Zurca Adrian D, Fisher Kiondra R, Flor Remigio J, Gonzalez-Marques Catalina D, Wang Jichuan, Cheng Yao I, October Tessie W
Division of Pediatric Critical Care Medicine, and
Division of Pediatric Critical Care Medicine, and.
Hosp Pediatr. 2017 Jan;7(1):9-15. doi: 10.1542/hpeds.2016-0071. Epub 2016 Dec 15.
Health care disparities have been described for children of limited English-proficient (LEP) families compared with children of English-proficient (EP) families. Poor communication with the medical team may contribute to these worse health outcomes. Previous studies exploring communication in the PICU have excluded LEP families. We aimed to understand communication experiences and preferences in the 3 primary communication settings in the PICU. We also explored LEP families' views on interpreter use in the PICU.
EP and Spanish-speaking LEP families of children admitted to the PICU of a large tertiary pediatric hospital completed surveys between 24 hours and 7 days of admission.
A total of 161 of 184 families were surveyed (88% response rate); 52 were LEP and 109 EP. LEP families were less likely to understand the material discussed on rounds (odds ratio [OR] 0.32, 95% confidence interval [CI] 0.11-0.90), to report that PICU nurses spent enough time speaking with them (OR 0.15, 95% CI 0.05-0.41), and to report they could rely on their nurses for medical updates (OR 0.07, 95% CI 0.02-0.25) controlling for covariates, such as education, insurance type, presence of a chronic condition, PICU length of stay, and mortality index. LEP families reported 53% of physicians and 41% of nurses used an interpreter "often."
Physician and nurse communication with LEP families is suboptimal. Communication with LEP families may be improved with regular use of interpreters and an increased awareness of the added barrier of language proficiency.
与英语熟练(EP)家庭的儿童相比,英语水平有限(LEP)家庭的儿童存在医疗保健差异。与医疗团队沟通不畅可能导致这些更差的健康结果。先前探索儿科重症监护病房(PICU)沟通情况的研究排除了LEP家庭。我们旨在了解PICU中3种主要沟通场景下的沟通体验和偏好。我们还探讨了LEP家庭对PICU中使用口译员的看法。
一家大型三级儿科医院PICU收治的儿童的EP家庭和说西班牙语的LEP家庭在入院24小时至7天内完成了调查。
共对184个家庭中的161个进行了调查(回复率88%);52个是LEP家庭,109个是EP家庭。在控制协变量(如教育程度、保险类型、慢性病的存在、PICU住院时间和死亡率指数)后,LEP家庭不太可能理解查房时讨论的内容(优势比[OR]0.32,95%置信区间[CI]0.11 - 0.90),不太可能报告PICU护士与他们交谈的时间足够(OR 0.15,95% CI 0.05 - 0.41),也不太可能报告他们可以依靠护士获取医疗最新信息(OR 0.07,95% CI 0.02 - 0.25)。LEP家庭报告称,53%的医生和41%的护士“经常”使用口译员。
医生和护士与LEP家庭的沟通并不理想。定期使用口译员并提高对语言能力这一额外障碍的认识,可能会改善与LEP家庭的沟通。