LEP patients were older (46.3 years vs. 43.8 years), more likely to be female (66.7% vs. 51.5%), and preferred Spanish (91.4%). ADI was obtained in 43.5% of EP and 48.1% of LEP. Adjusting for age, sex, and interpretation method, the OR was 1.09 (95% CI 0.90-1.32). There were no significant associations between interpretation type and acquisition of ADI. The proportion with actionable findings were similar in EP and LEP cohorts (29.6% vs. 26.7%). CONCLUSIONS Accounting for demographic differences, ADI acquisition was similar for ED patients with and without LEP. Further research is needed to determine optimal interpretation modalities in this setting to prevent unnecessary imaging.
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Affiliation(s)
- Neeraj Chhabra
- Department of Emergency Medicine, Cook County Health, Chicago, Illinois; University of Illinois Chicago, Chicago, Illinois
| | - Errick Christian
- Department of Emergency Medicine, Cook County Health, Chicago, Illinois
| | - Veronika Seseri
- Department of Emergency Medicine, Cook County Health, Chicago, Illinois; University of Illinois Chicago, Chicago, Illinois
| | - Faith George
- Department of Emergency Medicine, Cook County Health, Chicago, Illinois; University of Illinois Chicago, Chicago, Illinois
| | - Lum Rizvanolli
- Department of Emergency Medicine, Cook County Health, Chicago, Illinois
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Joseph G, Lindberg NM, Guerra C, Hernandez C, Karliner LS, Gilmore MJ, Zepp J, Rolf BA, Caruncho M, Riddle L, Kauffman TL, Leo MC, Wilfond BS. Medical interpreter-mediated genetic counseling for Spanish preferring adults at risk for a hereditary cancer syndrome. J Genet Couns 2023; 32:870-886. [PMID: 36938783 PMCID: PMC10509308 DOI: 10.1002/jgc4.1695] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 02/15/2023] [Accepted: 02/16/2023] [Indexed: 03/21/2023]
Abstract
The objective of this study was to identify interpretation challenges specific to exome sequencing and errors of potential clinical significance in the context of genetic counseling for adults at risk for a hereditary cancer syndrome. Thirty transcripts of interpreter-mediated telephone results disclosure genetic counseling appointments were coded for errors by bilingual researchers, and the coders applied an overall rating to denote the degree to which the errors interfered with communication overall. Genetic counselors reviewed a subset of errors flagged for potential clinical significance to identify those likely to have clinical impact. Qualitative interviews with 19 interpreters were analyzed to elucidate the challenges they face in interpreting for genetic counseling appointments. Our analysis identified common interpretation errors such as raising the register, omissions, and additions. Further, we found errors specific to genetic counseling concepts and content that appeared to impact the ability of the genetic counselor to accurately assess risk. These errors also may have impacted the patient's ability to understand their results, access appropriate follow-up care, and communicate with family members. Among interpreters' strengths was the use of requests for clarification; in fact, even more use of clarification would have been beneficial in these encounters. Qualitative interviews surfaced challenges stemming from the structure of interpreter work, such as switching from medical and nonmedical interpretations without substantial breaks. Importantly, while errors were frequent, most did not impede communication overall, and most were not likely to impact clinical care. Nevertheless, potentially clinically impactful errors in communication of genetics concepts may contribute to inequitable care for limited English proficient patients and suggest that additional training in genetics and specialization in healthcare may be warranted. In addition, training for genetic counselors and guidance for patients in working effectively with interpreters could enhance interpreters' transmission of complex genetic concepts.
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Affiliation(s)
- Galen Joseph
- Department of Humanities and Social Sciences, University of California, San Francisco, San Francisco, California, USA
| | | | - Claudia Guerra
- Department of Humanities and Social Sciences, University of California, San Francisco, San Francisco, California, USA
| | - Cindy Hernandez
- Cancer Genetics and Prevention Program, University of California, San Francisco, San Francisco, California, USA
- The University of Texas MD Anderson Cancer Center UTHealth Houston Graduate School of Biomedical Sciences, Houston, Texas, USA
| | - Leah S Karliner
- Department of General Internal Medicine, University of California, San Francisco, San Francisco, California, USA
| | - Marian J Gilmore
- Department of Translational and Applied Genomics, Kaiser Permanente Center for Health Research, Portland, Oregon, USA
| | - Jamilyn Zepp
- Department of Translational and Applied Genomics, Kaiser Permanente Center for Health Research, Portland, Oregon, USA
| | - Bradley A Rolf
- Division of Medical Genetics, Department of Medicine, University of Washington School of Medicine, Seattle, Washington, USA
| | - Mikaella Caruncho
- Department of Medical Humanities and Ethics, Columbia University, New York, New York, USA
| | - Leslie Riddle
- Department of Humanities and Social Sciences, University of California, San Francisco, San Francisco, California, USA
| | - Tia L Kauffman
- Kaiser Permanente Center for Health Research, Portland, Oregon, USA
| | - Michael C Leo
- Kaiser Permanente Center for Health Research, Portland, Oregon, USA
| | - Benjamin S Wilfond
- Seattle Children's Research Institute, University of Washington, Seattle, Washington, USA
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Berthold SM, Feinn R, Bermudez-Millan A, Buckley T, Buxton OM, Kong S, Kuoch T, Scully M, Ngo TA, Wagner J. Self-reported pain among Cambodian Americans with depression: patient-provider communication as an overlooked social determinant. J Patient Rep Outcomes 2022; 6:103. [PMID: 36138333 PMCID: PMC9500135 DOI: 10.1186/s41687-022-00504-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Accepted: 09/05/2022] [Indexed: 11/10/2022] Open
Abstract
Abstract
Objectives
Pain is common among torture survivors and refugees. Clear communication about one’s pain is vital to timely and precise diagnosis and treatment but is rarely recognized as a social determinant of health. We examined whether self-reported difficulty communicating with their health care provider, along with standard social determinants, is associated with self-reported pain in Cambodian American refugees.
Methods
Secondary data analysis was conducted on n = 186 baseline assessments from a diabetes prevention trial of Cambodian Americans with depression. Bilingual, bicultural community health workers (CHWs) conducted surveys including social determinants of health and past week pain occurrence and interference.
Results
The sample was 78% female, modal household income = $25,000, mean age = 55 years, and mean education = 6.9 years. About one-third had private insurance and two-thirds could not speak English conversationally. The average pain score was 2.8 on a scale from 0–8 with 37% reporting no pain at all. In bivariate analyses, predictors of higher pain scores were higher difficulty understanding healthcare provider, depressive symptoms, trauma symptoms, food insecurity, and social isolation; predictors of lower pain scores were higher years of education, income, English language proficiency, social support, working, and having private insurance. In the multivariate backward elimination model only two predictors were retained: difficulty understanding healthcare provider and depressive symptoms.
Discussion
We propose that healthcare communication is a modifiable social determinant of health. Healthcare institutions should receive the resources necessary to secure patients’ rights to clear communication including trained community health workers.
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Cooper S, Stevenson F. Communicating decisions about care with patients and companions in emergency department consultations. Health Expect 2022; 25:1766-1775. [PMID: 35715945 PMCID: PMC9327864 DOI: 10.1111/hex.13519] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Revised: 04/20/2022] [Accepted: 04/21/2022] [Indexed: 11/28/2022] Open
Abstract
INTRODUCTION This paper explores doctor-patient and companion communication about care decisions in a UK emergency department (ED). Doctors interface between patients and healthcare systems and facilitate access to care across a range of encounters, drawing on information and authority to make and communicate clinical care decisions. MATERIALS AND METHODS We explored characteristics of communication through ethnographic observation of 16 video-recorded case studies of ED consultations (average length: 1 h) collected over 6 months. Companions were present in 10 cases. We conducted a framework analysis to understand the roles of doctors, consultants, patients and companions in relaying ED care decisions. FINDINGS We present two cases to reflect companion roles and their effect on the consultation. The urgency for care and scarcity of resources means clinicians justify decisions and strategize to move patients along ED pathways. DISCUSSION Everyday care interactions between patients and doctors are goal-oriented and companions participate by providing case information, querying decisions and advocating for care. Our findings reflect how doctors justify decisions made in communicating the next steps in ways that characterize the clinical encounter. CONCLUSION By exploring everyday interactions our study contributes to a growing understanding of patient-clinician and companion communication in the ED. PATIENT OR PUBLIC CONTRIBUTION Patients and caregivers voluntarily participated in data collection and consented to video recordings being conducted of ED consultations between them and junior doctors. There was extensive consultation with all grades of staff about the acceptability of the work and the best way to conduct it to minimize the impact on patients and staff. Through this manuscript, we have demonstrated the presence and important role of companions. On reflection it would have been valuable to have included patients and companions in discussions about the work; however, this project was conducted with very limited funding and no resources were committed to patient and public involvement. Given the setting and scope of the study, it was not feasible to involve patients or members of the public in other stages of the research or preparation of the manuscript. We recognize this as a potential limitation of the work.
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Affiliation(s)
- Silvie Cooper
- Department of Applied Health Research, University College London, London, UK
| | - Fiona Stevenson
- Department of Primary Care and Population Health, University College London, London, UK
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Lor M, Badenoch N, Yang MJ. Technical Meets Traditional: Language, Culture, and the Challenges Faced by Hmong Medical Interpreters. J Transcult Nurs 2022; 33:96-104. [PMID: 34404302 PMCID: PMC10711740 DOI: 10.1177/10436596211039553] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION Ineffective intercultural communication can occur due to inaccurate medical interpreting for limited English proficiency (LEP) patients. Research shows that Hmong patients experience poorer quality interpreter services than other LEP populations. This study's purpose is to understand Hmong medical interpreters' perceptions of the factors that affect their ability to make accurate medical interpretations during clinical encounters. METHOD A qualitative study was conducted with Hmong-speaking medical interpreters. The interviews were semistructured, audio recorded, and analyzed using conventional content analysis. RESULTS 13 interpreters aged 29 to 49 years participated in the study. Three factors affected the interpreters' ability to make accurate medical interpretations for Hmong-speaking patients: (a) matched gender between the interpreter and patient, (b) culturally taboo topics in communicating about reproductive body parts and sexual health/activity, and (c) culture and generational language differences between interpreters and Hmong patients. DISCUSSION Clinical encounters that match patient-interpreter ages, gender, and/or local culture may reduce communication barriers.
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Affiliation(s)
- Maichou Lor
- University of Wisconsin–Madison, Madison, WI, USA
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Denson VL, Graves JM. Language Assistance Services in Nonfederally Funded Safety-Net Medical Clinics in the United States. Health Equity 2022; 6:32-39. [PMID: 35112044 PMCID: PMC8804243 DOI: 10.1089/heq.2021.0103] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/05/2021] [Indexed: 11/12/2022] Open
Affiliation(s)
- Vicki L. Denson
- College of Nursing, Washington State University, Vancouver, Washington, USA
| | - Janessa M. Graves
- College of Nursing, Washington State University, Spokane, Washington, USA
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Villalona S, Castañeda H, Wilson JW, Romero-Daza N, Yanez Yuncosa M, Jeannot C. Discordance Between Satisfaction and Health Literacy Among Spanish-Speaking Patients with Limited English-Proficiency Seeking Emergency Department Care. HISPANIC HEALTH CARE INTERNATIONAL 2021; 21:60-67. [PMID: 34931564 DOI: 10.1177/15404153211067685] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Introduction: The emergency department (ED) is one clinical setting where issues pertaining to health communication uniquely manifest themselves on a daily basis. This pilot study sought to understand satisfaction with care, perceptions of medical staff concern, awareness, and comprehension of medical care among Spanish-speaking patients with limited English-language proficiency (LEP). Methods: A two-phase, mixed-methods approach was employed among Spanish-speaking patients with LEP that presented to an ED in West Central Florida. The prospective phase consisted of semistructured interviews (n = 25). The retrospective phase analyzed existing patient satisfaction data collected at the study site (n = 4,940). Results: Content analysis revealed several linguistic barriers among this patient population including limited individual autonomy, self-blame for being unable to effectively articulate concerns, and lack of clarity in understanding follow-up care plans. Retrospective analysis suggested differences between responses from Spanish-speaking patients when compared with their English-speaking counterparts. Conclusions: Our findings suggest discordance between satisfaction and health literacy in this unique patient population. Although high satisfaction was reported, this appeared to be secondary to comprehension of follow-up care instructions.
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Affiliation(s)
- Seiichi Villalona
- 12287Rutgers Robert Wood Johnson Medical School, Piscataway, NJ, USA
| | - Heide Castañeda
- Department of Anthropology, University of South Florida, Tampa, FL, USA
| | - Jason W Wilson
- Emergency Department, 7829Tampa General Hospital, Tampa, FL, USA.,Department of Internal Medicine, Morsani College of Medicine at the University of South Florida, Tampa, FL, USA
| | - Nancy Romero-Daza
- Department of Anthropology, University of South Florida, Tampa, FL, USA
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