Dataset Information

Development and pilot testing a communication simulation training for interpreters to improve pain communication between primary care providers and patients with limited English proficiency.

ABSTRACT:

Context

Health disparities in patients with limited English proficiency are worsened due to scarcity of interpreter-focused communication interventions and trainings.

Objectives

To develop a high-fidelity simulation training for interpreters to use a novel pain communication tool, i.e., Pain Assessment Information Visualization (InfoViz) Tool, and evaluate interpreters' implementation fidelity during a pilot study.

Methods

This research methodology study involved training interpreters through high-fidelity simulations and assessing the implementation fidelity of 20 patient-provider visits in primary care clinics. Descriptive statistics were calculated for the assessment and fidelity. Debriefing interviews were conducted after the training and at the study completion. These were transcribed and analyzed using thematic analysis.

Results

Four interpreters completed training, requesting an average of 2.5 practice simulation studies prior to assessment (M = 54 min, score: M = 95%). Interviews revealed two themes: positive experiences and suggestions for improvement. Interpreters averaged 83% for implementation fidelity for the 20 visits. Post-study interviews revealed positive experiences and the need for refresher training.

Conclusion

The communication simulation training for interpreters is feasible, acceptable, and can ensure accurate use of the Pain InfoViz Tool during provider-patient communication.

Innovation

We applied a InfoViz Tool in pain simulations and extended high-fidelity training to medical interpreting.

SUBMITTER: Lor M

PROVIDER: S-EPMC10550806 | biostudies-literature | 2023 Dec

REPOSITORIES: biostudies-literature

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Publications

Development and pilot testing a communication simulation training for interpreters to improve pain communication between primary care providers and patients with limited English proficiency.

Lor Maichou M Hammes Abby M AM

PEC innovation 20230920

<h4>Context</h4>Health disparities in patients with limited English proficiency are worsened due to scarcity of interpreter-focused communication interventions and trainings.<h4>Objectives</h4>To develop a high-fidelity simulation training for interpreters to use a novel pain communication tool, i.e., Pain Assessment Information Visualization (InfoViz) Tool, and evaluate interpreters' implementation fidelity during a pilot study.<h4>Methods</h4>This research methodology study involved training i ...[more]

PMID: 37811194

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Project description:BackgroundLanguage barriers disrupt communication and impede informed consent for patients with limited English proficiency (LEP) undergoing healthcare procedures. Effective interventions for this disparity remain unclear.ObjectiveAssess the impact of a bedside interpreter phone system intervention on informed consent for patients with LEP and compare outcomes to those of English speakers.DesignProspective, pre-post intervention implementation study using propensity analysis.SubjectsHospitalized patients undergoing invasive procedures on the cardiovascular, general surgery or orthopedic surgery floors.InterventionInstallation of dual-handset interpreter phones at every bedside enabling 24-h immediate access to professional interpreters.Main measuresPrimary predictor: pre- vs. post-implementation group; secondary predictor: post-implementation patients with LEP vs. English speakers. Primary outcomes: three central informed consent elements, patient-reported understanding of the (1) reasons for and (2) risks of the procedure and (3) having had all questions answered. We considered consent adequately informed when all three elements were met.Key resultsWe enrolled 152 Chinese- and Spanish-speaking patients with LEP (84 pre- and 68 post-implementation) and 86 English speakers. Post-implementation (vs. pre-implementation) patients with LEP were more likely to meet criteria for adequately informed consent (54% vs. 29%, p = 0.001) and, after propensity score adjustment, had significantly higher odds of adequately informed consent (AOR 2.56; 95% CI, 1.15-5.72) as well as of each consent element individually. However, compared to post-implementation English speakers, post-implementation patients with LEP had significantly lower adjusted odds of adequately informed consent (AOR, 0.38; 95% CI, 0.16-0.91).ConclusionsA 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. Additional clinician educational interventions and more language-concordant care may be necessary for informed consent to equal that for English speakers.

Project description:BackgroundPatient awareness of CKD and primary care provider (PCP) recognition of CKD are lower than for other chronic conditions. Understanding how patients may become aware of CKD is critical to their participation in healthy behaviors to slow CKD progression. We examined factors associated with the concordance of CKD awareness among patients and providers and hypothesized that concordance of CKD awareness would be influenced by social and demographic factors that impact communication, such as limited English proficiency (LEP) and health literacy.MethodsBetween July 2011 to July 2014, patients with CKD from three primary care clinics in a public healthcare delivery system were surveyed with questions regarding their health, including awareness of their CKD status. Chart review was performed to identify PCP recognition of CKD, defined as CKD listed anywhere in the problem list within nine months before patient enrollment into the study. We used logistic regression to determine the association between provider recognition and patient awareness of kidney disease among those patients with CKD, adjusting for patient demographics, co-morbidities, and provider training.ResultsThe study population (n = 152) had a mean age of 57.4 (SD 13), was 48.7% male and was racially/ethnically and linguistically diverse: 89.5% self-identified as Black, Hispanic, or Asian and 32.2% had LEP. Most patients had hypertension (89.5%) and diabetes (77.6%); mean eGFR was 66.1 ml/min/1.73m2 (SD 32.8). Positive concordance of CKD awareness was 42% (n = 64). Odds of positive concordance with their providers were much higher among patients with LEP compared to English speaking patients (adjusted odds ratio = 11.07, 95%CI 1.60-76.39).ConclusionsConcordance of CKD awareness among PCPs and their patients with CKD in one public delivery system was higher among patients with LEP. While speculative, this may be due to greater caution in provider communication about CKD with LEP patients.

Project description:BackgroundLimited English proficiency (LEP) is associated with poor health status and worse outcomes.ObjectiveTo examine disparities in hypertension between National Health and Nutrition Examination Survey (NHANES) respondents with LEP versus adequate English proficiency.DesignRetrospective analysis of multi-year survey data.ParticipantsAdults 18 years of age and older who participated in the NHANES survey during the period 2003-2012.Main measuresWe defined participants with LEP as anyone who completed the NHANES survey in a language other than English or with the support of an interpreter. Using logistic regression, we estimated the odds ratio for undiagnosed or uncontrolled hypertension (systolic blood pressure (SBP) > 140 mmHg or diastolic blood pressure (DBP) > 90 mmHg) among LEP participants relative to those with adequate English proficiency. We adjusted for sociodemographic, acculturation-related, and hypertension-related variables.Key resultsFourteen percent (n = 3,269) of the participants had limited English proficiency: 12.4% (n = 2906) used a Spanish questionnaire and 1.6% (n = 363) used an interpreter to complete the survey in another language. Those with LEP had higher odds of elevated blood pressure on physical examination (adjusted odds ratio [AOR] = 1.47 [1.07-2.03]). This finding persisted among participants using an interpreter (AOR = 1.88 [1.15-3.06]) but not among those using the Spanish questionnaire (AOR = 1.32 [0.98-1.80]). In a subgroup analysis, we found that the majority of uncontrolled hypertension was concentrated among individuals with a known diagnosis of hypertension (AOR = 1.80 [1.16-2.81]) rather than those with undiagnosed hypertension (AOR = 1.14 [0.74-1.75]). Interpreter use was associated with increased odds of uncontrolled hypertension, especially among patients who were not being medically managed for hypertension (AOR = 6.56 [1.30-33.12]).ConclusionsIn a nationally representative sample, participants with LEP were more likely to have poorly controlled hypertension than those with adequate English proficiency. LEP is an important driver of disparities in hypertension management and outcomes.

Dataset Information

Development and pilot testing a communication simulation training for interpreters to improve pain communication between primary care providers and patients with limited English proficiency.

Context

Objectives

Methods

Results

Conclusion

Innovation

Publications

Development and pilot testing a communication simulation training for interpreters to improve pain communication between primary care providers and patients with limited English proficiency.

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