Lee Jonathan S, Pérez-Stable Eliseo J, Gregorich Steven E, Crawford Michael H, Green Adrienne, Livaudais-Toman Jennifer, Karliner Leah S
Division of General Internal Medicine, University of California San Francisco, San Francisco, CA, USA.
Multiethnic Health Equity Research Center, University of California San Francisco, San Francisco, CA, USA.
J Gen Intern Med. 2017 Aug;32(8):863-870. doi: 10.1007/s11606-017-3983-4. Epub 2017 Feb 9.
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.
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.
Prospective, pre-post intervention implementation study using propensity analysis.
Hospitalized patients undergoing invasive procedures on the cardiovascular, general surgery or orthopedic surgery floors.
Installation of dual-handset interpreter phones at every bedside enabling 24-h immediate access to professional interpreters.
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.
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).
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.
语言障碍会干扰沟通，并阻碍英语水平有限（LEP）的患者在接受医疗程序时做出知情同意。针对这种差异的有效干预措施仍不明确。
评估床边口译电话系统干预对LEP患者知情同意的影响，并将结果与英语使用者进行比较。
采用倾向分析的前瞻性干预前后实施研究。
在心血管、普通外科或整形外科病房接受侵入性手术的住院患者。
在每张病床安装双手持口译电话，使患者能够24小时立即联系到专业口译员。
主要预测因素：实施前与实施后组；次要预测因素：实施后LEP患者与英语使用者。主要结局：知情同意的三个核心要素，患者报告对（1）手术原因、（2）手术风险以及（3）所有问题均得到解答的理解。当满足所有三个要素时，我们认为同意是充分知情的。
我们纳入了152名说中文和西班牙语的LEP患者（实施前84名，实施后68名）和86名英语使用者。实施后（与实施前相比），LEP患者更有可能符合充分知情同意的标准（54%对29%，p = 0.001），并且在倾向得分调整后，充分知情同意的几率显著更高（调整后比值比[AOR] 2.56；95%置信区间[CI]，1.15 - 5.72），以及每个同意要素单独来看也是如此。然而，与实施后说英语的患者相比，实施后LEP患者充分知情同意的调整后几率显著更低（AOR，0.38；95% CI，0.16 - 0.91）。
增加快速联系专业口译员机会的床边口译电话系统干预与患者报告的知情同意改善相关联，寻求改善LEP患者护理的医院应予以考虑；然而，这些改善并未消除基于语言的差异。可能需要额外的临床医生教育干预措施以及更多语言匹配的护理，以使知情同意与说英语的患者达到同等水平。
