Limited English Proficiency Patients Research Articles

The Language of Equity in Digital Health: Prioritizing the Needs of Limited English Proficient Communities in the Patient Portal 2.0

Communication barriers faced by limited English proficient (LEP) patients have led to worse outcomes. Such disparities are entrenched in digital health and call into question the impact of tools such as patient portals, the primary digital touchpoint for patients. Over the last decade, portals have been implemented broadly but have done little to address the needs of LEP communities, who make up almost 10% of the U.S. population. The surge in telemedicine during the COVID-19 pandemic, which has relied in part on portals, increases the urgency for a comprehensive approach to digital disparities. We present recommendations grounded in the 7Ps of Stakeholder Engagement (policymakers, payers, product makers, purchasers, providers, patients, and principal investigators) for the next generation of portals (version 2.0). Our recommendations focus on expanding language accessibility, establishing messaging workflows to integrate language services, extending federal guidelines for language equity, and ensuring digital access and literacy.

Lost in Translation: An OSCE-Based Workshop for Helping Learners Navigate a Limited English Proficiency Patient Encounter

IntroductionResidents have been known to report a lack of self-efficacy in their ability to provide care for limited English proficiency (LEP) patients. Interpreters must be utilized to help navigate these patient encounters, but many institutions do not have a curriculum focused on utilizing interpreters effectively.MethodsWe created a 3-hour workshop for physician learners working with the pediatric population. It included a panel discussion, best-practices presentation, video demonstration, observing scenarios, and pre- and postworkshop objective structured clinical exams (OSCEs). The first OSCE introduced learners to a scenario (4-day-old with jaundice with an LEP parent) where interpreter use was imperative. The second OSCE allowed learners to perform another case (12-year-old with an abscess with an LEP parent) and practice newly obtained skills from the workshop. Both OSCEs were scored using a 16-item yes/no checklist. All pediatric residents filled out an eight-item survey to evaluate the workshop; a subset of that group performed the pre- and postworkshop OSCEs.ResultsForty pediatric residents attended the workshop and completed the survey. The workshop was well received, with the majority of residents stating they would change their current interpreter usage practices. Ten pediatric residents performed the pre- and postworkshop OSCEs; all improved their scores.DiscussionThe workshop was effective in improving how residents navigated LEP encounters. It is applicable to learners of all levels who want to improve their communication skills to provide better care for LEP patients and can be tailored to fit the needs of a specific institution.

Limited english proficiency and concordance of CKD awareness among primary care providers and patients

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.

Training Physician Assistants to Use Medical Interpreters Effectively.

To examine the internal consistency of a validated instrument for physician assistant (PA) communication skills with interpreters and evaluate a training activity focused on effectively working with interpreters during a standardized patient assessment. Six cohorts of PA students completed training on how to communicate with patients who required an interpreter. Students then completed an assessment with a limited English-proficient patient and interpreter. Student competency was assessed using a previously validated measure. Data were analyzed using a multivariable Poisson regression model. There were usable data on 439 PA students. The median number of areas that students performed/partially performed was 10 out of 12 (inter-quartile range: 3). The Poisson regression model revealed significant differences between cohorts. Areas for further training include using Teach-Back (n = 203) and thanking the interpreter (n = 170). Although the PA students performed well, there is considerable room for improvement in certain communication techniques.

Inpatient patient safety events in vulnerable populations: a retrospective cohort study

BackgroundWidespread attention to structural racism has heightened interest in disparities in the quality of care delivered to racial/ethnic minorities and other vulnerable populations. These groups may also be at increased...

The Influence of Patient-Provider Language Concordance in Cancer Care: Results of the Hispanic Outcomes by Language Approach (HOLA) Randomized Trial

Delivering linguistically competent care is critical to serving limited English proficiency (LEP) patients, and represents a key national strategy to help reduce health disparities. Current acceptable standards of communication with LEP patients include providers communicating through professional interpretive services, or bilingual providers speaking the patients’ preferred language directly. This study tests the impact of patient-provider language concordance on patient satisfaction with a randomized clinical trial. Eighty-three adult Spanish-speaking cancer patients were randomized to receive care from either 1) a bilingual physician speaking to the patient directly in Spanish or 2) from the same physicians speaking English and using a professional interpreter service. Validated questionnaires were administered to assess patient-reported satisfaction with both provider communication and overall care. Audio recordings of initial consultations with oncologists were transcribed and analyzed for content variations. Compared to patients receiving care through professional interpretive services, patients cared for in direct Spanish reported significantly improved general satisfaction, technical quality of care, care team interpersonal manner, communication, and time spent with patient. Specific to physician communication, patients rated direct Spanish care more highly in perceived opportunity to disclose concerns, physician empathy, confidence in physician abilities, and general satisfaction with their physician. Analyzing the content of consultation encounters revealed differences between study arms, with the direct Spanish arm having more physician speech related to patient history verification and partnering activities. Additionally, patients in the direct-Spanish arm were more likely to initiate unprompted speech, and asked their providers more questions. This study demonstrates improved patient-reported satisfaction among LEP cancer patients cared for in direct Spanish compared to patients cared for with interpreter-based communication. Further research into interventions to mitigate this patient-provider language barrier is necessary to optimize care for this minority population.

Student pharmacist opioid consultations with standardized limited English proficiency patients: A pre-post educational intervention study

Background and purposeThis study explored the effect of a structured educational intervention for student pharmacists to counsel limited English proficiency (LEP) patients on risks and safety of opioid medications for chronic pain. Specific aims were to compare 2018 pre-intervention versus 2019 post-intervention groups regarding: (1) dose and side effects discussed, (2) opioid risks and safety measures covered, and (3) LEP specific communication practices. Educational activity and settingThird-year student pharmacists (P3s) in a required communications course consulted LEP standardized patients (SPs) on opioid medications in 2018 and 2019. An educational intervention for the 2019 P3s consisted of a 50-min lecture, pre-lab instructions about techniques for communication about opioid risks and safety, and for LEP specific communication stressing teach-back. All consultations in the pre- and post-intervention phases were video recorded and quantitatively coded for verbal and non-verbal communication skills. Descriptive statistics and Fisher's exact tests were conducted on data. FindingsTwenty-three consultations were recorded in 2018 for the pre-intervention phase and 49 consultations were recorded in 2019 for the post-intervention phase. Only 17% of students in the pre- intervention phase called the medication an “opioid” or “narcotic” in the consultation as compared to 84% in the post-intervention phase. While 100% of students in the post-intervention phase used teach-back, only 61% did so in the pre-intervention group. Significant differences between the two groups were observed for minimizing dependency and overdose, offering naloxone, teach-back, integrating a patient handout into the consultation, and discussing use of alternate pain medications.

Access to palliative care services for limited English proficient patients with advanced NSCLC.

99 Background: More than a quarter of people living in British Columbia, Canada speak languages other than English in their homes. Immigrants often encounter communication challenges with their health care providers (HCPs), have poor health literacy, and have a limited understanding on navigating the health care system. NSCLC patients with limited English proficiency (LEP) may receive less palliative care services despite high symptom burden and significant needs due to these factors. The study goals were to observe the difference in access to community palliative home care (CPHC) and rate of completing a Do Not Resuscitate (DNR) form between NSCLC patients who are English proficient (EP) and LEP. Methods: All patients with advanced NSCLC referred to BC Cancer–Vancouver Centre in 2016 and received medical care were included (N=176). Patients seen with a medical interpreter were considered to be LEP. Demographics and clinical information were collected retrospectively. UVA using X2 test and Fisher’s exact test were used to compare EP and LEP patients. Mann-Whitney test was used to compare the median time from CPHC referral and signed DNR to death between EP and LEP patients. Results: Language of communication: English 65%, Cantonese 22%, Mandarin 6%, Korean 1%, Tagalog 1%, and other 5%. Baseline characteristics: median age 69 EP vs 76 LEP, female 44% EP vs 65% LEP, non-squamous 68% EP vs 72% LEP and squamous 14% EP vs 6% LEP. There was no difference in the rate of CPHC referral (87% EP vs 80% LEP, p=0.342) and signed DNR form (92% EP vs 89% LEP, p=0.549). The median time from CPHC referral to death was 10 weeks EP vs 15 weeks LEP (p=0.039). The median time from signed DNR to death was 5 weeks EP vs 6 weeks LEP (p=0.806). There was no statistically significant difference in location of death between the two groups: acute care 20% EP vs 24% LEP, home 27% EP vs 13% LEP, hospice 36% EP vs 39% LEP, and tertiary palliative care unit 17% EP vs 24% LEP (p=0.251). Conclusions: EP and LEP patients with NSCLC had similar rates of CPHC service referrals and end of life planning. This suggests assistance of medical interpreters at the time of oncology visits help message delivery between LEP patients and HCPs. LEP patients had earlier referrals to CPHC prior to death which may reflect an enhanced awareness and effort by HCPs to have earlier conversations with patients who may have language and cultural barriers with discussing goals of care. Good communication improves patients and their family’s understanding of the goals and scope of palliative care services and allow HCPs to better understand the patients’ wishes.

Resource utilization rates among English versus limited English proficient patients (pts) by patient-report of low health literacy (LHL).

107 Background: About 30 million people in the US report Limited-English Proficiency (LEP). LEP cancer pts are less likely to understand their medical condition(s) and are at increased risk of LHL, emergency department (ED) visits or hospitalizations. We examined the relationship between LEP, LHL, and ED visits/hospitalization in oncology. Methods: Dana-Farber Cancer Institute’s New Pt Intake Questionnaire (NPIQ) documents clinical and social determinants of health, including LHL. Pts reported LHL if they responded “a little bit”, “somewhat” or “not at all” to 1 of 2 questions: 1) “How confident are you in filling out medical forms?” and 2) “How confident are you in understanding medical statistics?”. Pts reported LEP if they noted a primary language other than English at registration. ED visits/hospitalizations were determined from Partners Healthcare System records. Statistically significant relationships between LEP, LHL and ED visits/hospitalizations and pt demographics (age, sex, race/ethnicity, zip code) and clinical (disease center, treatment intent) characteristics were determined with χ2 tests. Results: From 5/30/15 – 4/30/20, 21570 of 98200 eligible pts responded to NPIQ (response rate 22.0%). LHL differed by age (p-value < 0.001), gender (p-value < 0.001) and race/ethnicity (p-value = 0.007). Among LEP pts reporting LHL, financial distress (p-value = 0.004), emotional distress (PROMIS score; p-value = 0.014), and prior cancer (p-value = 0.006) were more prevalent; however, there was no significant statistical increase in ED visits (p-value = 0.237) or hospitalizations (p-value = 0.965) compared to LEP not reporting LHL. Conclusions: The results indicate that sociodemographic and other pt characteristics contribute to ED and hospital utilization in LEP cancer pts. Future studies will employ prospective data to examine the covariates’ predictive ability for resource utilization with LHL among LEP pts. [Table: see text]

Cultural Awareness: Ensuring High-Quality Care for Limited English Proficient Patients.

Cancer hospitals throughout the United States have seen an increase in the number of adults who are considered limited English proficient (LEP); such individuals do not speak English as their primary language and have a limited ability to read, speak, write, or understand the language. This population requires nurses who are responsive to their language and cultural needs. The purpose of this study was to assess cultural awareness among inpatient oncology nurses and to identify areas for cross-cultural training and educational development. 44 inpatient oncology nurses from an oncology unit that admits a large number of Spanish-speaking patients responded to an online survey containing 23 Likert-type questions and 4 open-ended questions. Despite survey results indicating a moderate to high level of cultural awareness, nurses expressed a need for tools and resources to provide equitable and safe care to LEP adults diagnosed with cancer. To improve the care of LEP patients, nurses suggested the use of resources such as an assigned unit interpreter, an increase in bilingual nursing staff, dual language materials, and free language lessons.

98. LOST IN TRANSLATION: SIMULTANEOUS SPANISH MEDICAL INTERPRETATION DURING FAMILY CENTERED ROUNDS FOR IMPROVED RESIDENT AND FAMILY ENGAGEMENT

Background Language barriers significantly contribute to medical errors compromising patient safety, quality of care, and resident engagement with patients. Spanish speakers account for the fastest growing population of patients within US pediatric hospitals. However, the communication needs of limited English proficiency (LEP) patients frequently remain unmet. PURPOSE: The purpose of this study is to implement equipment assisted simultaneous medical interpretation (EASMI) for Spanish speaking families on family centered bedside rounds (FCR) and determine family and trainee provider satisfaction. Methods In-person interpreters joined FCR at a tertiary care academic children's hospital. All medical discussion on FCR was interpreted simultaneously from English to Spanish. Interpreters wore a noise-cancelling microphone connected to a transmitter and family members were given a receiver with an earpiece. Qualitative interviews were performed with family members on their experience (N=25). Online qualitative and quantitative surveys were completed by medical students, residents, fellows, attendings, and nurses (N= 136). Results Surveys demonstrated 94% of physicians and 100% of nurses were “very satisfied” with EASMI. Common themes from the resident and fellow survey were improved efficiency of rounds, increased family engagement, improved understanding of the care plan, decreased communication errors and improving patient safety. After the intervention Spanish speaking families reported an increase in the domains of communication with physicians and nurses on the Child HCAHPS survey. Conclusion Medical interpretation for LEP patients and families is critical for improved healthcare and reduction in health disparities. Overall, EASMI is both an efficient and effective patient-centered intervention during pediatric FCR for increased trainee engagement with patients.

Assessing Daily Patient Communication for Radiation Therapy Patients with Limited English Proficiency

A diverse patient demographic at a cancer centre can present communication challenges due to language barriers in limited English proficiency (LEP) patients. Studies show that language barriers are linked to less health education, lower interpersonal care and lower patient satisfaction. The project’s aim is to increase communication with available interpretation tools while incorporating staff and patient perspective.

Deficiencies in Provider-Reported Interpreter Use in a Clinical Trial Comparing Telephonic and Video Interpretation in a Pediatric Emergency Department

Professional interpretation improves health care quality and outcomes for limited English proficient (LEP) patients, yet interpreter use remains low even when interpretation is available remotely. The researchers analyzed the effect of remote interpretation (telephone or video) on pediatric emergency provider attitudes and behaviors around professional interpretation. A cross-sectional questionnaire of pediatric emergency providers was conducted as part of a randomized trial of telephone vs. video interpretation with Spanish speaking LEP families. Providers recalled lapses of professional interpretation for medical communication (use of an ad hoc or no interpreter), if they had delayed or deferred communication due to the need for professional interpretation, and were asked about their satisfaction with the interpretation modality. Bivariate and multivariate analysis of professional interpreter use and communication behaviors were analyzed by self-report of study group assignment. One third of providers reported lapses of professional interpretation and many reported less frequent (45.6%) and deferred (34.6%) communication due to the need for interpretation. There was no significant difference in these outcomes between telephone and video assignment. Interpreter skill and technical difficulties were similar between groups. Providers assigned to telephone, compared to video, were more likely to be dissatisfied (p < 0.001) and to report that interpretation was ineffective (p = 0.002). Despite access to interpretation, providers caring for patients enrolled in a study of professional interpreter modalities reported frequent lapses in professional interpretation and deferring or delaying communication because an interpreter was needed. Addressing barriers to remote interpreter use will improve quality of care and health equity for LEP patients.

“Providing care across a language barrier” – A program at the intersection of inter-professional education and co-curricular engagement

Background and purposeAs the number of patients with limited English proficiency (LEP) in the United States grows, so does the importance of finding solutions for the unique challenges that may arise in the healthcare arena. The need for culturally and linguistically appropriate services (CLAS) is clear, and this topic provides fertile ground for interprofessional collaboration both in practice and education. Educational activity and settingThe authors present a description of a six-hour interdisciplinary program offered as a dual continuing education and co-curricular opportunity for faculty, preceptors, and students in health professional programs at one university. The program covered topics related to CLAS, such as Spanish language basics, ethical considerations when language barriers are present, common misconceptions that exist, and strategies and resources to improve care for LEP patients. FindingsA total of 24 participants (four nurses, two nurse practitioners, six pharmacists, two nursing students, and 10 pharmacy students) completed the program. Post-evaluation responses revealed that 94% of participants would change how they cared for patients as a result of the home study, with 80% concordance for each of the live sessions. DiscussionResponses provided helpful feedback for integration of these topics into coursework and on the value of resources for current practitioners, ultimately highlighting the value of an inter-professional training module for delivery of the content. This program was a positively received offering that enhanced inter-professional education and co-curricular offerings on an important topic.

Supply and Demand: Association Between Non-English Language-Speaking First Year Resident Physicians and Areas of Need in the USA.

Over 25 million US inhabitants are limited English proficient (LEP). It is unknown whether physicians fluent in non-English languages are training in geographic areas with the highest proportion of LEP people. Diversity of language ability in the physician workforce is an important complement to language assistance services for providing quality care to LEP patients. To determine whether non-English language-speaking resident physicians matched in the geographic areas where language skills are needed. Cross-sectional study. Postgraduate medical training applicants to the Association of American Medical College's Electronic Residency Application Service in 2013-2014 (n = 50,766). We included data from the Graduate Medical Education Track database, mapped against American Community Survey data. N/A. We assessed the geographic alignment of non-English language-speaking resident physicians relative to the distribution of the LEP-speaking population. While 37% of resident physicians spoke at least one non-English language, in most cases the languages they spoke were not those in greatest need by the US LEP population. LEP speakers' potential exposure to non-English language-speaking residents varied. For Spanish, the language with the lowest national resident physician to Spanish LEP patient ratio, the ratio was most favorable in New York at 23.7/100,000 LEP population versus 5.1 in Los Angeles. For Tagalog, the group with the highest geographic mismatch, the ratio was 70.4 in New York but 0 in San Diego, San Jose, and Seattle. Among the top five LEP languages in the USA, Chinese-speaking resident physicians were the most geographically matched. We found considerable misalignment of the geographic distribution of non-English language-speaking resident physicians relative to the distribution of the LEP-speaking population. Residency programs in areas of high need could consider better matching the non-English language needs of their community with the language abilities of the resident physicians they are recruiting.

Exploring patient preference regarding interpreter use in primary care.

Effective communication is considered an essential component of delivering health care. Trained, professional interpreters are the gold standard for overcoming language barriers with those with limited English proficiency (LEP). However, LEP patients often use unqualified interpreters such as family members and friends. Existing literature explores the rationale behind choosing different interpreters, but rarely from the patient perspective. To explore the patient perspective on the type of interpreter best suited for primary care consultations. Participants self-identified as having LEP were recruited from four GP practices in areas of Sheffield with high proportions of black and minority ethnic (BME) residents. The participants were from Urdu-, Arabic-, or Romani-speaking ethnic groups. Semi-structured interpreted interviews were recorded, transcribed, and analysed thematically with independent verification of emergent themes. Interviews continued to data saturation. All participants expressed a preference for face-to-face interpreters. Urdu and Arabic participants highlighted the importance of using an interpreter with the same dialect; Roma participants were passionate about the need for qualified Roma interpreters. Most participants also identified trust and sex as important factors. However, interpreter preference varied between participants: some valued the continuity of family members, whereas others favoured the professionalism and linguistic accuracy associated with qualified interpreters. This study identified conflicts between patient preferences and guidance for healthcare professionals; all of the participants disliked telephone interpreting, and many recognised the benefits of untrained interpreters. The study highlights the complexities of interpreter preference in primary care and suggests that the decision should be flexible, and patient centred.

Walking the talk: understanding how language barriers affect the delivery of rehabilitation services

Purpose Individuals who lack proficiency in the dominant language of their region experience difficulty accessing healthcare and exhibit poorer health outcomes. Utilization of professional interpreters can improve health services and outcomes for this population. Most existing studies focus on medical settings, with very little research about language barriers in rehabilitation services such as occupational and physical therapy. The purpose of this study was to explore experiences of English-speaking rehabilitation clinicians working with limited English proficient (LEP) patients, as well as LEP patients receiving rehabilitation services. Methods A qualitative study was conducted involving four focus groups with seven Spanish-speaking patients and 13 primarily English-speaking occupational and physical therapy clinicians. Transcripts and field notes were analyzed using directed content analysis. Results Time and resource constraints, session demands, environmental factors, previous experiences, and patient characteristics influenced clinicians’ decisions about whether to use professional interpretation, rely on untrained interpreters, or go without interpretation. Clinicians discussed both challenges and joys of working across language barriers. Patients reported minimal experiences with, and expectations of professional interpretation in rehabilitation, instead describing clinicians’ attempts to “get by” with limited non-English language skills. Conclusions Findings highlight unique considerations for language access in rehabilitation compared with other settings. These findings inform structural, process, and outcomes recommendations and changes in practice guidelines to improve language access in rehabilitation services. Implications for Rehabilitation Rehabilitation encounters present unique challenges for language interpretation services that require creative technological, procedural, and structural solutions. Technological solutions include flexible and mobile telecommunication devices, such as headsets, which allow real-time interpreting without interfering with treatment processes. Procedural solutions include establishing a systematic mechanism for recording patients’ language needs, creating a standard and seamless protocol for clinicians to obtain language supports, and hiring trained interpreters who are familiar with rehabilitation jargon. Structural solutions include budgeting for interpreter services, sponsoring trainings for staff and clinicians, and adjusting clinicians’ workload and expectations to allow greater time and flexibility to meet patients’ language needs.

Abstract A035: The influence of patient-provider language concordance in cancer care: Results of the Hispanic Outcomes by Language Approach (HOLA) randomized trial

Abstract Purpose: Delivering linguistically competent care is critical to serving limited English proficiency patients, and represents a key national strategy to reduce health disparities. Current acceptable standards of communication with non-English speaking patients include providers communicating through professional interpretive services, or bilingual providers speaking patients’ non-English languages directly. This study tests the impact of patient-provider language concordance on patient satisfaction through the conduct of a randomized clinical trial. Methods and Materials: Eighty-three adult Spanish-speaking cancer patients were randomized to receive care from either 1) a bilingual physician speaking to a patient directly in Spanish or 2) from the same physician speaking English and using a professional interpreter service. Validated questionnaires were administered to assess patient-reported satisfaction with both provider communication and overall care. Audio recordings of initial consultations with oncologists were transcribed and analyzed for content variations. Results: Compared to using professional interpretive services, patients cared for in direct Spanish reported significantly improved general satisfaction, technical quality of care, care team interpersonal manner, communication, and time spent with patient. Specific to physician communication, patients rated direct Spanish care more highly in perceived opportunity to disclose concerns, physician empathy, confidence in physician abilities, and general satisfaction with their physician. Analyzing the content of consultation encounters revealed differences between study arms, with the direct Spanish arm having more physician speech related to patient history verification and partnering activities. Additionally, patients in the direct-Spanish arm were more likely to initiate unprompted speech, and ask their providers questions. Conclusions: This study demonstrates improved patient-reported satisfaction among Spanish-speaking cancer patients cared for in direct Spanish compared to patients cared for with interpreter-based communication. Further research into interventions to mitigate this patient-provider language barrier is necessary to optimize care for this minority population. Citation Format: Daniel M Seible, Souma Kundu, Alexa Azuara, Daniel Cherry, Steven Arias, Vinit Nalawade, Jonathan Cruz, Rolando Arreola, Elena M Martinez, Jesse Nodora, Douglas A Rahn, James D Murphy. The influence of patient-provider language concordance in cancer care: Results of the Hispanic Outcomes by Language Approach (HOLA) randomized trial [abstract]. In: Proceedings of the Twelfth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2019 Sep 20-23; San Francisco, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl_2):Abstract nr A035.

Provider–patient Language Discordance and Cancer Operations: Outcomes from a Single Center Linked to a State Vital Statistics Registry

Patterns of worldwide immigration have resulted in high rates of discordance between medical providers and the patients they treat. For example, in the USA, 25 million individuals in the USA self-identified that they speak English less than "very well." Previous studies have generated mixed results regarding differences in postoperative outcomes between English proficient (EP) and limited English proficient (LEP) patients. Our objective was to determine whether a difference in outcomes exists for non-English-speaking patients compared to English-speaking patients after operations commonly performed to treat cancer. A retrospective cohort study was performed in an urban, safety net and tertiary referral medical center over a five-year period. Adult patients undergoing cancer operations were stratified as EP and LEP. We evaluated 30-day revisit to the ED, length of stay (LOS), long-term all-cause mortality, and any major complication on index admission. Regression was used to adjust for baseline comorbidities, case risk, and socioeconomic factors. A total of 2467 patients were included. There was no difference in case risk between language groups, but EP had a larger proportion of high comorbidity scores. Patients in the non-English group were more likely to be uninsured/self-pay andlive in neighborhoods with lower median income. After adjustment, we found no difference in long-term mortality [hazard ratio: 0.87 (95% CI 0.52-1.45)]. LEP patients had the same LOS compared to primary EP patients with an IRR of 0.99 (95% CI 0.88-1.10). There was no difference in the odds of revisit to hospital for LEP versus EP, with an OR of 1.08, 95% CI [0.75-1.53] and no difference in major complication (OR 0.76 (95% CI 0.39-1.45). We found no association between language and outcomes after cancer operations. This lack of difference may reflect local efficacy at treating non-English-speaking patients, and health systems with fewer services for LEP patients might show different results.

Quality of Care and Communication With Limited English Proficiency (LEP) Obstetric Patients [37J

INTRODUCTION: Hospital guidelines and standards recommend the routine use of professional interpreters for patients with Limited English Proficiency (LEP). There is no preexisting data on LEP obstetrics patients and their communications with physicians and nurses. Our objective was to review English LEP patients’ communication with physicians and nurses during their delivery hospitalization, including the use of interpreters and language proficient providers, as well as its association with patient satisfaction. METHODS: Cross-sectional study with in-person survey methodology and retrospective chart review of patients admitted to our postpartum service after delivery at our institution. IRB exempt. RESULTS: 148 postpartum patients were screened. After applying inclusion and exclusion criteria, 20 patients participated in the survey. 70% of these patients were admitted by non-language proficient provider. Of these, only 36% documented use of interpreter during admission. 2 of the 3 patients who underwent cesarean section reported that the reason for cesarean was explained to them in English without the use of interpreter. Despite this, there was reported 100% satisfaction with overall physician care, physician communication with respect to medical condition, and physician respect for culture and language. CONCLUSION: We hypothesized that the rate of use of interpreters and language-proficient providers would be poor, and this proved to be correct in our internal review. The high reported rates of patient satisfaction with both physician and nursing care, communication, and perception of respect for culture and language was a seemingly discordant finding that warrants further exploration. Patient satisfaction drivers may be somewhat different for obstetric populations. This warrants further investigation.