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Communication with Limited English Proficiency Patients: Assessment of Resident Behaviors and Training
Abstract Number: F3A-6
Abstract Type: Original Research
Background: Healthcare outcome disparities, errors, and adverse events are more common in patients with Limited English proficiency (LEP),[1,2] including OB patients.[3,4] Parturients with LEP report lower analgesic satisfaction scores, delayed analgesic responsiveness, unhelpful staff, and limited/no access to interpretation services. Perineal trauma after vaginal delivery was reported to be 2-fold more frequent in LEP mothers compared to English-speakers.. We surveyed anesthesia residents on training and knowledge related to LEP, and practice patterns with LEP patients.
Methods: Residents assigned to OB Anesthesia from 8/2014 to 8/2016 were surveyed on their language skills, interpreter services (IS) training, knowledge, attitude, and practice caring for LEP patients. Quantitative data were analyzed with descriptive statistics. Three investigators conducted qualitative content analysis of textual responses. Each reviewed and coded responses independently and developed a preliminary coding scheme using inductive grounded approach. Coding schemes were compared and a final scheme was derived through consensus. Investigators independently applied the scheme to all responses. Analyses were compared, disagreements resolved through consensus.
Results: 51 of 52 residents completed the survey. Med school education regarding LEP was variable, but post-graduate training was minimal. Many reported some knowledge of LEP communication issues and recommended best practices, yet, despite ready access to IS, most reported clinical practices at odds with that knowledge—e.g. communicating without interpreters; using ad hoc interpreters; reliance on own language skills; performing procedures without an interpreter. Most (94%) described problems with telephonic IS (technical; language concordance; time intensity/delays; imperfect interpretation; "impersonal" communication). They admitted limiting or abbreviating interactions with LEP patients because of language barriers often (10%), occasionally (68%), or never (22%). Many reported lack of knowledge on issues with ad hoc interpreter use (49%), federal/state laws (85%), and institutional policies (90%) on access to IS.
Conclusion: Nearly 20% of parturients at our institution have LEP. Our results reveal important knowledge gaps on best practices among residents, consistent with reports of non-anesthesia clinical practices in centers with large LEP populations and ample IS support.[5,6] Our results suggest possible reasons—education deficiencies, perceived time-related constraints, perceived problems with IS, logistical barriers, and the hidden curriculum. Our findings highlight need for training interventions to promote best practices when caring for LEP patients.
1) Betancourt. Int J Health Policy Manag 2014;2:91
2) Divi. Int J Qual Health Care 2007;19:60
3) Jimenez. J Gen Intern Med 2012;27:1602
4) Sentell. Women Health 2016;56:257
5) Diamond. JGIM 2008;24:256
6) Parsons. BMJ Open 2014;4:e004613