Spanish-speaking Patients Research Articles

Integrating Gender-Affirming Care in a Medical Spanish Endocrine System Curriculum.

With a growing Hispanic population in the United States, medical education is adapting to provide the necessary language skills and cultural competence for effective health care. However, the incorporation of gender-affirming care in the context of medical education for Hispanic populations requires further emphasis. This curriculum presented a 3-week medical Spanish endocrine system module designed for first-year medical students. The module aimed to enhance students' ability to communicate effectively with Spanish-speaking patients about endocrine health while integrating principles of gender-affirming care. It included classroom sessions, standardized patient practice, and clinical practice with peer tutors. Pre- and postmodule surveys and assessments were conducted to evaluate the module's effectiveness. Out of 76 participants, 72 completed the postmodule evaluation. Survey results indicated significant increases in confidence levels across various aspects of patient interaction in Spanish, with statistically significant gains observed in all assessed areas. Knowledge test outcomes revealed enhanced proficiency in Spanish terminology related to the endocrine system, with scores increasing from an average of 22.3 premodule to 25.7 postmodule (p = .002), as measured by the paired t test. Additionally, students performed well in the diabetic consultation objective structured clinical examination station, with a high mean score of 86%, surpassing the satisfactory threshold. This curriculum highlights the success of a comprehensive educational approach in expanding medical students' language proficiency and ability to provide gender-affirming care to address health care disparities and improve patient outcomes among diverse populations.

Supplementing provider counseling with an educational video prior to scheduled induction of labor

BackgroundInduction of labor (IOL) is common with one in four labors being induced in the United States (US). IOL has been associated with lower birth satisfaction. Video education can address gaps in education and promote anticipatory guidance. Prior studies in obstetrics have focused on randomized designs in English-speaking patients, leaving opportunities to explore how these tools perform in a pragmatic fashion with diverse patient populations. Our objective was to evaluate the effects of a video education tool on patient satisfaction and knowledge of IOL experience in English and Spanish-speaking patients scheduled for IOL at a tertiary care hospital.MethodsThis was a single site pragmatic implementation of a quality improvement measure at an academic hospital. A bilingual survey was developed to evaluate the impact of an educational video on birth satisfaction and knowledge of IOL procedures. The video is freely available in English and Spanish. Baseline postpartum surveys were collected from June to July 2021. The video was subsequently recommended by providers when scheduling IOLs. Post-intervention surveys were collected from September to November 2021 after an implementation period. Groups were compared using t-tests for satisfaction scores and chi-square analyses for categorical variables.ResultsThirty-two participants completed the baseline survey and 72 completed the post-implementation survey with response rates of 88.9% and 91.1%, respectively. There were no statistically significant changes between mean total satisfaction scores (26.9 vs 28.0 out of 40.0, p = 0.290). 61 participants were English speaking (58%) and 43 Spanish (42%). Thirty (42%) patients reported watching the video.Correct identification of amniotomy use improved in the post-intervention group (p = 0.002). No changes were seen in anticipated duration of labor nor in whether patients would choose to be induced again.ConclusionsRecommendation of video education before scheduled IOL was associated with little improvement in knowledge about IOL, but no significant improvement in patient satisfaction. While video education has improved these measures in randomized trials, our study demonstrated that real-world implementation and patient uptake may be initially difficult. This study may help providers emphasize direct education and counseling and promote optimal implementation of innovative educational media.

Whole Exome Sequencing and Panel-Based Analysis in 176 Spanish Children with Neurodevelopmental Disorders: Focus on Autism Spectrum Disorder and/or Intellectual Disability/Global Developmental Delay

Background: Neurodevelopmental disorders (NDDs) represent a significant challenge in pediatric genetics, often requiring advanced diagnostic tools for the accurate identification of genetic variants. Objectives: To determine the diagnostic yield of whole exome sequencing (WES) with targeted gene panels in children with neurodevelopmental disorders (NDDs). Methods: This observational, prospective study included a total of 176 Spanish-speaking pediatric patients with neurodevelopmental disorders (NDDs), encompassing intellectual disability (ID), global developmental delay (GDD), and/or autism spectrum disorder (ASD). Participants were recruited from January 2019 to January 2023 at a University Hospital in Madrid, Spain. Clinical and sociodemographic variables were recorded, along with genetic study results. The age range of the subjects was 9 months to 16 years, and the percentage of males was 72.1%. The diagnostic yield of whole exome sequencing (WES) was calculated both before and after parental testing via Sanger DNA sequencing. Results: The study included 176 children: 67 (38.1%) with ID, 62 (35.2%) with ASD, and 47 (26.7%) with ASD + ID. The diagnostic yield of proband-only exome sequencing was 12.5% (22/176). By group, the diagnostic yield of proband-only exome sequencing was 3.2% in the ASD, 12.7% in the ASD + ID, and 20.8% in the ID group. Variants of uncertain significance (VUS) were found in 39.8% (70/176). After parental testing, some variants were reclassified as “likely pathogenic”, increasing the diagnostic yield by 4.6%, with an overall diagnostic yield of 17.1%. Diagnostic yield was higher in patients with syndromic ID (70.6%% vs. 29.4%; p = 0.036). Conclusions: A sequential approach utilizing WES followed by panel-based analysis, starting with the index case and, when appropriate, including the parents, proves to be a cost-effective strategy. WES is particularly suitable for complex conditions, as it allows for the identification of potentially causative genes beyond those covered by targeted panels, providing a more comprehensive analysis. Including parental testing enhances the diagnostic yield and improves accuracy, especially in cases with variants of uncertain significance (VUS), thereby advancing our understanding of NDDs.

Spanish-speaking Patients' Experiences with Hearing Health Care.

Background/introduction: Health care providers working with Spanish-speaking patients must provide culturally and linguistically appropriate care to meet the communication needs of this population. Disparities related to hearing health care access remain understudied, leaving gaps in clinical practice and guidance for audiologists. The purpose of this study was to explore the experiences of Spanish-speaking patients with hearing loss when accessing hearing health care services through a limited income hearing aid program. Methods: Six Spanish-speaking patients (three monolingual Spanish, three bilingual Spanish/English) with hearing loss from the Oklahoma City metropolitan area completed in-depth, semi-structured interviews. Results/findings: Three main themes emerged: (1) perceived barriers to service delivery (cost, language, and transportation); (2) success with hearing health care (use of interpreters and reduced cost of services and amplification); and (3) cultural factors (family, religion, and use of home remedies). Discussion/conclusion: The themes identified can provide a foundation for service delivery of patient-centered services that are culturally and linguistically appropriate to help improve access to and quality of hearing health care, particularly for this population of patients. This study identified factors that may contribute to hearing health care disparities for Spanish-speaking adults, which may not be observed in other disciplines that are less communication-focused. Suggestions for improving services for audiologists serving Spanish-speaking patients are discussed.

S421 Lost in Translation: Deciphering the Barriers to Colorectal Cancer Screening Among Spanish Speaking Patients

S421 Lost in Translation: Deciphering the Barriers to Colorectal Cancer Screening Among Spanish Speaking Patients

Navigating the Distinct Needs of English- and Spanish-Speaking Patients with Kidney Diseases

Navigating the Distinct Needs of English- and Spanish-Speaking Patients with Kidney Diseases

Evaluating the Readability, Credibility, and Quality of Spanish-Language Online Educational Resources for Knee Arthroplasty: Implications for Patient Education and Health Disparities.

Spanish-speaking individuals may experience language-based disparities related to elective orthopaedic procedures. Because patients often seek online health information, we assessed the readability, credibility, and quality of Spanish-language educational websites for knee arthroplasty. We queried "Google," "Yahoo," and "Bing" using the term "reemplazo de rodilla" (knee replacement in Spanish) and extracted the top 50 websites per search engine. Websites were categorized by information source (physician/community hospital, university/academic, other) and presence of HONcode certification. Information was assessed for readability (Fernández-Huerta formula), credibility (Journal of the American Medical Association benchmark criteria), and quality (Brief DISCERN tool); scores were compared between the categories. A total of 77 unique websites were included (40.3% physician/community hospital, 35.1% university/academic). The median readability score was 59.4 (10th to 12th-grade reading level); no websites achieved the recommended level of ≤6th grade. The median Journal of the American Medical Association benchmark score was 2 (interquartile range 1 to 3), with only 7.8% of websites meeting all criteria. The median Brief DISCERN score was 16 (interquartile range 12 to 20), with 50.7% meeting the threshold for good quality. University/academic websites had better readability (P = 0.02) and credibility (P = 0.002) but similar quality (P > 0.05) compared with physician/community hospital websites. In addition, HONcode-certified websites had better quality scores (P = 0.045) but similar readability and credibility (P > 0.05) compared with noncertified websites. We identified limitations in readability, credibility, and quality of Spanish-language online educational resources for knee arthroplasty. Healthcare providers should be aware of these patient education barriers when counseling patients, and efforts should be made to support the online information needs of Spanish-speaking orthopaedic patients and mitigate language-based disparities.

The Development of a Digital Patient Navigation Tool to Increase Colorectal Cancer Screening Among Federally Qualified Health Center Patients: Acceptability and Usability Testing.

Federally Qualified Health Centers (FQHCs) are an essential place for historically underserved patients to access health care, including screening for colorectal cancer (CRC), one of the leading causes of cancer death in the United States. Novel interventions aimed at increasing CRC screening completion rates at FQHCs are crucial. This study conducts user testing of a digital patient navigation tool, called eNav, designed to support FQHC patients in preparing for, requesting, and completing CRC screening tests. We recruited English- and Spanish-speaking patients (N=20) at an FQHC in New York City to user-test the eNav website (2 user tests; n=10 participants per user test). In each user test, participants engaged in a "think aloud" exercise and a qualitative interview to summarize and review their feedback. They also completed a baseline questionnaire gathering data about demographics, technology and internet use, medical history, and health literacy, and completed surveys to assess the website's acceptability and usability. Based on participant feedback from the first user test, we modified the eNav website for a second round of testing. Then, feedback from the second user test was used to modify and finalize the eNav website. Survey results supported the overall usability and acceptability of the website. The average System Usability Scale score for our first user test was 75.25; for the second, it was 75.28. The average Acceptability E-scale score for our first user test was 28.3; for the second, it was 29.2. These scores meet suggested benchmarks for usability and acceptability. During qualitative think-aloud exercises, in both user tests, many participants favorably perceived the website as motivating, interesting, informative, and user-friendly. Respondents also gave suggestions on how to improve the website's content, usability, accessibility, and appeal. We found that some participants did not have the digital devices or internet access needed to interact with the eNav website at home. Based on participant feedback on the eNav website and reported limitations to digital access across both user tests, we made modifications to the content and design of the website. We also designed alternative methods of engagement with eNav to increase the tool's usability, accessibility, and impact for patients with diverse needs, including those with limited access to devices or the internet at home. Next, we will test the eNav intervention in a randomized controlled trial to evaluate the efficacy of the eNav website for improving CRC screening uptake among patients treated at FQHCs.

A roadmap for improving representation in clinical trials

Clinical trials continue to struggle with recruiting diverse participants that include historically underrepresented and minoritized patients, who are typically patients in non-white racial and ethnic groups and have low income (Medicaid). Enrolling diverse participants will benefit the health sciences by providing more generalizable findings. The Cancer Financial Experience project (CAFÉ) study sought to improve financial distress by providing financial navigation for newly diagnosed cancer patients, and intentionally recruited diverse participants. All diverse participants consented at slightly higher rates than non-diverse participants (21.3 % vs. 20.1 %). Spanish-speaking patients consented at a much higher rate than non-Spanish speakers (36.4 % vs. 20.2 % respectively). Here we discuss how we increased our recruitment of diverse participants. Obtaining diverse participation is achievable and will provide more meaningful findings.

Reliability and Preliminary Validation of a Body Image Scale Survey for Use in Bladder Cancer Patients

Introduction Extirpative bladder surgery for bladder cancer requires urinary diversion which causes cosmetic and functional changes that affect a patient’s body image and quality of life. Current health-related quality of life (HRQOL) surveys validated for use in bladder cancer patients have no dedicated domain evaluating body image. We sought to validate the ten-item Body Image Scale (BIS) for use in bladder cancer patients. The BIS is scored on a 4-point Likert scale with a maximum score of 30. Higher scores represent increasing distress. Methods With Institutional Review Board approval, native English or Spanish speaking patients who had undergone radical cystectomy and urinary diversion with either ileal conduit formation or orthotopic neobladder creation within the past 5 years for muscle-invasive bladder cancer were identified. The survey was conducted via telephone or e-mail. Surveys were scored and analyzed for reliability and validity. Results 32 patients were identified (22 men, 10 women). 25 patients had ileal conduits and 7 had orthotopic neobladders. Cronbach’s alpha reliability coefficient measuring internal consistency for the BIS instrument in this group was 0.926. All ten items met the response criteria (score of >0 by >30% respondents) in our study population. Though the ileal conduit group mean (17.4) and median (16) scores were lower than the neobladder (mean=19.1 and median=22), there was no statistically significant difference in BIS scores between the two cohorts (p=0.755). Conclusions We present a validation study for use of BIS in bladder cancer patients to be utilized in future clinical trials or psycho-oncology research.

Abstract A153: Patient-informed patient navigation for colorectal cancer screening among racial and ethnic minorities: A qualitative work

Abstract INTRODUCTION: Black individuals experience higher mortality from colorectal cancer (CRC) compared to non-Hispanic White individuals, and the incidence of CRC, while increasing among all minority populations, has increased the most among Hispanic/Latinx individuals. Furthermore, minority populations have significantly lower likelihood of being up to date with CRC screening, due in part to unaddressed social determinants of health. These disparities suggest room for evidence-based interventions such as patient navigation to address barriers and facilitate screening among these populations. To understand perceptions of a referral-based patient navigation program for CRC screening, we conducted interviews with Black/African American and Hispanic/Latinx patients to understand the challenges, preferences, and considerations of CRC screening and navigation. METHODS: We recruited English- and Spanish-speaking patients who were due for CRC screening in the electronic health record (EHR). Patients were either Black/African American and/or Hispanic/Latino and between the ages of 45-75. Interviews lasted 60 minutes and topics included preferences, barriers, and facilitators to screening, and preferences for patient navigation. Data were transcribed and analyzed for emergent themes. RESULTS: 15 interviews were conducted between January to April 2024. Approximately half of all participants identified as women (n=8, 53%), ethnically as Hispanic/Latino (n=8, 53%), and racially as Black/African American (n=8, 53.3%). Most patients had received some form of CRC screening within their lifetime. Awareness of CRC varied: Many participants were aware of CRC from family history or friends diagnosed with the condition, whereas others did not associate CRC screening with CRC. At least one patient sought screening outside of the US due to differences in colonoscopy prep requirements. When asked about barriers to screening, common themes included fear of the colonoscopy process (specifically regarding social image, preparation, and cancer diagnoses), education (lack of awareness of CRC and the importance of screening), and social needs (cost, transportation, and flexibility with work). Finally, when inquiring about preferences for patient navigation, participants requested help with transportation and expressed preferences including simple language and tailoring conversations to patient’s literacy levels, accommodating language preferences, and avoiding medical jargon. Patients also suggested navigators should be prepared to explain things to patients in-depth (e.g., what will happen during the procedure), providing patients options, talking about public figures who have battled CRC, and speaking about the benefits and the risks of screening. CONCLUSION: This work explores patient needs, concerns, and perceptions of navigation for CRC screening among historically marginalized groups. Results from this work will be used to tailor navigation strategies, ensuring equitable navigation and promoting the importance of CRC screening. Citation Format: Laura C. Schubel, Jessica Rivera Rivera, Katarina AuBuchon, Jennifer Tran, Marjorie Locke, Hannah Arem. Patient-informed patient navigation for colorectal cancer screening among racial and ethnic minorities: A qualitative work [abstract]. In: Proceedings of the 17th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2024 Sep 21-24; Los Angeles, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2024;33(9 Suppl):Abstract nr A153.

Abstract A141: Exploring patient barriers and facilitators to colorectal cancer screening during the SARS-CoV-2 pandemic

Abstract Intro While there has been a national initiative to achieve 80% colorectal cancer (CRC) screening rates, not all population subgroups reach this target. Specifically, Latino populations have shown lower CRC screening rates compared to non-Latino White populations. Furthermore, the SARS-CoV-2 pandemic led to a decline in CRC screening uptake, particularly in Federally Qualified Health Centers (FQHCs). One large, urban FQHC, primarily serving Latino patients, has invested in stool-based, home-mailed CRC screening outreach. This FQHC serves as the site for the RESTORE study. Here, we describe patient-level barriers and facilitators to home fecal immunochemical test (FIT) screening throughout the COVID-19 pandemic. Methods Patients (n=15) were interviewed between August 2022 and May 2023. Interviews addressed health care utilization and CRC screening throughout the COVID-19 pandemic. Patient interviews were audio recorded and transcribed. A preliminary review of these interviews was conducted to assess patients’ use of telehealth as well as patients’ self-reported FIT completion. Results Participants’ average age was 58.5 years old; 53% identify as female; 66% report Spanish as their preferred language; and 80% identify as Latino. Ten patients (6 Spanish-speaking and 4 English-speaking) reported completing a home-mailed screening test. Among them, four emphasized the convenience of completing their CRC screening at home and found it beneficial to have wordless instructions included in their mailed FIT to guide them through the process. While these patients were able to complete their FIT, 3 reported that they never received their result. Of note, one of the Spanish speakers postponed FIT completion until in-person care resumed. Of the 4 Spanish-speaking patients who did not complete a FIT: 2 completed a colonoscopy, while the other 2 disposed of their FIT. The lone English speaker who did not complete FIT cited a fear of cancer as a barrier to screening. Patients who completed a colonoscopy described the procedure as easy; however, one patient experienced complications post-procedure. Telehealth visits were utilized by 80% of patients in 2020 and 73% in 2021, covering various health topics such as COVID-19 symptoms, infection, medication refills, and exam referral and results, with some patients citing convenience and quicker access to providers. Conclusions Throughout the SARS-CoV-2 period, patients continued to benefit from the FQHC’s mailed FIT outreach. As a novel primary care modality, patients reported completing clinical encounters via telehealth during the COVID-19 pandemic to discuss a range of health topics with a provider. To improve preparedness for future natural disasters, it is imperative to understand FQHC patients’ CRC screening experiences during this dynamic period. Citation Format: Anne Escaron, Robert Lara, Karina Ramirez, Adolfo Jacobo, Jennifer Schneider, Jennifer Rivelli, Crystal Gomez, Alexis Perez, Gloria Coronado. Exploring patient barriers and facilitators to colorectal cancer screening during the SARS-CoV-2 pandemic [abstract]. In: Proceedings of the 17th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2024 Sep 21-24; Los Angeles, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2024;33(9 Suppl):Abstract nr A141.

Artificial intelligence generates proficient Spanish obstetrics and gynecology counseling templates

BackgroundEffective patient counseling in Obstetrics and gynecology is vital. Existing language barriers between Spanish-speaking patients and English-speaking providers may negatively impact patient understanding and adherence to medical recommendations, as language discordance between provider and patient has been associated with medication noncompliance, adverse drug events, and underuse of preventative care. Artificial intelligence large language models may be a helpful adjunct to patient care by generating counseling templates in Spanish. ObjectivesThe primary objective was to determine if large language models can generate proficient counseling templates in Spanish on obstetric and gynecology topics. Secondary objectives were to (1) compare the content, quality, and comprehensiveness of generated templates between different large language models, (2) compare the proficiency ratings among the large language model generated templates, and (3) assess which generated templates had potential for integration into clinical practice. Study designCross-sectional study using free open-access large language models to generate counseling templates in Spanish on select obstetrics and gynecology topics. Native Spanish-speaking practicing obstetricians and gynecologists, who were blinded to the source large language model for each template, reviewed and subjectively scored each template on its content, quality, and comprehensiveness and considered it for integration into clinical practice. Proficiency ratings were calculated as a composite score of content, quality, and comprehensiveness. A score of >4 was considered proficient. Basic inferential statistics were performed. ResultsAll artificial intelligence large language models generated proficient obstetrics and gynecology counseling templates in Spanish, with Google Bard generating the most proficient template (p<0.0001) and outperforming the others in comprehensiveness (P=.03), quality (P=.04), and content (P=.01). Microsoft Bing received the lowest scores in these domains. Physicians were likely to be willing to incorporate the templates into clinical practice, with no significant discrepancy in the likelihood of integration based on the source large language model (P=.45). ConclusionsLarge language models have potential to generate proficient obstetrics and gynecology counseling templates in Spanish, which physicians would integrate into their clinical practice. Google Bard scored the highest across all attributes. There is an opportunity to use large language models to try to mitigate the language barriers in health care. Future studies should assess patient satisfaction, understanding, and adherence to clinical plans following receipt of these counseling templates.

Access to the internet and mobile applications in a mixed population emergency department: A repeated cross-sectional survey

ObjectiveThis study aimed to assess patients' interest in education content delivered through electronic modalities and identify trends in internet access and use among emergency department patients of various socioeconomic statuses. MethodsA prospective, cross-sectional survey with 50 questions was completed by 241 English and Spanish-speaking patients in 2014 and repeated with 253 participants in 2019 at the University of California, Irvine Medical Center's Emergency Department (UCIMCED). ResultsInternet access increased from 83.8 % in 2014 to 88.1 % in 2019. Most internet-using patients owned smartphones (80.1 % in 2014, 89.7 % in 2019). Patients used electronic devices, such as fit bits and activity trackers, to obtain health information. Email was the preferred method for receiving discharge instructions. ConclusionsAs of 2019, 88.1 % of UCIMCED patients have access to the internet or email, making electronic media a reasonable venue for patient education. Given that we have a predominantly low-income patient population—61 % and 32 % of respondents in 2014 and 2019, respectively, reporting an income of less than $25,000—these results are provide new avenues to reach patients of all socioeconomic statuses. InnovationThe implications of this study can be used to develop electronic resources tailored to educate emergency department patients about their healthcare beyond the confines of a hospital.

A - 136 Clinical Features of Agrammatism in Spanish Speakers with Non-Fluent/Agrammatic Variant of Primary Progressive Aphasia (Nappa): a Case Study Analysis

Abstract Objective A clinical diagnosis of naPPA includes presence of agrammatism and effortful speech (Gorno-Tempini et al., 2011). Agrammatism, specifically verb agreement, has emerged as a key clinical feature distinguishing PPA subtyping in English (Thomson et al., 2012). Patterns of agrammatism in English are well-established and were thought to extend to other languages (Gorno-Tempini et al., 2004; Benedet et al., 1998). Agrammatism in post-stroke Spanish patients has unique linguistic characteristics including gender-object agreement errors (Benedet et al., 1998; Reznik et al., 1995, Ardila, 2001). Research assessing agrammatism in PPA Spanish speakers is limited (Gonzalez et al., 2022). These three cases describe gender agreement errors as a clinical feature of agrammatism in Spanish speakers with naPPA. Method Three Spanish-dominant patients with primary speech deficits underwent neuropsychological evaluation across three outpatient clinics and were diagnosed with naPPA (all had brain MRI, two had FDG-PET). Narrative language samples were analyzed to explore patterns of agrammatic language production. Results Patients made few to no verb agreement errors. Instead, common errors included inconsistent speech sounds and gender disagreement within common object-article pairings, including substitutions in Spanish-language articles like “el” or “la” (e.g., “el silla”). Conclusions These cases revealed gender-object agreement errors as a consistent clinical feature of agrammatism in Spanish naPPA patients. Research assessing the linguistic profiles and agrammatisms of Spanish-speaking PPA patients, with confirmatory neuroimaging and biomarker correlates, is needed to aid clinicians in differentiating PPA subtypes among Spanish speakers. This is especially important with emergence of new disease modifying treatments specifically helpful in some but not all subtypes.

Characterizing Spanish-speaking patients' patient-centered care experiences in the emergency department.

Patient-centered care (PCC) is an essential component of high-quality health, yet patients with non-English language preferences (NELP) experience worse PCC outcomes. Additionally, there are likely unique aspects to PCC for patients with NELP in the emergency department (ED). To inform the development of strategies to improve PCC for NELP in the ED, we sought to understand how Spanish-speaking ED patients experience care and the factors that influenced their perceptions of the patient-centeredness of that care. We conducted a single-center qualitative study using semistructured interviews with adult, Spanish-speaking patients who had been discharged home from the ED. Interviews were conducted using an interview guide, recorded, transcribed, and analyzed iteratively in Spanish using inductive and deductive thematic analysis. We conducted 19 interviews with participants from 24 to 72 years old. Participants were born in seven different Spanish-speaking countries. Participants identified three domains of PCC: patient, medical team's skills, and system. Several of the identified themes such as shared decision making, open communication, compassionate care, and coordination of follow-up care are often incorporated into PCC definitions. However, other themes, including uncertainty leading to fear, use of professional interpreters to promote understanding, receiving equitable care, technical proficiency, and efficiency of care expand upon existing domains in PCC definitions. We now have a more nuanced understanding of how Spanish-speaking patients with NELP experience PCC in the ED and what matters to them. Several of the themes identified in this analysis add details about what matters to patients within the domains of previous PCC definitions. This suggests that the conceptualization of PCC may vary based on the setting where care is provided and the population who is receiving this care. Future work should consider patient population and setting when conceptualizing PCC.

Abstract P318: English and Spanish-Speaking Patient Preferences on Home Blood Pressure Monitors: A Qualitative Study in an Urban Safety Net Setting

Background: Self-measured blood pressure (SMBP) monitoring improves hypertension (HTN) control. Adoption of SMBP monitoring is lower among low-income or minoritized patients, who have higher rates of uncontrolled HTN. Little is known about these patients’ preferences for or challenges with SMBP monitoring. Objective: We explored patient perspectives on SMBP monitoring among patients receiving care at an urban safety-net system. Methods: We interviewed English and Spanish-speaking patients with HTN about preferences for different BP monitoring devices and their accompanying mobile apps, past experiences sharing BP data with their clinical care team, and knowledge about home BP monitoring. Interviews were conducted in the participants’ preferred language. We also asked participants to demonstrate a home BP measurement to evaluate their measurement technique. We presented two BP monitoring devices: a Bluetooth-enabled device and a cellular-enabled device. Rapid qualitative data analysis was used to analyze data. Results: Of the 15 participants (8 English-speaking; 7 Spanish-speaking), eight identified as Latine, four as Black or African American, one as American Indian/Native American, one as Asian/Pacific Islander, and one as multi-ethnic. Highest educational attainment varied: five less than high school, five high school/GED, and five college. Most required assistance with Bluetooth pairing to share data and navigating app features. All participants valued tracking their BP and were motivated to engage in SMBP monitoring but desired more training. Nearly all participants demonstrated inadequate BP knowledge and incorrect BP measurement techniques based on AHA/AMA recommendations. Few reported receiving training on SMBP monitoring techniques. Spanish speakers reported that using apps was challenging due to language discordance and wanted translated apps and resources. Costs related to device features were a key factor in preferences. Conclusions: Patient-reported barriers to SMBP adoption include cost, insufficient training, digital exclusion, and language discordance. Addressing these challenges may increase adoption of SMBP monitoring in safety-net populations. Clinicians should consider patients’ preferences when recommending SMBP monitoring. Cellular SMBP devices that automatically transmit BP readings may mitigate challenges with digital literacy and promote data sharing with clinical care teams, though future studies are needed to evaluate usability.

Achieving Equitable Lung Cancer Screening Implementation in a Texas Safety Net Health System

IntroductionA lung cancer screening program using low dose CT (LDCT) in a Federally Qualified Health Center (FQHC) in Central Texas was developed and assessed for equitable implementation. MethodsFrom 11/2020-8/2023, patients aged 55-77 years who currently smoked or quit within 15 years with ≥ 20 pack-years of exposure were identified through EHR query and mailed outreach, or through direct provider referrals. A bilingual social worker confirmed eligibility, provided tele-care shared decision-making (SDM), coordinated screening, and offered smoking cessation. To assess equity, LDCT completion across demographics was compared, in 2023. Results6,486 patients were mailed outreach materials; 479 patients responded, of whom 108 (22.5%) were eligible and 71 (65.7%) participated in SDM. 629 eligible patients were referred internally; 579 (92.0%) completed SDM. Of the 650 patients who completed SDM, 636 (97.8%) agreed to screening.Mean age was 61.7; 38.1% were female. The population was diverse: 35.8% identified as Latino, 17.8% as African-American, 26.8% had Medicare or Medicaid, 48.0% used the county medical assistance program, 14.2% were uninsured, and 76.7% currently smoked.Overall, 528 (83.0%) patients completed LDCT. There were no statistically significant differences in completion by age, gender, race/ethnicity, or insurance status. Spanish-speaking patients were more likely to complete the CT than English speakers (OR 2.22, 95% CI 1.22, 4.41) and those who formerly smoked were more likely to complete the CT than patients who currently smoked (OR 1.93, 95% CI 1.12, 3.51). ConclusionsThe navigator-centered program achieved equitable implementation of lung cancer screening in a diverse FQHC system.

Weathering the storm when the end of the road is near: A qualitative analysis of supportive care needs during CAR T-cell therapy in pediatrics.

Chimeric antigen receptor (CAR) T-cell therapy provides promising outcomes in relapsed/refractory B acute lymphoblastic leukemia (ALL), yet still carries high toxicity rates and relatively poor long-term survival. Efficacy has yet to be demonstrated in other diagnoses while toxicity and risk profiles remain formidable. To date, treatment-related symptom burden is gleaned from clinical trial toxicity reports; the patient perspective remains understudied. English- or Spanish-speaking patients (ages 8-25years) undergoing CAR T-cell therapy for any malignancy and their primary caregivers were recruited from Seattle Children's Hospital (SCH), St. Jude Children's Research Hospital (SJCRH), and the Pediatric Oncology Branch of the National Cancer Institute (NCI). Both patient and caregiver completed semi-structured dyadic interviews 3months post treatment. We used directed content analysis for codebook development and thematic network analysis for inductive qualitative analysis. Twenty families completed interviews (13 patients, 15 parents). Patients were a median age 16.5years, predominantly female (65%), White (75%), and diagnosed with ALL (75%). Global themes included "A clear decision," "Coping with symptoms," and "Unforeseen psychosocial challenges." When families were asked to describe the "most challenging part of treatment," most described "the unknown." Most reported "the symptoms really weren't that bad," even among patients hospitalized for severe toxicity events. Fatigue, pain, and nausea were the most prevalent symptoms. Importantly, only one family would have chosen a different therapy, if given another opportunity. Although physical symptoms were largely tolerable, recognizing supportive care opportunities remains imperative, particularly psychosocial concerns.

Validation of the Spanish Version of the Breakthrough Pain Assessment Tool in Patients With Cancer.

Assessment of breakthrough pain is essential for adequate management of cancer pain. The Breakthrough Pain Assessment Tool (BAT) has been proven to be a brief, multidimensional, and reliable questionnaire for the assessment of breakthrough cancer pain (BTCP). Currently, there are no validated instruments in Spanish that allow assessing BTCP. The objective of this study was to validate the Breakthrough Pain Assessment Tool - Spanish (BAT-S) version of the BAT in adult patients with cancer. The BAT-S was tested in a prospective observational study conducted in adult patients with cancer-related pain and treated in a comprehensive cancer center in Mexico. We conducted a forward-backward translation and cross-cultural equivalence test in the Spanish language. The psychometric properties in patients with cancer were assessed using factor analysis, reliability, and validity. To assess reliability, the Kappa test and the intra-class correlation coefficient were used. For consistency, Cronbach's alpha test was used. Seventy patients participated in the study; 140 questionnaires were analyzed. The Spanish translation was well accepted by participants. Reliability was comprised between 0.746 for "use of analgesics" and 1.00 for "pain location." Thirteen of the 14 items had values above 0.8, and 12 above 0.9. Cronbach´s alpha coefficient was 0.7. This study confirms that BAT-S is a valid and reliable questionnaire to assess breakthrough pain in Mexican patients with cancer. This newly validated tool may be used to facilitate clinical management of primarily Spanish-speaking patients with breakthrough cancer pain. This study describes a prospective observational study to assess the validity and reliability of the Breakthrough Pain Assessment Tool in its Spanish version. The results support the use of this newly validated tool to facilitate clinical management of primarily Spanish-speaking patients with breakthrough cancer pain.