A recent study published in the Journal of General Internal Medicine found “Increased Access to Professional Interpreters in the Hospital Improves Informed Consent for Patients with Limited English Proficiency.”
As we are well aware, language barriers can disrupt communication and impede informed consent for patients who are limited English proficient (LEP) and are undergoing healthcare procedures. This was reaffirmed in a recent study evaluating the impact of a bedside interpreter phone system intervention on informed consent for patients with LEP compared to English speakers.
The study included hospitalized patients undergoing invasive procedures on the cardiovascular, general surgery or orthopedic surgery floors and evaluated LEP patients vs. English speakers both with and without access to an interpreter. The researchers wanted to understand central informed consent, including whether the patient reported an understanding of the reason for a procedure, the risks of the procedure and if all of their questions were answered. The study concluded that a patient was adequately informed when all three elements of the procedure were met.
The study enrolled 152 Chinese and Spanish-speaking patients who were LEP and 86 English speakers. After an interpreter was made available to the patients (as opposed to patients who did not have access to an interpreter), the LEP patients were more likely to meet criteria for adequately informed consent and had significantly higher odds of adequately informed consent as well as each consent element individually. The study concluded that a bedside interpreter phone system intervention to increase rapid access to professional interpreters was associated with improvements in patient-reported informed consent and should be considered by hospitals seeking to improve care for patients with LEP; however, these improvements did not eliminate the language-based disparity. The researchers believe additional clinician education and language access programs may be necessary for informed consent to equal that for English speakers.
It is promising to see that phone interpreters makes a difference in facilitating effective communication for both patients and providers and is improving patient care in the healthcare setting. Anthropologist Ray Birdwhistell pioneered the original study of nonverbal communication where he discovered the verbal component of face-to-face conversation is less than 35 percent and over 65 percent of communication is nonverbal. Would medically qualified interpreters provided through video technology help to eliminate language based disparity?
Seattle Children’s Hospital conducted a randomized clinical trial in December 2015, which found that compared to telephone interpretation, families with limited English proficiency (LEP) who received video remote interpretation (VRI) experienced clear, observable benefits, including better comprehension and more consistent receipt of professional interpretation. The objective of the trial was to test the effect of telephone versus video interpretation on communication during pediatric, emergency care which included parent comprehension, communication and utilization in the pediatric emergency department. The report, “Effect of Telephone vs Video Interpretation on Parent Comprehension, Communication, and Utilization in the Pediatric Emergency Department: A Randomized Clinical Trial,” published by JAMA Pediatrics cites that language barriers in healthcare are associated with increased costs, decreased satisfaction and treatment adherence, and increased risk for harm and that professional interpretation could help mitigate these effects. The findings in the report claim that families with limited English proficiency who received video interpretation were more likely to correctly name the child’s diagnosis and had fewer lapses in interpreter use. The study concluded that expanding access to video interpretation may improve the quality and safety of care for patients and families with LEP.
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To view the full study, visit: https://link.springer.com/article/10.1007/s11606-017-3983-4