Spanish Interpretation Research Articles

12262 Pheochromocytoma Masquerading As An Acute Myocardial Infarction And Takotsubo Cardiomyopathy In A Hispanic Woman: A Case Report

Abstract Disclosure: A. Hoskote: None. J. Seidenberg: None. V. Gupta: None. Pheochromocytoma is a rare neuroendocrine tumor (<1 per 100,000 person-years) that occurs sporadically or due to mutations. While most patients do not have the classic headache, sweating and tachycardia, about 50% have paroxysmal hypertension and 90% have headaches. We present a rare case of pheochromocytoma masquerading as myocardial infarction (MI) and cardiomyopathy. A 67-year-old Hispanic female with history of hypertension and uncontrolled Type 2 DM, presented to the ER for chest pain and diaphoresis. Home medications were metformin, sitagliptin, lisinopril, simvastatin and aspirin. EKG showed non-specific ST elevations in chest leads without STEMI, and labs revealed a dynamic troponin and hemoglobin A1C of 13.6%. CT angiography ruled out pulmonary embolism. A left heart catheterization and echocardiogram revealed non obstructive coronary artery disease (CAD), a left ventricular ejection fraction of 25%, apical ballooning and a laminar thrombus. She was diagnosed with acute myocardial infarction and Takotsubo cardiomyopathy and discharged on metoprolol and apixaban. During our evaluation 7 months later, we noted several ER and hospital admissions for symptomatic hypertensive emergency with a pattern of labile blood pressures and on review of initial CT scan, a sequentially growing left adrenal mass (3.9cm 29HU) was present. A careful history using Spanish interpretation revealed episodic headaches, diaphoresis and palpitations. Subsequently, on two separate occasions, plasma normetanephrine was 2006 pg/mL (ULN<148 pg/mL) and urine normetanephrine was 12516 mcg/g cr (ULN <524 mcg/g cr). Prazosin was prescribed with stabilization of hypertension. An adrenalectomy is now scheduled. Symptoms of pheochromocytoma and paraganglioma (PPGs) are caused by hypersecretion of one or combinations of catecholamines: norepinephrine, epinephrine and dopamine. In one study 27% were discovered due to symptoms while 61% were found incidentally. PPGs occur in up to 1:500 patients with arterial hypertension and can also be a secondary cause of diabetes. MI and acute or chronic cardiomyopathy are rare presenting features of PPGs. Takotsubo cardiomyopathy is the most common phenotype. In one acute MI study, Hispanic women were significantly more likely to receive delayed care as compared to non-Hispanic women, due to misinterpretation of symptoms by patients and providers. A meticulous history with formal interpretation in patients with limited English proficiency can lead to prompt diagnosis of this surgically curable cause of hypertension. Pheochromocytomas rarely present as acute myocardial infarction and stress cardiomyopathy. A high suspicion for PPGs must be maintained in patients with labile hypertension, cardiomyopathy and an incidental adrenal mass. History should be carefully revisited especially in patients with limited English proficiency. Presentation: 6/3/2024

The effect of primary language on access to specialized orthopedic care

BackgroundLanguage barriers can negatively impact the quality of care for non-English speaking patients. Lack of access to health-care providers who speak multiple languages or interpreters in medical offices can result in delayed appointment times, delayed treatment, and increased complications. Access to shoulder surgeons with subspecialty training is limited and this has been established which may further exacerbate the problem with access for these patients. The purpose of this study was to determine the effect of primary language spoken on access to specialty shoulder care in South Florida. MethodsThree populous, diverse counties in South Florida were selected for data collection. Sixty-nine orthopedic offices were identified by Google search and selected via random number generator. Investigators used the Secret Shopper methodology to contact each office to schedule an appointment for a shoulder arthroplasty for a family member who spoke exclusively English or Spanish using a blocked phone number. The ability to schedule a new patient appointment with a fellowship-trained shoulder specialist, the waiting period for the scheduled appointment, and interpretation services for Spanish-speaking patients were collected. ResultsOf the 69 offices called, 35 met inclusion criteria. There were no significant differences in wait times for shoulder arthroplasty based on primary language spoken. There was no difference in wait time to see a shoulder specialist between Spanish (13.7 days) and English-speaking patients (12.9 days) (P = .835)). Wait times with a nonfellowship-trained orthopedic surgeon between Spanish and English-speaking patients was also not different (9.5 days and 11.96 days, respectively (P = .522). Similarly, no difference existed in phone call duration (P = .56), median income and wait times for a general orthopedic surgeon, with r = −0.26 (P = .105), or a shoulder specialist, with r = −0.19 (P = .22). Of the clinics accepting patients, 74.3% (n = 26/35) offered Spanish interpretation with 42.3% (n = 11/26) providing a multilingual physician, 26.9% (n = 7/26) a translating service, 23.1% (n = 6/26) had a staff member capable of translation, and 7.7% (n = 2/26) had an available professional interpreter. ConclusionWhile access to orthopedic specialty care may be similar for Spanish-speaking and English-speaking patients in South Florida, over 25% of clinics lack multilingual physicians or qualified interpreter access. This can negatively impact surgical decision-making, postoperative care and outcomes after shoulder surgery. It is essential the orthopedic community advocates for the proper resources to optimally assist surgeons and provide quality care for Spanish-speaking orthopedic patients.

Barriers and Facilitators to Telemedicine Contraception Among Patients Who Speak Spanish: A Qualitative Study [ID 2692431

INTRODUCTION: The objective of this study was to evaluate the barriers and facilitators of telemedicine for contraception care among patients who speak Spanish using a community-based participatory research approach. METHODS: We interviewed 20 patients after telemedicine and in-person contraception visits conducted in Spanish at Planned Parenthood of the Pacific Southwest in Southern California. Two coders analyzed the data using content analysis. RESULTS: Most participants had some college education (14, 65%) and public insurance (18, 90%). Most chose a short-acting contraceptive method (11, 55%). Five key themes were identified. 1) Participants reported less comfort with video technology and a preference to not be seen during the appointment, therefore preferring audio-only for telemedicine visits. 2) Participants did not report difficulty with Spanish interpreters using telemedicine. 3) Telemedicine has conveniences related to time, work, childcare, and transportation but may have inconveniences related to method receipt. 4) Preference for comprehensive care with physical examination and familiarity of the in-clinic model motivated people who sought in-person care rather than technology barriers with telemedicine. 5) There is trust in the privacy and confidentiality of the visits, but privacy at home for the individual may affect choice for in-person care. CONCLUSION: Many patients who speak Spanish preferred audio-only technology for telemedicine contraception visits. Use of interpreters and technology were not perceived barriers for care. There is a need for prospective studies comparing the quality of telemedicine among patients who speak Spanish for contraception care.

Quality Improvement Initiative: Utilization of Video Postoperative Instructions in Breast Reduction Enhances Patient Experience

Abstract Goals/Purpose The current standard of care for providing postoperative instructions to patients undergoing elective, ambulatory surgeries often falls short in efficiency, clarity, and patient-centeredness. Patients are given a single set of written instructions at the time of discharge after their surgery, which often leads to confusion and increased reliance on phone calls, urgent clinic appointments, and even unnecessary visits to the emergency department. Recognizing this, we propose a quality improvement initiative to enhance postoperative instructions for breast reduction patients through a video format. Methods/Technique With institutional IRB approval, all adult patients undergoing bilateral breast reduction (CPT 19318) at an urban academic hospital were included over a 3-month period. A 2-minute video with standardized narrative instructions and visual aids was created. Patients viewed the video during the preoperative visit, and a QR code link to the video was provided in the visit summary on the day of surgery. A Spanish version of the video was available if a Spanish interpreter was used during informed consent. The number of phone calls and emergency department visits within 30 days were recorded and compared to a cohort of patients before this intervention. Qualitative surveys were administered pre- and post-operatively to collect patient feedback. Results/Complications During the study period, 59 patients received breast reduction surgery and were given the standardized video instructions pre- and post-operatively (video group). In comparison, 75 breast reduction patients from the prior 3 months, who received nonstandardized, written instructions post-operatively, served as the control group. In the video group, 47% of patients (28 out of 59) made at least one phone call to the clinic, averaging 0.7 calls per patient, while 56% of the control group patients (42 out of 75) made at least one phone call, averaging 1.1 calls per patient. Categorizing reasons for the calls, there was a significantly higher proportion of calls related to wound dehiscence or minor drainage in the video group (41%) compared to the control group (22%; p=0.03). This shift may be attributed to a reduction in routine postoperative care questions due to the clarity provided by the video instructions (FIGURE1). There were 4 unnecessary emergency department visits within 30 days post-surgery in the study period, slightly decreased from the control period's 6 visits (after excluding 1 visit with the patient diagnosed with pulmonary embolism); however, the difference was not statistically significant. Fifteen patients who received the video instruction completed a survey, with 80% rating the video as very helpful, and 80% were able to access the QR code without assistance. These patients scored an average of 81 out of 100 on satisfaction with information measured using the BREAST-Q module after receiving the video instruction. There was no difference in complication between the two groups of patients. Conclusion Video instruction proves to be a viable format for patient education and postoperative instruction, offering consistency, multilingual support, and enhanced learning through visual aids. Patient acceptance is high, indicating good baseline digital literacy and encouraging the use of this technology among surgery providers.

Association between no-show rates and interpreter use in a pediatric otolaryngology clinic.

To understand how primary language and interpreter use affect no-show rates in pediatric otolaryngology. This is a retrospective cohort study using medical records of new patients in a pediatric otolaryngology clinic from 2014 to 2019. Data was collected on patient demographics including age, primary language, insurance type, maternal education level, maternal primary language, interpreter use at the first visit, total number of appointments scheduled, number of missed appointments, and number of completed appointments. Inferential statistics using parametric (ANOVA) and non-parametric (Mann-Whitney U tests, Kruskal-Wallis tests, and Spearman correlation coefficient) methods were used. Primary language was associated with significant differences in no-show rates (p=0.0474), with Spanish and English speakers having the lowest no-show rate (33%). Overall, interpreter use at the first visit was not significantly associated with subsequent appointment attendance (p=0.3674). Patients with a documented Spanish interpreter at the first visit had the lowest average no-show rate (31%±19%) compared to Haitian Creole (42%±18%) and all other languages (32%±19%) (p=0.0265). Hispanic ethnicity, maternal education level, and maternal primary language were not associated with attendance. Interpreter use at the first visit was not significantly correlated with no-show rates, but among patients that did require an interpreter at the first visit, those receiving services in Spanish had the best clinic attendance.

Preparation of Individuals Who Are Visually Impaired for Employment as Spanish Interpreters

Preparation of Individuals Who Are Visually Impaired for Employment as Spanish Interpreters

Optimizing Care for Spanish-Speaking Patients and Families in the Hospital: Defining the Gaps and Interventions.

Clinical and safety outcomes continue to be unequal between Spanish-speaking limited-English-proficient patients and English-proficient patients in the US healthcare system. In our study, “Spanish Interpreter Services for the Hospitalized Pediatric Patient: Provider and Interpreter Perceptions,” we conducted focus groups at one freestanding children's hospital to elicit perspectives on interpreter and provider roles, modalities of interpretation, and barriers to accessing language services.1 Staff agreed interpreters should provide word-for-word interpretation (conduit role); some felt interpreters could also act as advocates or cultural brokers.

Perceptions and experiences of Latinx parents with language barriers in a pediatric emergency department: a qualitative study

BackgroundPrior research has shown disparities exist among Latinx children who require treatment for respiratory illnesses within the pediatric emergency department (PED). Limited data exist regarding Latinx families’ experiences on the care they received at PEDs within non-traditional destination areas (NDA). Their experiences can identify areas of improvement to potentially reduce healthcare disparities among pediatric patients within this population. The purpose of this qualitative study was to explore the lived experiences of Latinx families with low English proficiency in the PED with a NDA. The broader purpose was to identify areas of improvement for reducing health care disparities among Latinx families.MethodsWe used qualitative methods to analyze semi-structured interviews among Latinx families who presented to the PED with their 0–2 year-old child for a respiratory illness from May 2019 through January 2020. All participants had low English proficiency and requested a Spanish interpreter during registration. All interviews were transcribed and reviewed using thematic analysis based on a phenomenology framework.ResultsInterviews were conducted with 16 Latinx parents. Thematic analysis revealed four major themes: (1) Uncertainty - Families expressed uncertainty regarding how to care for a child with distressing symptoms, (2) Communication – Families favored in-person interpreters which enhanced communication and allowed families to feel more informed, (3) System Burden – Families reported that the unfamiliarity with the US health system and lack of resources are additional burdens, and (4) Emotional Support – The emergency department visits garnered confidence and reassurance for families.ConclusionsOur study identified four major themes among Latinx families within a PED of a NDA. Potential areas of interventions should focus on supporting access to an interpreter, improving information delivery, and enhancing education on community resources for families with low English proficiency.

A Mother's Loss and a Case of Failed Cultural Humility

We describe a case of a 25-year-old Quiché (or K'iche') speaking G2P2022 (2 pregnancies, 2 term births, 2 live births) woman who was transferred from an outside hospital on postpartum day 3, to preserve mother-baby dyad while her infant required a higher level of care after suffering an apneic episode at 22 hours of life. Although the patient was a known Quiché speaker, lack of access to Quiché interpreters in the hospital led to the use of Spanish interpreters. Her treatment team subsequently described her affect as “flat” and reported “poor maternal care,” leading to a report to the Administration for Children's Services. As we analyze this case, we use person-centered maternity care as a framework to discuss areas for improvement in providing care to peripartum individuals, as well as cultural safety and humility as solutions to cultural gaps between patients and providers. [ Psychiatr Ann. 2022;52(12):500–503.]

Assessing Availability and Effectiveness of Pharmacy Spanish Interpreter Services: A Systematic Review

Assessing Availability and Effectiveness of Pharmacy Spanish Interpreter Services: A Systematic Review

Teaching English-Spanish Simultaneous and Consecutive Interpretation During COVID-19

In this article, I would like to leave written testimony about how we coped with the COVID-19 pandemic in the Spanish Interpretation Program at the Middlebury Institute of International Studies at Monterey (MIIS), where I teach English into Spanish simultaneous and consecutive interpretation. I will describe our experience immediately after COVID-19 hit the US, how professors and students transitioned from an in-person program to a remote one, how we stayed in a fully remote program for two and a half semesters, and how we went back to the physical classroom to a hybrid model once restrictions were lifted in the US. I will explain how I structured my simultaneous and consecutive interpretation classes in each semester that we stayed remote and the changes that I introduced once we went back to campus to a hybrid model. In addition, I will address some of the pros and cons that I found with each model based on my own experience. I will also cover the different initiatives that MIIS has put in place to support the professional development of professors to adapt our classes to the remote and hybrid model. To conclude, I would like to share with the readers the results of a survey conducted among students taking the Master of Arts in Translation and Interpretation (MATI), Master of Arts in Conference Interpretation (MACI), Master of Arts in Translation (MAT), and Master of Arts in Translation and Localization Management (MATLM) in the Spanish Interpretation Program at MIIS. The students who completed the survey were exposed to the remote, hybrid, and in-person models. The purpose of the survey was to informally gather the students’ opinions on the different models for learning interpretation that they experienced: in-person, online, and hybrid. I will finish the article with a reflection on the future of teaching interpretation in the Spanish Interpretation Program at MIIS.

Prenatal Considerations and Outcomes for Girls Aged 14 and Under: Development of a Multidisciplinary Team in a Large Tertiary Care Facility.

Adolescent girls account for 11% of all births that occur globally every year. Among developing countries, the United States continues to have one of the highest adolescent birth rates, despite a decreasing trend between 1990 and 2010. Pregnant adolescents are a vulnerable population who are at increased risk for maternal morbidity and mortality. Additional risks are noted within the early adolescent population, usually defined as age 10 to 14. At Parkland hospital, a large tertiary care facility in Dallas, Texas, a multidisciplinary team was created in 2017 to care for this vulnerable population. The team consisted of a certified nurse-midwife (CNM), a Certified Child Life Specialist, a maternal fetal medicine physician, a social worker, and a Spanish interpreter, with additional services consulted as needed. Between 2017 and 2020, this team grew to include 8 CNMs and provided care to 76young adolescents ages 14 and younger. Of the young adolescents who attendedprenatalvisits with theAdolescent Prenatal Care Team at Parkland, 87%presented toParkland for birth.Eighteen percent had pregnancy-induced hypertension or eclampsia. Only7% of adolescents in the program gave birthprior to 37 weeks. Seventy-four percent had vaginal births. Sixty percentof the adolescents attendedknown postpartum visits. In contrast to most studies, this Adolescent Care Team did not find a high rate of premature birth in early adolescents. Further work by this team is needed to compare the data obtained during this period with data on similar adolescents who have given birth at Parkland in prior years. In addition, comparing outcomes of early adolescents with those aged 15 to 19, who were not included in the Adolescent Care Team, will help to understand the impact that such a team or similar intervention might have on this vulnerable population.

Inpatient Telehealth Experience of Patients With Limited English Proficiency: Cross-sectional Survey and Semistructured Interview Study.

BackgroundPatients with limited English proficiency (LEP) are at a higher risk of poor health outcomes and are less likely to use telehealth than English-speaking patients. To date, there is no formal evaluation of inpatient (IP) telehealth user experience of patients and their families by language preference during visits with their clinicians.ObjectiveThis study aims to compare the experiences of English- and Spanish-speaking patients and their families using IP telehealth, as well as to evaluate the experience of Spanish interpreters providing services through IP telehealth.MethodsWe prospectively administered a survey to English- and Spanish-speaking patients and their families who used IP telehealth from October 1, 2020, to March 31, 2021. We performed semistructured phone interviews of hospital-based Spanish interpreters who provided services through IP telehealth.ResultsA total of 661 surveys were administered, with completion rates of 18% (112/621) in English and 62% (25/40) in Spanish. On a 10-point scale, the overall satisfaction of Spanish speakers (median 10, IQR 10-10) was higher than that of English speakers (median 9, IQR 8-10; P=.001). Both English- and Spanish-speaking patients used IP telehealth for visits with their primary IP care team, subspecialty consultants, and other clinicians. Hospital tablets were used more often than personal devices, and only English-speaking patients used personal laptops. Patients and their families encountered challenges with log-in, team coordination with multiple users, and equipment availability. Interpreters encountered challenges with audio and video quality, communication, safety, and Wi-Fi access.ConclusionsBoth English- and Spanish-speaking patients reported high satisfaction using IP telehealth across multiple disciplines despite the workflow challenges identified by interpreters. Significant investment is needed to provide robust infrastructure to support use by all patients, especially the integration of multiple users to provide interpreter services for patients with LEP.

Bridging the Gap: A Palliative Care–Modeled Goals of Care Curriculum for In-Person Spanish Interpreters Providing Language Services to Patients with Limited English Proficiency

Bridging the Gap: A Palliative Care–Modeled Goals of Care Curriculum for In-Person Spanish Interpreters Providing Language Services to Patients with Limited English Proficiency

ОТ КРАУЗИЗМА К ПОЗИТИВИЗМУ: РАЗВИТИЕ ИСПАНСКОЙ ИСТОРИКО-ФИЛОСОФСКОЙ МЫСЛИ КОНЦА XIX – НАЧАЛА XX ВЕКА ГЛАЗАМИ ИСПАНСКИХ ИССЛЕДОВАТЕЛЕЙ

This article considers the development of Spanish historical thought between the mid-19th and the early 20th centuries. The main stages in the development of the Spanish historical tradition are singled out. The features and driving forces of each stage are analyzed. The representatives of the traditions under study are given in chronological order. Their contributions to Spanish historical thought are specified. The brightest ideas of the most prominent scholars that reveal the unique nature of Spanish historical thought are discussed. Moreover, it was these ideas that provoked the dramatic changes in the Spanish interpretation of history in general, as well as in the approaches and methods of its study. The gradual movement of Spanish historiography to its current state is presented through a variety of views from the works of Spanish historians. The common interpretations of every phenomenon or trend are supplemented with alternative theories and concepts. The progress of Spanish historical thought is traced up to the early 20th century. The first step is marked by the adaptation of the ideas of Krausism, which largely affected the subsequent evolution of Spanish historical thought. The period that followed is associated with positivist ideas; its characteristics and various interpretations by Spanish scholars are summarized. The results obtained make it possible to conclude about the basic features typical of the development of Spanish historical thought in the late 19th–early 20th centuries.

Precedent phenomena of the contemporary Russian and Spanish mass media as cognitive structures of a linguistic identity

The present study is important since precedent phenomena, transmitting both traditional and newly created cultural values, are more widely represented in the mass media language. The paper suggests a cognitive approach aimed at identifying the role of knowledge (linguistic, non-linguistic, individual) in forming the precedent unit meaning, being the primary object of research in cognitive science. Examples of universal precedent names (Napoleon, Cinderella, Don Quixote, Adam) suggest that they store culturally valued (thematized) and implicit knowledge shared by communicants. Studying the binary structures (designator/designatum) of a concept defines the development dynamics of the precedent name’s meaning, relevant changes in structure of the core components of meaning, desemantization of the precedent name. Different Russian and Spanish interpretations show that prevailing content varies, and the language meaning of an invariant of universal precedent names reflects not the reality as such but the cognitive structures of a linguistic identity of a particular society.

Linguistic-Cultural Mediation in Asylum and Refugee Settings and Its Emotional Impact on Arabic-Spanish Interpreters.

Emotional factors in linguistic–cultural mediation have attracted the attention of prior literature for a number of decades, both regarding the cognitive processes involved in language interpreting and the impact of stress and emotion on the performance of interpreters. However, research has not yet been replicated in the Arabic–Spanish pair, despite it being one of the combinations most requested by public services in Spain and Europe. Methodology: An exploratory study conducted by an anonymous online 17-item survey was carried out in order to discover the perception of Arabic–Spanish interpreters in asylum and refugee settings about the emotional impact of their job. Out of 30 contacted, 23 active interpreters completed the survey. Results: The answers showed that all of the interpreters had been exposed to situations that had emotionally impacted them. Triggering situations and a list of negative emotions were collected. Discussion: Direct and indirect implications of the referred emotional episodes and their consequences on the performance of the interpreters were analysed and discussed. Conclusions: Linguistic–cultural mediation in these settings exposes interpreters to harsh stories that trigger mostly negative emotions. These professionals lack psychological support; thus, they are forced to deal individually with each situation, without taking into account the possible consequences on their work and their physical and mental health.

Lessons Learned: Social Determinants of Health Screening Pilot in 2 Urology Clinics.

Unmet social needs lead to adverse health outcomes and contribute to health inequities. Efforts to screen for social determinants of health (SDOH) have occurred primarily within primary care. Here, we describe the feasibility of implementing a workflow for SDOH screening within 2 urology clinics in Charlotte, North Carolina. Our pilot was adapted from the WE CARE Model, which integrates a referral to community resources for patients identified with social needs and an optional followup with a navigator for additional assistance. Patients were screened with the validated Healthy Opportunities SDOH tool to assess food, housing, utilities, transportation and physical safety needs; 40 patients were screened at 2 urology clinics, totaling 80 patients. Surveys were sent to 16 clinicians and staff who participated in the pilot to assess feasibility of implementation. In all, 24/80 patients (30%) were screened for 1 or more social needs, with food and housing being the most frequent; 20/24 patients with social need (83%) successfully received a community resource guide, and 13 of those patients also requested a referral. All survey respondents either agreed or strongly agreed that screening was valuable and allowed them to better understand the needs of their patients. They also felt that understanding SDOH aligns with departmental goals and mission. Our results suggest that SDOH screening within a urological setting is feasible, and dedicated support staff should be available to ensure adequate followup for patients with unmet needs. Future work is needed to expand resources for patients and optimize workflow for clinicians.

The Parent's Perspective: A Focus Group Study on Spanish Interpreter Services for Hospitalized Children

BackgroundThe US Census confirms a rise in Spanish-speakers, many of whom have limited English proficiency (LEP) and require interpreters. Parent perceptions of interpreter services throughout hospitalization are unknown. ObjectiveTo explore Spanish-speaking LEP parents’ views regarding roles of interpreters and providers (attending, resident, or nurse) during a hospital encounter, optimal modalities of interpretation, and barriers to services. MethodsSpanish-speaking LEP parents of children discharged from the hospital medicine service participated in focus groups. Sessions were audio-recorded and transcribed in Spanish, translated into English, and verified for translation accuracy. Qualitative methods were used for thematic analysis. ResultsFour sessions (n = 23 participants representing 15 families) were held. Parents felt the interpreter's primary role was to act as a conduit for word-for-word interpretation. They desired kind and trustworthy interpreters with medical knowledge. They saw providers as leaders of the encounter who should allot enough time for interpretation, not use Spanish unless they were fluent, and give frequent medical updates. In-person interpreters were preferred over telephone and video for their ability to convey body language and build relationships. Barriers to requesting interpreters included embarrassment and inability to directly request services, which resulted in using family members as interpreters. On family-centered rounds, parents preferred professional interpreters over bilingual providers. ConclusionsModifications are required to improve interpreter services to meet the needs of LEP families. Parents emphasized in-person interpreters’ social skills, frequent provider updates, and additional navigation support as essential components of effective care. Next steps include implementing guidelines and interventions to optimize interpreter services.

Caregiver-Perceived Facilitators and Barriers to Oral Iron Therapy in Young Children with Iron Deficiency Anemia

BackgroundIn the U.S., 2 to 3% of children age 1 to 3 years are affected by nutritional iron deficiency anemia (IDA). Children of Hispanic/Latino ethnicity are disproportionately affected and have rates approximately double that of other racial and ethnic groups. IDA is associated with inferior neurodevelopmental outcomes, poorer executive functioning, and decreased visual and auditory processing time. Treatment with oral iron mitigates against the consequences of IDA. Non-adherence to oral iron often results in treatment failure, and incomplete therapy prolongs the extent of IDA consequences. We aim to characterize barriers to and facilitators of oral iron therapy in young children with nutritional IDA.MethodsInfants and children aged 9 months to 4 years (all racial and ethnic groups) with nutritional IDA (assessed by history and laboratory criteria) and treated with oral iron therapy in the outpatient hematology clinic at a large US tertiary care pediatric hospital are identified. English or Spanish-speaking caregivers of identified children are invited to participate with the goal of conducting half the interviews in each language. In person audio-recorded semi-structured interviews are conducted by a research coordinator trained in qualitative methods using an IDA interview guide developed by a multidisciplinary research team. The guide is divided into 6 broad categories: diagnosis, consequences, experience with oral iron therapy (barriers to and facilitators of adherence), motivation, and alternate treatment options. For Spanish-speaking caregivers, an in-person Spanish interpreter assists with the interview.Verbatim transcripts are reviewed manually by 2 members of the research team to perform thematic analysis and identify common patterns in responses. Interviews and qualitative analysis will continue until thematic saturation is achieved (i.e. no new themes emerge from subsequent interviews). Clinical data, including laboratory values and treatment regimen, are abstracted from the patient's electronic medical record. Here we present findings from the initial six months of the study (February to July 2017).ResultsNine caregivers to date have been approached, and all enrolled. Patients had a mean age of 20 months (range 12 to 32 months); 5 (55%) were male. Nine caregiver interviews were completed; six in English and three in Spanish. All caregivers self-identified as White and Hispanic/Latino. Median hemoglobin concentration at patients' first visit within the hematology clinic was 8.6 g/dL (range 5.4 to 10.4 g/dL). Median duration of oral iron therapy at the time of interview was 4 months (range 2 to 10 months).Caregivers expressed a range of emotions that included fear and anxiety at time of diagnosis and optimism with treatment resolution. Many stated desire to have received information on risk factors and prevention of iron deficiency prior to their child's development of IDA. Regarding the diagnosis of IDA, most caregivers had a basic understanding of the condition, though some misinformation was present. Widely variable consequences of IDA were described, which included: changes in skin color, decreased energy, and potential for more severe disease if undetected. Negative traits of iron therapy, specifically poor taste and difficulty in getting child to take the medication, were barriers. Transition to better tasting formulations overcame these barriers for some families. When presented with information on intravenous iron therapy, most caregivers demonstrated willingness for their child to receive it if oral iron failed. Most caregivers deferred treatment-related decision-making to the recommendation of the physician.ConclusionCaregiver-perceived barriers to oral iron adherence were poor taste and difficulty in getting the child to take the medication. Knowledge regarding the diagnosis of IDA was not a consistent barrier as most caregivers reported a basic understanding of the condition. Specific caregiver-identified motivating factors and facilitators to oral iron adherence have not yet been elucidated. Additional, more targeted qualitative interviews with caregivers will be performed to elicit such information. These results will inform future patient-centered interventions aimed at promoting treatment in children with IDA. DisclosuresNo relevant conflicts of interest to declare.