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Krishnamurthy N, David D, Odom JN, Mathelier K, Lin JJ, Smith C, Peralta M, Moorehead D, Mazor M. "If we don't speak the language, we aren't offered the same opportunities": Qualitative perspectives of palliative care access for women of color living with advanced breast cancer. SSM. QUALITATIVE RESEARCH IN HEALTH 2024; 5:100440. [PMID: 38957483 PMCID: PMC11218668 DOI: 10.1016/j.ssmqr.2024.100440] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 07/04/2024]
Abstract
Context Despite efforts to enhance equity, disparities in early palliative care (PC) access for historically minoritized patients with advanced breast cancer (ABC) persist. Insight into patient and clinician perspectives are needed to inform future models aimed at improving equity in PC access and outcomes. Objectives To explore qualitative barriers and facilitators to early PC access in an urban setting with Black and Latina women with ABC. Methods In this qualitative descriptive study, we conducted one-on-one interviews with Black and Latina women with ABC (N = 20) and interdisciplinary clinicians (N = 20) between February 2022 and February 2023. Participants were recruited from urban academic and community cancer clinics. Transcripts were analyzed using an inductive coding and thematic analysis approach. Results Barriers identified by both patients and clinicians included lack of communication between oncology, PC, and primary care teams, limited understanding of PC among patients and non-PC clinicians, language and health literacy-related communication challenges, and racism and marginalization, including implicit bias and lack of diverse racial/ethnic representation in the supportive care workforce. Facilitators identified by both patients and clinicians included patient-to-patient referrals, support groups breaking cultural stigma on topics including self-advocacy and PC, referrals from trusted providers, and community organizations' abilities to overcome challenges related to social determinants of health, most specifically logistical and financial support. Conclusions Patients and clinicians reported similar barriers and facilitators to PC access, most commonly through the lens of care coordination and communication. These findings will inform future adaptation of a culturally and linguistically care model to improve access to early PC services for Black and Latina women with ABC.
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Affiliation(s)
| | - Daniel David
- NYU Rory Meyers College of Nursing, New York, NY, USA
| | - J. Nicholas Odom
- School of Nursing, University of Alabama at Birmingham, Birmingham, AL, USA
| | | | - Jenny J. Lin
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | | | - Maria Peralta
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | | | - Melissa Mazor
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
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Ortega P, Gregorich SE, Karliner L, González J, Pérez-Cordón C, Iñiguez RX, Izquierdo K, Diamond LC. Validity Evidence for the Physician Oral Language Observation Matrix as a Measure of Medical Spanish Proficiency. J Gen Intern Med 2024; 39:1088-1094. [PMID: 37670071 PMCID: PMC11116337 DOI: 10.1007/s11606-023-08391-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Accepted: 08/21/2023] [Indexed: 09/07/2023]
Abstract
BACKGROUND The lack of a standardized language assessment process for medical students and physicians communicating in a non-English language threatens healthcare quality and safety. OBJECTIVE To evaluate the validity of a new rating tool, the Physician Oral Language Observation Matrix (POLOM)™, in assessing medical students' oral communication with Spanish-speaking standardized patients (SPs). DESIGN POLOM scores were compared to measures of student medical Spanish proficiency to examine convergent validity and to measures of clinical performance to examine concurrent/criterion validity. PARTICIPANTS Forty-two students at two schools completed SP encounters between January 2021 and April 2022, and POLOM raters scored the videorecorded performances between January and June 2022. MAIN MEASURES Two approaches to generating POLOM total scores were investigated: rater average and strict consensus. Convergent validity was examined via the POLOM's correlations with (1) the phone-based Clinician Cultural and Linguistic Assessment (CCLA) and (2) the self-rated Interagency Language Roundtable scale for healthcare (ILR-H). Concurrent/criterion validity was examined via correlations with (1) the Comunicación y Habilidades Interpersonales (CAI) scale, (2) a checklist completed by the SP, and (3) a faculty rating of the student's post-encounter clinical note. Pearson's correlations of r ≥ 0.5 and r ≥ 0.2 were considered evidence of convergent validity and concurrent/criterion validity, respectively. KEY RESULTS Both rater average and strict consensus POLOM scores were strongly correlated with ILR-H (r = 0.72) and CCLA (r ≥ 0.60), providing evidence of convergent validity. The POLOM was substantially correlated with the CAI (r ≥ 0.29), the SP Checklist (r = 0.32), and the faculty scoring of the student's clinical note (r ≥ 0.24), providing concurrent/criterion validity evidence. CONCLUSIONS The POLOM has demonstrated evidence of convergent and concurrent/criterion validity as a measure of medical students' Spanish proficiency during SP encounters. Additional research is needed to evaluate how the POLOM can be implemented with resident and practicing physicians, applied to other health professions, and adapted to other languages.
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Affiliation(s)
- Pilar Ortega
- Departments of Medical Education and Emergency Medicine, University of Illinois College of Medicine, Chicago, IL, USA.
- Diversity, Equity, and Inclusion, Accreditation Council for Graduate Medical Education, Chicago, IL, USA.
| | - Steven E Gregorich
- Division of General Internal Medicine, Department of Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Leah Karliner
- Division of General Internal Medicine, Center for Aging in Diverse Communities, Multiethnic Health Equity Research Center, Department of Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Javier González
- Language Initiatives Program, Immigrant Health and Cancer Disparities Service, Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Cristina Pérez-Cordón
- Language and Communication Training Unit, United Nations Headquarters, New York, NY, USA
| | - Reniell X Iñiguez
- Internal Medicine, Northwestern University Chicago, Chicago, IL, USA
| | - Karen Izquierdo
- Anesthesiology, Maimonides Medical Center, Brooklyn, NY, USA
| | - Lisa C Diamond
- Hospital Medicine Service, Immigrant Health and Cancer Disparities Service, Departments of Medicine and Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY, USA
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Rivera L, Butler H, Salinas KE, Wade C, Bazan M, Larson E, Molina RL. Communication Preferences During Pregnancy Care Among Patients With Primary Spanish Language: A Scoping Review. Womens Health Issues 2024; 34:164-171. [PMID: 37827863 DOI: 10.1016/j.whi.2023.08.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Revised: 08/15/2023] [Accepted: 08/31/2023] [Indexed: 10/14/2023]
Abstract
BACKGROUND Qualified language service providers (QLSPs)-professional interpreters or multilingual clinicians certified to provide care in another language-are critical to ensuring meaningful language access for patients. Designing patient-centered systems for language access could improve quality of pregnancy care. OBJECTIVE We synthesized and identified gaps in knowledge about communication preferences during pregnancy care among patients with Spanish primary language. METHODS We performed a scoping review of original research studies published between 2000 and 2022 that assessed communication preferences in Spanish-speaking populations during pregnancy care. Studies underwent title, abstract, and full-text review by three investigators. Data were extracted for synthesis and thematic analysis. RESULTS We retrieved 1,539 studies. After title/abstract screening, 36 studies underwent full-text review, and 13 of them met inclusion criteria. Two additional studies were included after reference tracing. This yielded a total of 15 studies comprising qualitative (n = 7), quantitative (n = 4), and mixed-methods (n = 4) studies. Three communication preference themes were identified: language access through QLSPs (n = 7); interpersonal dynamics and perceptions of quality of care (n = 9); and information provision and shared decision-making (n = 8). Although seven studies reported a strong patient preference to receive prenatal care from Spanish-speaking clinicians, none of the included studies assessed clinician Spanish language proficiency or QLSP categorization. CONCLUSIONS Few studies have assessed communication preferences during pregnancy care among patients with primary Spanish language. Future studies to improve communication during pregnancy care for patients with primary Spanish language require intentional analysis of their communication preferences, including precision regarding language proficiency among clinicians.
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Affiliation(s)
- Luis Rivera
- Harvard Medical School, Boston, Massachusetts
| | | | | | - Carrie Wade
- Harvard Medical School, Boston, Massachusetts
| | - Maria Bazan
- Harvard T.H. Chan School of Public Health, Boston, Massachusetts; Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Elysia Larson
- Harvard Medical School, Boston, Massachusetts; Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Rose L Molina
- Harvard Medical School, Boston, Massachusetts; Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Boston, Massachusetts.
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Jenstad LM, Howe T, Breau G, Abel J, Colozzo P, Halas G, Mason G, Rieger C, Simon L, Strachan S. Communication between healthcare providers and communicatively-vulnerable patients with associated health outcomes: A scoping review of knowledge syntheses. PATIENT EDUCATION AND COUNSELING 2024; 119:108040. [PMID: 37951163 DOI: 10.1016/j.pec.2023.108040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Revised: 09/30/2023] [Accepted: 10/26/2023] [Indexed: 11/13/2023]
Abstract
OBJECTIVE Summarize literature on provider-patient communication linked to health outcomes in communicatively-vulnerable patient populations. METHODS Scoping review of reviews: systematically searched six databases. INCLUSION CRITERIA systematic searches and syntheses of literature; one or more providers and communicatively-vulnerable patients; synchronous in-person communication; intermediate or health outcome linked to communication. RESULTS The search yielded 14,615 citations; 47 reviews - with wide range of providers, communication vulnerabilities, communication practices, and health outcomes - met inclusion criteria. Methodology included qualitative, quantitative, and mixed approaches. Quality ranged from very low to high. Six categories of communication practices linked to health outcomes were identified: 1) motivation-based; 2) accommodation of language, culture, gender, sexual identity, and other concordance with the patient; 3) cultural adaptations of interventions; 4) use of interpreters; 5) other provider-patient communication practices; 6) patient communication practices. CONCLUSION Communication practices were studied in a wide range of providers, with common themes regarding best practices. A unique finding is the role of the patient's communication practices. The specificity of communication practices studied is heterogeneous, with many reviews providing insufficient details. PRACTICE IMPLICATIONS Motivation-based practices and culturally- and linguistically-appropriate care have impacts on patient outcomes across a range of settings with different professions and communicatively-vulnerable groups.
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Affiliation(s)
- Lorienne M Jenstad
- School of Audiology and Speech Sciences, University of British Columbia, Vancouver, Canada
| | - Tami Howe
- School of Audiology and Speech Sciences, University of British Columbia, Vancouver, Canada
| | - Genevieve Breau
- School of Human Sciences, Faculty of Education, Health, and Human Sciences, University of Greenwich, Old Royal Naval College, Park Row, London SE10 9LS, UK.
| | - Jennifer Abel
- School of Audiology and Speech Sciences, University of British Columbia, Vancouver, Canada
| | - Paola Colozzo
- School of Audiology and Speech Sciences, University of British Columbia, Vancouver, Canada
| | - Gayle Halas
- Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Glenda Mason
- School of Audiology and Speech Sciences, University of British Columbia, Vancouver, Canada
| | - Caroline Rieger
- Department of Central, Eastern and Northern European Studies, University of British Columbia, Vancouver, Canada
| | - Leora Simon
- Department of Epidemiology and Biostatistics, McGill University, Montreal, Canada
| | - Shaelyn Strachan
- Faculty of Kinesiology and Recreation Management, University of Manitoba, Winnipeg, Canada
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Gershengorn HB, Patel S, Mallow CM, Falise J, Sosa MA, Parekh DJ, Ferreira T. Association of language concordance and restraint use in adults receiving mechanical ventilation. Intensive Care Med 2023; 49:1489-1498. [PMID: 37843570 DOI: 10.1007/s00134-023-07243-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Accepted: 09/25/2023] [Indexed: 10/17/2023]
Abstract
PURPOSE Clinician-patient language concordance improves patient outcomes in non-intensive care unit (ICU) settings. We sought to assess the association of ICU nurse-patient language concordance with delirium-related outcomes. METHODS We conducted a retrospective cohort study of adult English- or Spanish-speaking mechanically ventilated ICU patients admitted to ICUs at the University of Miami Hospital and Clinics (January 2021-September 2022). Our primary exposure was nurse-patient language concordance on each shift. We used mixed-effects multivariable regression to evaluate the association of language concordance with the primary outcome of restraint use, and secondary outcomes of agitation and identification of delirium, during each shift (with patient as a random effect). RESULTS Our cohort included 4326 shifts (3380 [78.1%] with language concordance) from 548 patients and 157 nurses. Spanish language was preferred by 269 (49.1%) of patients. English-speaking patients tended to be younger (65 [53, 75] vs 73 [61, 83], p < 0.001) and of non-Hispanic ethnicity (55.5% vs 7.1%, p < 0.001). English-speakers had restraints ordered on fewer of their included shifts (0 [0, 3] vs 1 [0, 3], p = 0.005). After adjustment, the odds of restraint use on shifts with language concordance was significantly lower (odds ratio [OR, 95% confidence interval [CI]]: 0.50 [0.39-0.63], p < 0.001). Agitation (18.6% vs 25.2%; OR [95% CI]: 0.71 [0.55-0.92], p = 0.009) and delirium identification (34.5% vs 41.3%; OR [95% CI]: 0.54 [0.34-0.88], p = 0.014) were also less common. CONCLUSIONS We identified a twofold reduction in the odds of restraint use among mechanically ventilated patients for language concordant nurse-patient dyads. Ensuring nurse-patient language concordance may improve ICU delirium, agitation, and restraint use.
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Affiliation(s)
- Hayley B Gershengorn
- Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, University of Miami Miller School of Medicine, 1951 NW 7th Avenue, Miami, FL, 33136, USA.
- Division of Critical Care Medicine, Albert Einstein College of Medicine, Bronx, NY, USA.
| | - Samira Patel
- Care Transformation, University of Miami Hospital and Clinics, Miami, FL, USA
| | - Christopher M Mallow
- Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, University of Miami Miller School of Medicine, 1951 NW 7th Avenue, Miami, FL, 33136, USA
| | - Joseph Falise
- Nursing, University of Miami Hospital and Clinics, Miami, FL, USA
| | - Marie Anne Sosa
- Division of Nephrology and Hypertension, Department of Medicine, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Dipen J Parekh
- Department of Urology, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Tanira Ferreira
- Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, University of Miami Miller School of Medicine, 1951 NW 7th Avenue, Miami, FL, 33136, USA
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Graves JM, Ross N, Gonzalez C, Moore M, Denson V, Vavilala MS. Compassion and Trauma: Occupational Health Experiences of Certified Medical Interpreters in Five U.S. States. Workplace Health Saf 2023; 71:436-444. [PMID: 37191167 DOI: 10.1177/21650799231167586] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
Abstract
Medical interpreters play a vital role in fostering understanding and ensuring safety and transparency in healthcare for patients with non-English language preference. Limited research describes work-related experiences of medical interpreters. The purpose of this research was to explore perceptions of occupational health and safety among medical interpreters. A structured, online survey was administered to all certified medical interpreters in Hawaii, New York, New Jersey, California, and Texas. Participants described occupational experiences as an interpreter via an open-ended question. Responses were coded using qualitative thematic analysis. Response text was reviewed, a codebook of descriptive themes developed, and data thematically coded and summarized. Of 981 potential participants, 199 responded (20.3% response rate). Four main themes were identified: Professionalism and Role, Work-Related Challenges, Approaches to Mitigate Vicarious Trauma, and The Rewarding Nature of the Job. Respondents described compassion fatigue, vicarious trauma, intentional emotional distancing from clients, and loneliness. Respondents identified needs for workplace support to ensure professionalism and safeguard interpreter safety. Medical interpreters appreciate their work, yet face challenges, including compassion fatigue and vicarious trauma. Employers and healthcare institutions should support the occupational and emotional needs of medical interpreters as a vital member of the healthcare team.
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Affiliation(s)
| | - Nicole Ross
- College of Nursing (Spokane), Washington State University
- Honors College, Washington State University
| | | | - Megan Moore
- School of Social Work, University of Washington
- Harborview Injury Prevention and Research Center (HIPRC)
| | - Vicki Denson
- College of Nursing (Vancouver), Washington State University
| | - Monica S Vavilala
- Harborview Injury Prevention and Research Center (HIPRC)
- School of Medicine, University of Washington
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7
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Edelman DS, Palmer DM, Romero EK, Chang BP, Kronish IM. Impact of Native Language, English Proficiency, and Language Concordance on Interpersonal Care During Evaluation of Acute Coronary Syndrome. J Gen Intern Med 2023; 38:946-953. [PMID: 36127540 PMCID: PMC10039209 DOI: 10.1007/s11606-022-07794-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Accepted: 09/07/2022] [Indexed: 10/14/2022]
Abstract
BACKGROUND High-quality interpersonal interactions between clinicians and patients can improve communication and reduce health disparities among patients with novice English proficiency (NEP). Yet, little is known about the impact of native language, NEP, and native language concordance on patient on perceptions of interpersonal care in the emergency department (ED). OBJECTIVE To determine the associations of native language, NEP, and native language concordance with patient perceptions of interpersonal care among patients undergoing evaluation for suspected acute coronary syndrome (ACS) in the ED. DESIGN, SETTING, AND PARTICIPANTS This prospective cohort study included 1000 patients undergoing evaluation for suspected ACS at an urban ED from 2013 to 2016. MAIN MEASURES English- and Spanish-speaking patients were surveyed to identify native language, English proficiency (classified as advanced, intermediate, or novice), and perceived language of the treating ED clinician. Patient perceptions of interpersonal care were assessed using the Interpersonal Processes of Care (IPC) survey, a validated 18-item tool for assessing social-psychological domains of patient-clinician interactions. IPC scores ≤ 4 were categorized as sub-optimal (range, 1-5). The associations between native language, English proficiency, and native language concordance with sub-optimal communication were assessed using hierarchical logistic regression adjusted for all three language variables, sociodemographic characteristics, and depression. KEY RESULTS Nine hundred thirty-three patients (48.0% native non-English-speaking, 55.7% Hispanic) completed the IPC; 522 (57.4%) perceived native language concordance. In unadjusted analyses, non-English native language (OR 1.38, 95% CI 1.04-1.82) and NEP (OR 1.45, 95% CI 1.06-1.98) were associated with sub-optimal communication, whereas language concordance was protective (OR 0.61, 95% CI 0.46-0.81). In fully adjusted analyses, only language concordance remained significantly associated with sub-optimal communication (AOR 0.62, 95% CI 0.42-0.93). CONCLUSIONS This study suggests that perceived native language concordance acts as a protective factor for patient-clinician interpersonal care in the acute setting, regardless of native language or English proficiency.
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Affiliation(s)
- David S Edelman
- Primary Care/Social Internal Medicine Residency Program, Department of Medicine, Montefiore Medical Center, Bronx, NY, USA
| | - Dana M Palmer
- Department of Epidemiology, Columbia University Irving Medical Center, New York, NY, USA
| | - Emily K Romero
- Teachers College, Columbia University, New York, NY, USA
| | - Bernard P Chang
- Department of Emergency Medicine, Columbia University Irving Medical Center, New York, NY, USA
| | - Ian M Kronish
- Center for Behavioral Cardiovascular Health, Columbia University Irving Medical Center, 622 West 168th Street, PH9-311, New York, NY, 10032, USA.
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8
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Escobedo LE, Cervantes L, Havranek E. Barriers in Healthcare for Latinx Patients with Limited English Proficiency-a Narrative Review. J Gen Intern Med 2023; 38:1264-1271. [PMID: 36720766 PMCID: PMC9888733 DOI: 10.1007/s11606-022-07995-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2022] [Accepted: 12/23/2022] [Indexed: 02/02/2023]
Abstract
Latinx (includes Hispanics and is the non-gendered term for Latino/Latina which is a person of Latin American origin or descent) constitutes the largest racial and ethnic minority group in the United States (US). Many members of this group report limited English proficiency, experience discrimination, feel distrust in the healthcare setting, and face poorer health outcomes than non-Latinx Whites. As healthcare systems assess internal structures of care, understanding the experiences of Latinx patients may inform strategies to improve care. This narrative review describes studies that assessed the experiences of Latinx patients with limited English proficiency (LEP) in the inpatient and outpatient settings in the US. We searched PubMed for studies published between January 1, 1990, and March 2021. We reviewed all citations and available abstracts (n = 429). We classified study titles (n = 156) as warranting detailed consideration of the original article. Limited English proficiency is a well-documented challenge reported by Latinx patients seeking care in the outpatient setting, resulting in mistrust of healthcare organizations and clinicians. The effects of LEP overlap substantially with challenges related to patients' immigration status, cultural traditions, and socioeconomic needs. Use of professional interpretation rather than ad hoc interpretation improves trust and satisfaction. There is no consensus about the most effective mode of delivering professional interpretation (in person, telephonic, video conferencing), although rapid simultaneous telephone translation is a promising modality. Increasing awareness of the barriers to effective communication, improving skills in communicating through translators, and increasing the amount of time spent with patients may improve communication and trust more than structural changes like mode of translation or bedside rounding. Cultural fluency training, standardized language training for providers, and incentive pay for fluency are also deserving of further consideration.
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Affiliation(s)
- Luis E Escobedo
- University of Colorado Internal Medicine Residency Training Program, Aurora, CO, USA.
| | - Lilia Cervantes
- Division of Hospital Medicine and General Internal Medicine, University of Colorado Anschutz School of Medicine, Aurora, CO, USA
| | - Edward Havranek
- Department of Medicine, Denver Health and Hospital Authority, Denver, CO, USA
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Dong E, Xu T, Sun X, Wang T, Wang Y, Shi J. Association between acculturation and physician trust for internal migrants: A cross-sectional study in China. PLoS One 2023; 18:e0280767. [PMID: 36893080 PMCID: PMC9997971 DOI: 10.1371/journal.pone.0280767] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Accepted: 01/06/2023] [Indexed: 03/10/2023] Open
Abstract
BACKGROUND Physician trust is a critical determinant of the physician-patient relationship and is necessary for an effective health system. Few studies have investigated the association between acculturation and physician trust. Thus, this study analyzed the association between acculturation and physician trust among internal migrants in China by using a cross-sectional research design. METHODS Of the 2000 adult migrants selected using systematic sampling, 1330 participants were eligible. Among the eligible participants, 45.71% were female, and the mean age was 28.50 years old (standard deviation = 9.03). Multiple logistic regression was employed. RESULTS Our findings indicated that acculturation was significantly associated with physician trust among migrants. The length of stay (LOS), the ability of speaking Shanghainese, and the integration into daily life were identified as contributing factors for physician trust when controlling for all the covariates in the model. CONCLUSION We suggest that specific LOS-based targeted policies and culturally sensitive interventions can promote acculturation among Shanghai's migrants and improve their physician trust.
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Affiliation(s)
- Enhong Dong
- School of Nursing and Health Management, Shanghai University of Medicine & Health Science, Pudong New District, Shanghai, China
- School of Media and Communication, Shanghai Jiao Tong University, Shanghai, China
- Institute of Healthy Yangtze River Delta, Shanghai Jiao Tong University, Shanghai, Shanghai, China
| | - Ting Xu
- School of Nursing and Health Management, Shanghai University of Medicine & Health Science, Pudong New District, Shanghai, China
- School of Media and Communication, Shanghai Jiao Tong University, Shanghai, China
- Institute of Healthy Yangtze River Delta, Shanghai Jiao Tong University, Shanghai, Shanghai, China
| | | | - Tao Wang
- Department of Emergency, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China
- College of Arts and Media, Tongji University, Shanghai, China
| | - Yang Wang
- China Center for Health Development Studies, Peking University, Beijing, China
- * E-mail: (JS); (YW)
| | - Jiahua Shi
- HuangPu District Health Promotion Center, ShangHai, China
- * E-mail: (JS); (YW)
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King M, Ward H, Soto G, Barrett TS. Supporting Emergent Bilinguals Who Use Augmentative and Alternative Communication and Their Families: Lessons in Telepractice From the COVID-19 Pandemic. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2022; 31:2004-2021. [PMID: 35926088 DOI: 10.1044/2022_ajslp-22-00003] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
PURPOSE The purpose of this project was to examine the effect of the COVID-19 pandemic on speech-language pathologist (SLP) service provision for emergent bilinguals who use augmentative and alternative communication (AAC). One prominent issue in AAC service delivery is the efficacy and feasibility of providing AAC services via telepractice. The COVID-19 pandemic intensified this issue as most providers, clients, and families adjusted to remote service delivery models. While emerging evidence supports telepractice in AAC, little is known about the potential benefits and challenges of telepractice for emergent bilinguals who use AAC and their families. METHOD Data were collected via a nationwide survey. Licensed SLPs (N = 160) completed an online questionnaire with Likert-type, multiple-choice, and open-ended questions, analyzed using mixed methods. RESULTS Findings illustrated a shift in service delivery from in-person to telepractice and hybrid (both telepractice and in-person) models. Overall, child intervention outcomes declined for emergent bilinguals who used AAC during the COVID-19 pandemic, regardless of service delivery format. However, collaboration increased for many providers and families. Qualitative analyses highlighted barriers to AAC service provision for emergent bilinguals who use AAC that were exacerbated by the COVID-19 pandemic, as well as factors that facilitated collaboration and family engagement. CONCLUSION These findings suggest that, despite challenges, telepractice or hybrid services may be a promising approach to provide more culturally responsive, family-centered care for emergent bilinguals who use AAC. SUPPLEMENTAL MATERIAL https://doi.org/10.23641/asha.20405673.
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Affiliation(s)
- Marika King
- Department of Communicative Disorders and Deaf Education, Utah State University, Logan
| | - Hannah Ward
- Department of Communicative Disorders and Deaf Education, Utah State University, Logan
| | - Gloria Soto
- Department of Speech, Language and Hearing Sciences and Department of Special Education, San Francisco State University, CA
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Rollins A, Wandell G, Epstein S, Bonilla-Velez J. Evaluating Patient and Family Experience Among Spanish-Speaking and LatinX Patients: a Scoping Review of Existing Instruments. J Racial Ethn Health Disparities 2022:10.1007/s40615-022-01371-x. [PMID: 35913545 DOI: 10.1007/s40615-022-01371-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Revised: 07/10/2022] [Accepted: 07/13/2022] [Indexed: 10/16/2022]
Abstract
INTRODUCTION LatinX populations are rapidly growing in the USA, but still report lower levels of patient centered care and satisfaction when compared to their non-LatinX white counterparts. This review encompasses literature which describes patient experience instruments that (1) evaluate LatinX experience, (2) have validated Spanish versions, or (3) measure language-concordant care experiences. METHODS A scoping review of literature in Ovid Medline, CINAHL, and PsycINFO was conducted. Articles were excluded if they were not applicable to the health care industry, did not include a patient experience instrument, or did not include LatinX or Spanish-speaking individuals within their study population. Data extraction was performed for concepts measured, study size, population, health care setting, and languages validated. RESULTS This review identified 224 manuscripts. Of these, 81 met full inclusion criteria and represented 60 unique instruments. These covered six categories: general patient experience (43%, n = 26/60), experiences of discrimination/mistrust (12%, n = 7/60), cultural factors (10%, n = 6/60), patient-provider relationship (10%, n = 6/60), and communication (8%, n = 5/60). The remaining instruments measured multiple categories (17%, n = 10/60). Just over one third of instruments (n = 24, 5 pediatric, 19 adult) were validated in Spanish and an additional 14 (23%) were validated in English alone. Finally, 4 (7%) instruments were identified which were developed for use in a language concordant setting. CONCLUSION Many instruments were identified which evaluate LatinX patient experience; however, none was both validated in Spanish and measured in all key categories of experience described above. Additionally, few instruments were developed for holistic evaluation of patient experience in pediatric or language concordant care settings.
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Affiliation(s)
- Allison Rollins
- Department of Otolaryngology-Head and Neck Surgery, University of Washington School of Medicine, Seattle, WA, USA
| | - Grace Wandell
- Department of Otolaryngology-Head and Neck Surgery, University of Washington School of Medicine, Seattle, WA, USA
| | - Sherise Epstein
- Department of Otolaryngology-Head and Neck Surgery, University of Washington School of Medicine, Seattle, WA, USA
| | - Juliana Bonilla-Velez
- Department of Otolaryngology-Head and Neck Surgery, University of Washington School of Medicine, Seattle, WA, USA. .,Division of Pediatric Otolaryngology, Seattle Children's Hospital, 4800 Sand Point Way NE, Mail Stop OA.9.220, Seattle, WA, 98105, USA. .,Center for Clinical and Translational Research, Seattle Children's Research Institute, Seattle, WA, USA.
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Ortiz AC, Akgün KM, Bazan IS. Embracing the Diversity of Latinx Communities to Promote Vaccinations. THE YALE JOURNAL OF BIOLOGY AND MEDICINE 2022; 95:257-263. [PMID: 35782479 PMCID: PMC9235259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
While vaccine hesitancy is well documented in the literature among the Latinx community, little attention or effort is given to the nuances among the members of individual communities, such as country of origin, immigration status, generational status, primary language, race, age, sex, gender, or rural residence and how these complexities affect vaccine messaging and uptake. We have evidence that this heterogeneity causes differences in access to healthcare, attitudes towards vaccines, and degree of health disparities. In this review we will describe their impact on vaccination rates in the Latinx community, highlighting missed opportunities for public health outreach, and how targeted messaging could improve vaccine uptake.
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Affiliation(s)
- Alexander C. Ortiz
- Department of Medicine, Yale School of Medicine, New
Haven, CT, USA,To whom all correspondence should be addressed:
Alexander Ortiz, MD, MS, Department of Internal Medicine, Yale University School
of Medicine;
| | - Kathleen M. Akgün
- Pulmonary, Critical Care and Sleep Medicine, VA
Connecticut Healthcare System, West Haven, CT, USA,Section of Pulmonary, Critical Care, & Sleep
Medicine, Yale University School of Medicine, New Haven, CT, USA
| | - Isabel S. Bazan
- Section of Pulmonary, Critical Care, & Sleep
Medicine, Yale University School of Medicine, New Haven, CT, USA
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Greenberg MB, Gandhi M, Davidson C, Carter EB. Society for Maternal-Fetal Medicine Consult Series #62: Best practices in equitable care delivery-Addressing systemic racism and other social determinants of health as causes of obstetrical disparities. Am J Obstet Gynecol 2022; 227:B44-B59. [PMID: 35378098 DOI: 10.1016/j.ajog.2022.04.001] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
The Centers for Disease Control and Prevention define social determinants of health as "the conditions in the places where people live, learn, work, and play" that can affect health outcomes. Systemic racism is a root cause of the power and wealth imbalances that affect social determinants of health, creating disproportionate rates of comorbidities and adverse outcomes in the communities of racial and ethnic minority groups. Focusing primarily on disparities between Black and White individuals born in the United States, this document reviews the effects of social determinants of health and systemic racism on reproductive health outcomes and recommends multilevel approaches to mitigate disparities in obstetrical outcomes.
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Lor M, Koleck TA. Patient Race, Ethnicity, Language, and Pain Severity in Primary Care: A Retrospective Electronic Health Record Study. Pain Manag Nurs 2022; 23:385-390. [PMID: 35260338 PMCID: PMC9308623 DOI: 10.1016/j.pmn.2022.01.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Revised: 01/21/2022] [Accepted: 01/29/2022] [Indexed: 10/18/2022]
Abstract
BACKGROUND Patient race, ethnicity, and culture including language are intertwined and may influence patient reporting of pain severity. PURPOSE To describe documentation of patient's self-reported pain presence and severity by race, ethnicity, and language, specifically, Spanish, Hmong, Lao, or Khmer requiring an interpreter or English. DESIGN AND SAMPLE Retrospective, electronic health record clinical data mining study of 79,195 patient visits with documented pain scores from one primary care clinic. METHODS Hurdle regression was used to explore the effect of race, ethnicity, and language on the chances of having any pain (vs. no pain) and pain severity for visits with pain scores ≥1, controlling for age, sex, and documentation of a pain diagnosis. Mann-Whitney tests were used to explore the influence of English vs. non-English language on pain severity within a race or ethnicity category. RESULTS Pain scores were higher for limited English proficiency, compared with English-speaking, patients within the Asian race or Hispanic/Latino ethnicity category. Older age, female sex, pain diagnosis, Black or African American race, and Spanish or Lao language increased the chance of having any pain. These same factors, plus American Indian or Alaska Native race, contributed to higher pain severity. Asian race, in contrast, decreased the chance of reporting any pain and contributed to lesser pain severity. CONCLUSIONS Race, in addition to a new area of focus, language, impacted both the chances of reporting any pain and pain severity. Additional research is needed on the impact of language barriers on pain severity reporting, documentation, and differences in pain outcomes and disparities.
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Ortega P, Avila S, Park YS. Patient-Reported Quality of Communication Skills in the Clinical Workplace for Clinicians Learning Medical Spanish. Cureus 2022; 14:e22222. [PMID: 35340494 PMCID: PMC8930460 DOI: 10.7759/cureus.22222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Accepted: 02/14/2022] [Indexed: 11/05/2022] Open
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Denson VL, Graves JM. Language Assistance Services in Nonfederally Funded Safety-Net Medical Clinics in the United States. Health Equity 2022; 6:32-39. [PMID: 35112044 PMCID: PMC8804243 DOI: 10.1089/heq.2021.0103] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/05/2021] [Indexed: 11/12/2022] Open
Affiliation(s)
- Vicki L. Denson
- College of Nursing, Washington State University, Vancouver, Washington, USA
| | - Janessa M. Graves
- College of Nursing, Washington State University, Spokane, Washington, USA
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Patel P, Muscat DM, Trevena L, Zachariah D, Nosir H, Jesurasa N, Hadi A, Bernays S. Exploring the expectations, experiences and tensions of refugee patients and general practitioners in the quality of care in general practice. Health Expect 2021; 25:639-647. [PMID: 34951092 PMCID: PMC8957721 DOI: 10.1111/hex.13411] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Revised: 11/16/2021] [Accepted: 12/07/2021] [Indexed: 11/27/2022] Open
Abstract
Background Refugees and asylum seekers arrive in the Australian community with complex health needs and expectations of healthcare systems formed from elsewhere. Navigating the primary healthcare system can be challenging with communication and language barriers. In multicultural societies, this obstacle may be removed by accessing language‐concordant care. Emerging evidence suggests language‐concordance is associated with more positive reports of patient experience. Whether this is true for refugees and asylum seekers and their expectation of markers of quality patient‐centred care (PCC) remains to be explored. This study aimed to explore the expectations around the markers of PCC and the impacts of having language‐concordant care in Australian primary healthcare. Methods We conducted semi‐structured individual in‐language (Arabic, Dari, and Tamil) remote interviews with 22 refugee and asylum seekers and 9 general practitioners (GPs). Interview transcripts were coded inductively and deductively, based on the research questions, using Thematic Analysis. Extensive debriefing and discussion took place within the research team throughout data collection and analysis. Results Community member expectations of markers of PCC are constantly evolving and adapting based on invisible and visible actions during clinical encounters. Challenges can occur in the clinical encounter when expectations are ‘unsaid’ or unarticulated by both community members and GPs due to the assumption of shared understanding with language concordant care. Expectations of what constitutes satisfactory, quality PCC are dynamic outcomes, which are influenced by prior and current experiences of healthcare. Conclusion This study highlights the importance of understanding that language concordant care does not always support aligned expectations of the markers of quality PCC between community members and their GP. We recommend that GPs encourage community members to provide explicit descriptions about how their prior experiences have framed their expectations of what characterizes quality PCC. In addition, GPs could develop a collaborative approach, in which they explain their own decision‐making processes in providing PCC to refugees and asylum seekers. Patient or Public Contribution Bilingual researchers from multicultural backgrounds and experience working with people from refugee backgrounds were consulted on study design and analysis. This study included individuals with lived experiences as refugees and asylum seekers and clinicians as participants.
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Affiliation(s)
- Pinika Patel
- Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia.,Ask Share Know: Rapid Evidence for General Practice Decisions (ASK-GP), Centre for Research Excellence, School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia.,Sydney Health Literacy Lab, School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Danielle M Muscat
- Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia.,Ask Share Know: Rapid Evidence for General Practice Decisions (ASK-GP), Centre for Research Excellence, School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia.,Sydney Health Literacy Lab, School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Lyndal Trevena
- Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia.,Ask Share Know: Rapid Evidence for General Practice Decisions (ASK-GP), Centre for Research Excellence, School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Dipti Zachariah
- Multicultural Health, Integrated and Community Health Directorate, Western Sydney Local Health District, Cumberland, New South Wales, Australia
| | - Hanaa Nosir
- Multicultural Health, Integrated and Community Health Directorate, Western Sydney Local Health District, Cumberland, New South Wales, Australia
| | - Nishanthie Jesurasa
- Multicultural Health, Integrated and Community Health Directorate, Western Sydney Local Health District, Cumberland, New South Wales, Australia
| | - Amina Hadi
- Multicultural Health, Integrated and Community Health Directorate, Western Sydney Local Health District, Cumberland, New South Wales, Australia
| | - Sarah Bernays
- Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia.,Department of Global Health and Development, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
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Considerations and Strategies for Enhancing the Supervision and Training of Foreign-Born Spanish-Speaking Supervisees. JOURNAL OF CONTEMPORARY PSYCHOTHERAPY 2021. [DOI: 10.1007/s10879-021-09495-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Martinez GA, Parés-Avila JA, Graham M, Stauber L, Szalacha L, Menon U. Communicating and Coaching in Spanish for Chronic Care. J Nurs Educ 2021; 60:34-37. [PMID: 33400806 DOI: 10.3928/01484834-20201217-08] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Accepted: 08/12/2020] [Indexed: 11/20/2022]
Abstract
BACKGROUND Language barriers affect millions of health care consumers each year in the United States. One in five U.S. residents over the age of 5 years speaks a language other than English. METHOD A multidisciplinary team consisting of applied linguists and nurse educators developed a graduate elective for nursing students who demonstrated a minimum Spanish proficiency level. The course was organized around three core content components: management of type 2 diabetes, motivational interviewing competencies, and strategic communication in Spanish. Course activities included discourse analysis, simulated mini-conversations, and standardized patient simulations. RESULTS A multidisciplinary team-teaching approach was ideal in assisting students to develop culturally sensitive clinical language skills. CONCLUSION Language concordance is imperative to providing quality health care to non-English-speaking patients. Health care providers must be able to demonstrate empathy, an understanding of cultural dynamics, and the ability to provide care to non-English-speaking patients. [J Nurs Educ. 2021;60(1):34-37.].
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