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. 2017 Aug;32(8):863-870.
doi: 10.1007/s11606-017-3983-4. Epub 2017 Feb 9.

Increased Access to Professional Interpreters in the Hospital Improves Informed Consent for Patients with Limited English Proficiency

Jonathan S Lee  1   2 , Eliseo J Pérez-Stable  3 , Steven E Gregorich  1   2 , Michael H Crawford  4 , Adrienne Green  5 , Jennifer Livaudais-Toman  1   2 , Leah S Karliner  6   7
Affiliations

Increased Access to Professional Interpreters in the Hospital Improves Informed Consent for Patients with Limited English Proficiency

Jonathan S Lee et al. J Gen Intern Med. 2017 Aug.

Abstract

Background: Language barriers disrupt communication and impede informed consent for patients with limited English proficiency (LEP) undergoing healthcare procedures. Effective interventions for this disparity remain unclear.

Objective: Assess the impact of a bedside interpreter phone system intervention on informed consent for patients with LEP and compare outcomes to those of English speakers.

Design: Prospective, pre-post intervention implementation study using propensity analysis.

Subjects: Hospitalized patients undergoing invasive procedures on the cardiovascular, general surgery or orthopedic surgery floors.

Intervention: Installation of dual-handset interpreter phones at every bedside enabling 24-h immediate access to professional interpreters.

Main measures: Primary predictor: pre- vs. post-implementation group; secondary predictor: post-implementation patients with LEP vs. English speakers. Primary outcomes: three central informed consent elements, patient-reported understanding of the (1) reasons for and (2) risks of the procedure and (3) having had all questions answered. We considered consent adequately informed when all three elements were met.

Key results: We enrolled 152 Chinese- and Spanish-speaking patients with LEP (84 pre- and 68 post-implementation) and 86 English speakers. Post-implementation (vs. pre-implementation) patients with LEP were more likely to meet criteria for adequately informed consent (54% vs. 29%, p = 0.001) and, after propensity score adjustment, had significantly higher odds of adequately informed consent (AOR 2.56; 95% CI, 1.15-5.72) as well as of each consent element individually. However, compared to post-implementation English speakers, post-implementation patients with LEP had significantly lower adjusted odds of adequately informed consent (AOR, 0.38; 95% CI, 0.16-0.91).

Conclusions: A bedside interpreter phone system intervention to increase rapid access to professional interpreters was associated with improvements in patient-reported informed consent and should be considered by hospitals seeking to improve care for patients with LEP; however, these improvements did not eliminate the language-based disparity. Additional clinician educational interventions and more language-concordant care may be necessary for informed consent to equal that for English speakers.

Keywords: communication barriers; informed consent; language access; limited English proficiency; medical interpreters; physician-patient relations.

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Conflict of interest statement

Compliance with Ethical Standards

The findings and conclusions in this article are those of the authors and do not necessarily represent the views or the official position(s) of the National Institutes of Health or any of the sponsoring organizations and agencies of the US government.

Conflicts of Interest

The authors report no conflicts of interest pertaining to this manuscript. An earlier version of this manuscript was presented at the Society of General Internal Medicine annual conference in San Diego, CA, in 2014.

Figures

Figure 1
Figure 1
Visual depiction of bedside interpreter phone intervention providing rapid phone access to remote professional interpreters
Figure 2
Figure 2
Comparison of informed consent between pre- (N = 84) and post-bedside (N = 68) interpreter phone implementation patients with limited English proficiency
Figure 3
Figure 3
Comparison of informed consent between post-bedside interpreter phone implementation patients with limited English proficiency (N = 68) and English speakers (N = 86)
See this image and copyright information in PMC

Comment in

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