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Peters S, Peebles E, Carwana M. Lost in translation: a national cross-sectional study on medical interpreter use by pediatric residents. Postgrad Med J 2024; 100:504-511. [PMID: 38453142 DOI: 10.1093/postmj/qgae026] [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] [Received: 10/10/2023] [Revised: 01/25/2024] [Accepted: 01/27/2024] [Indexed: 03/09/2024]
Abstract
BACKGROUND Lack of communication in a family's preferred language is inequitable and results in inferior care. Pediatric residents provide care to many families with non-English or French language preferences (NEFLP). There is no data available about how Canadian pediatric residents use interpreters, making it difficult to develop targeted interventions to improve patient experience. OBJECTIVES Our purpose was to assess translation services in pediatric training centers and evaluate resident perception of their clinical skills when working with NEFLP patients and families. This survey represents the first collection of data from Canadian pediatric residents about interpreter services. METHODS Eligible participants included all pediatric residents enrolled in an accredited Canadian pediatric training program. An anonymous survey was developed in REDCap© and distributed via email to all pediatric residents across Canada. Descriptive statistics were performed in STATA v15.1. RESULTS 122 residents responded. Interpreter services were widely available but underused in a variety of clinical situations. Most (85%) residents felt they provided better care to patients who shared their primary language (English or French), compared with families who preferred other languages-even when an interpreter was present. This finding was consistent across four self-assessed clinical skills. CONCLUSIONS Residents are more confident in their clinical and communication skills when working with families who share their primary language. Our findings suggest that residents lack the training and confidence to provide equal care to families with varying language preferences. Pediatric training programs should develop curriculum content that targets safe and effective interpreter use while reviewing non-spoken aspects of cultural awareness and safety.
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Affiliation(s)
- Sarah Peters
- Department of Pediatrics, University of British Columbia, UBC Faculty of Medicine Rm 2D19, 4480 Oak Street, BC Children's Hospital, Vancouver, BC V6H 3V4, Canada
- BC Children's Hospital Research Institute, 938 W 28th Ave, Vancouver, BC V5Z 4H4, Canada
| | - Erin Peebles
- Department of Pediatrics, University of British Columbia, UBC Faculty of Medicine Rm 2D19, 4480 Oak Street, BC Children's Hospital, Vancouver, BC V6H 3V4, Canada
- BC Children's Hospital Research Institute, 938 W 28th Ave, Vancouver, BC V5Z 4H4, Canada
| | - Matthew Carwana
- Department of Pediatrics, University of British Columbia, UBC Faculty of Medicine Rm 2D19, 4480 Oak Street, BC Children's Hospital, Vancouver, BC V6H 3V4, Canada
- BC Children's Hospital Research Institute, 938 W 28th Ave, Vancouver, BC V5Z 4H4, Canada
- University of British Columbia, Human Early Learning Partnership, 2206 E Mall, Vancouver, BC V6T 1Z3, Canada
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Rajbhandari P, Glick AF, Brown MF, VanGeest J. Communication Training for Pediatric Hospitalists and its Impact on Clinical Practice with Families Using Languages Other than English. Acad Pediatr 2023:S1876-2859(23)00468-0. [PMID: 38110055 DOI: 10.1016/j.acap.2023.12.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Revised: 12/07/2023] [Accepted: 12/11/2023] [Indexed: 12/20/2023]
Abstract
OBJECTIVE Providing equitable health care for children of families speaking Language Other than English (LOE) relies on linguistic services, including interpretation and translation. Inadequate education on effectively utilizing linguistic services can lead to a knowledge gap and subsequent challenges in leveraging these services. This study aims to evaluate the educational training provided to pediatric hospitalists and its association with clinical practice. METHODS A multicenter cross-sectional survey of pediatric hospitalists was conducted through the Pediatric Research in Inpatient Setting (PRIS) network, a hospital-based independent research network. The survey was distributed to PRIS site leads with one response per institution. Associations between educational training received on proper communication with families speaking LOE and practice behaviors were analyzed using chi-square or Fisher's exact tests. RESULTS We received responses from 72 out of 112 PRIS hospital site-leads. Among the respondents, 56% did not receive training on communication during their Graduate Medical Education years (residency or fellowship); 47% did not receive training at their current workplace. Only 6% of those receiving workplace training reported annual updates or refresher courses. Furthermore, 26% of respondents rated the training as "good," while 35% considered it "fair." Respondents who received training during Graduate Medical Education years and at their workplace reported that they asserted/advocated more on behalf of patients speaking LOE than those who did not (P < .01). CONCLUSION Pediatric hospitalists lack adequate training to communicate effectively with families speaking LOE. Increased training is associated with increased advocacy. Further work should explore increasing communication training and its effect on patient outcomes.
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Affiliation(s)
- Prabi Rajbhandari
- Division of Hospital Medicine (P Rajbhandari), Department of Pediatrics, Akron Children's Hospital, Akron, Ohio.
| | - Alexander F Glick
- Division of Hospital Medicine (A Glick), Department of Pediatrics, NYU Grossman School of Medicine, New York, NY
| | - Miraides F Brown
- Rebecca D Considine Research Institute (MF Brown), Akron Children's Hospital, Akron, Ohio
| | - Jonathan VanGeest
- College of Public Health (J VanGeest), Kent State University, Kent, Ohio
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Prochaska EC, Caballero TM, Fabre V, Milstone AM. Infection prevention requires attention to patient and caregiver language: Removing language barriers from infection prevention education. Infect Control Hosp Epidemiol 2023; 44:1707-1710. [PMID: 37039600 PMCID: PMC10691433 DOI: 10.1017/ice.2023.58] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/12/2023]
Affiliation(s)
- Erica C. Prochaska
- Department of Pediatrics, Division of Pediatric Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Department of Hospital Epidemiology and Infection Control, Johns Hopkins Health System, Baltimore, MD, USA
| | - Tania Maria Caballero
- Department of Pediatrics, Division of General Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Valeria Fabre
- Division of Infectious Diseases, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Aaron M. Milstone
- Department of Pediatrics, Division of Pediatric Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Department of Hospital Epidemiology and Infection Control, Johns Hopkins Health System, Baltimore, MD, USA
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Rojas CR, Coffin A, Taylor A, Ortiz P, Jenicek G, Hart J, Callahan JM, Shaw KN. Resident Communication With Patients and Families Preferring Languages Other Than English. Hosp Pediatr 2023:191228. [PMID: 37125495 DOI: 10.1542/hpeds.2022-007003] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
Abstract
OBJECTIVES Patients and families preferring languages other than English (LOE) often experience inequitable communication with their health care providers, including the underutilization of professional interpretation. This study had 2 aims: to characterize resident-perceived communication with families preferring LOE and to evaluate the impact of language preference on frequency of resident interactions with hospitalized patients and families. METHODS This was a cross-sectional study at a quaternary care children's hospital. We developed a questionnaire for residents regarding their interactions with patients preferring LOE. We concurrently developed a communication tracking tool to measure the frequency of resident communication events with hospitalized patients. Data were analyzed with logistic and Poisson regression models. RESULTS Questionnaire results demonstrated a high level of resident comfort with interpretation, though more than 30% of residents reported "sometimes" or "usually" communicating with families preferring LOE without appropriate interpretation (response rate, 47%). The communication tracking tool was completed by 36 unique residents regarding 151 patients, with a 95% completion rate. Results demonstrated that patients and families preferring LOE were less likely to be present on rounds compared with their counterparts preferring English (adjusted odds ratio, 0.17; 95% confidence interval [CI], 0.07-0.39). Similarly, patients and families preferring LOE were less likely to receive a resident update after rounds (adjusted odds ratio, 0.29; 95% CI, 0.13-0.62) and received fewer resident updates overall (incidence rate ratio, 0.45; 95% CI, 0.30-0.69). CONCLUSIONS Hospitalized patients and families preferring LOE experience significant communication-related inequities. Ongoing efforts are needed to promote equitable communication with this population and should consider the unique role of residents.
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Affiliation(s)
- Christina R Rojas
- Department of Pediatrics
- Division of Emergency Medicine, Children's National Hospital, Washington, District of Columbia; and
| | | | | | | | | | - Jessica Hart
- Department of Pediatrics
- Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - James M Callahan
- Division of Emergency Medicine, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
- Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Kathy N Shaw
- Division of Emergency Medicine, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
- Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
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Milki AA, Bechara M, Lew SQ, Poon AN. Chronic Kidney Disease of Non-traditional Etiology in a Young Man From Central America: Geography, Poverty, and Uncertain Pathophysiology Create a Formidable Medical Challenge. Cureus 2023; 15:e38876. [PMID: 37303355 PMCID: PMC10257359 DOI: 10.7759/cureus.38876] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/11/2023] [Indexed: 06/13/2023] Open
Abstract
A man in his early 20s with kidney biopsy-confirmed focal segmental glomerulosclerosis (FSGS) was admitted with one month of nausea and vomiting, intermittent episodes of confusion, shortness of breath, and dysuria. He reported that many people from his native village in Central America, where he harvested sugarcane as a child, have died from kidney disease, including his father and cousin. He believed the source of disease to be agrochemicals found in the village's water supply. Although FSGS would be a rare manifestation, the patient's risk factors strongly suggested chronic kidney disease of unknown etiology (CKDu) - also known as Mesoamerican nephropathy (MeN) - a phenomenon he had never previously heard of. He took lisinopril for the last six years to manage his kidney disease. Due to uremic symptoms and abnormal electrolytes, he was initiated on hemodialysis.
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Affiliation(s)
- Anthony A Milki
- Department of Medicine, George Washington University School of Medicine and Health Sciences, Washington, USA
| | - Michael Bechara
- Department of Medicine, Division of Hospital Medicine, Virginia Hospital Center, Arlington, USA
| | - Susie Q Lew
- Department of Medicine, Division of Kidney Disease and Hypertension, George Washington University School of Medicine and Health Sciences, Washington, USA
| | - Adrienne N Poon
- Department of Medicine, Division of Hospital Medicine, George Washington University School of Medicine and Health Sciences, Washington, USA
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Maletsky KD, Worsley D, Tran Lopez K, Del Valle Mojica C, Ortiz P, Bonafide CP, Tenney-Soeiro R. Communication Experiences of Caregivers Using a Language Other Than English on Inpatient Services. Hosp Pediatr 2023:191227. [PMID: 37125497 DOI: 10.1542/hpeds.2022-007011] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
Abstract
OBJECTIVES Individuals who prefer to communicate about health care in a language other than English (LOE) experience poorer quality medical care and challenges when communicating with health care providers. The objective of this study was to elucidate how caregivers who prefer an LOE perceive communication with their physicians on an inpatient general pediatrics service. METHODS Caregivers of patients admitted to the general pediatrics service at our urban freestanding children's hospital whose preferred language for medical care was Spanish, Arabic, Brazilian Portuguese, or Mandarin were eligible for this qualitative study. Semistructured interviews using video interpreter services were conducted to explore the participants' experiences communicating with their physicians. Interview transcripts were analyzed using conventional content analysis. RESULTS We interviewed 15 participants representing 7 countries of origin and 4 non-English languages: Spanish, Arabic, Brazilian Portuguese, and Mandarin. Three main domains emerged, including: (1) use of interpreter services, (2) overall communication experience with physician providers, and (3) suggestions for improvement in physician communication. Salient themes included early identification of the need for an interpreter is essential and physicians' use of body language in combination with an interpreter enhances successful communication. CONCLUSIONS This project fills a gap in existing literature by describing the perspectives of caregivers who prefer an LOE, including those speaking languages other than Spanish, because they communicate with inpatient pediatricians. In addition to ensuring appropriate use of interpreter services, physicians can focus on using plain language and gestures during encounters, helping to facilitate communication and provide culturally competent care for this population.
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Affiliation(s)
- Kristin D Maletsky
- Section of Hospital Medicine, Divisions of General Pediatrics
- Perelman School of Medicine, and
| | - Diana Worsley
- Clinical Futures: A CHOP Research Institute Center of Emphasis
- PolicyLab, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Kim Tran Lopez
- Section of Hospital Medicine, Divisions of General Pediatrics
- Perelman School of Medicine, and
| | | | | | - Christopher P Bonafide
- Section of Hospital Medicine, Divisions of General Pediatrics
- Clinical Futures: A CHOP Research Institute Center of Emphasis
- Perelman School of Medicine, and
- Penn Implementation Science Institute at the Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Rebecca Tenney-Soeiro
- Section of Hospital Medicine, Divisions of General Pediatrics
- Perelman School of Medicine, and
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Sina B, Noemi G, Myriam G, Ursula F, Anne J, Jabeen F, Kristina K, Julia B. The use of intercultural interpreter services at a pediatric emergency department in Switzerland. BMC Health Serv Res 2022; 22:1365. [DOI: 10.1186/s12913-022-08771-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Accepted: 11/01/2022] [Indexed: 11/18/2022] Open
Abstract
AbstractThe aim of our study was to analyze the use of interpreter services and improve communication during health encounters with families with limited language proficiency (LLP) at the pediatric emergency department (ED) of the University Hospital of Bern.This study is a pre- and post-intervention study analyzing the use of interpreter services for LLP families. All families originating from a country with a native language other than German, English or French presenting to the ED were eligible to participate in the study. If they agreed to participate, the language proficiency of the caregiver present during the health encounter was systematically assessed during a phone interview within a few days after the consultation, using a standardized screening tool. If screened positive (relevant LLP), a second phone interview with an interpreter was conducted. Further variables were extracted including nationality, age, gender and date of visit using administrative health records. To increase the use of interpreter services, a package of interventions was implemented at the department during 3 months. It consisted of: i) in person and online transcultural teaching ii) awareness raising through the regular information channels and iii) the introduction of a pathway to systematically identify and manage LLP families.The proportion of LLP families who received an interpreter was 11.0% (14/127) in the pre-intervention period compared to 14.8% (20/135) in the post-intervention period. The interpreter use was therefore increased by 3.8% (95% CI − 0.43 to 0.21; p = 0.36).The assessed level of language proficiency of caregivers differed from the self-reported level of language proficiency. Of the study participants in the interview whose language proficiency was screened as limited, 77.1% estimated their language proficiency level as intermediate. More than half of the LLP families who did not receive an interpreter and participated in the interview reported, that they would have liked an interpreter during the consultation.Conclusions: Interpreter services are largely underused during health encounters with LLP families. Relying on caregivers´ self-assessed language proficiency and their active request for an interpreter is not sufficient to ensure safe communication during health encounters. Systematic screening of language proficiency and standardized management of LLP families is feasible and needed at health care facilities to ensure equitable care. Further studies are needed to analyze personal and institutional barriers to interpreter use and find interventions to sustainably increase the use of interpreter services for LLP families.
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Rajbhandari P, Garber MD. Improving Language Equity in Hospitalized Children of Families With LEP: Challenges and Solutions. Hosp Pediatr 2022; 12:e367-e373. [PMID: 36124635 DOI: 10.1542/hpeds.2022-006537] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Affiliation(s)
- Prabi Rajbhandari
- Division of Hospital Medicine, Department of Pediatrics, Akron Children's Hospital, Akron, Ohio
| | - Matthew D Garber
- Division of Hospital Medicine, Department of Pediatrics, Wolfson Children's Hospital University of Florida Health, Jacksonville, Florida
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Brady PW. The Second Decade of Hospital Pediatrics. Hosp Pediatr 2021; 11:659-661. [PMID: 34193587 DOI: 10.1542/hpeds.2021-006035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Affiliation(s)
- Patrick W Brady
- Division of Hospital Medicine and James M. Anderson Center for Health Systems Excellence, Cincinnati Children's Hospital Medical Center and Department of Pediatrics, College of Medicine, University of Cincinnati, Cincinnati, Ohio
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