Padilla Laura Karina, Hodges Priscila Delgado, Ricker Charité, Geurts Jennifer L
The Medical College of Wisconsin, Milwaukee, Wisconsin, USA.
Indiana University School of Medicine, Indianapolis, Indiana, USA.
J Genet Couns. 2025 Apr;34(2):e2026. doi: 10.1002/jgc4.2026.
Patients in the United States with Limited English Proficiency (LEP) lack access to language-concordant genetic counselors. This places patients with LEP at a disadvantage during appointments due to previously identified factors such as time constraints, lack of formal training for genetic counselors, and interpreters' limited training in genetics terminology. When done well, interpretation services enhance healthcare and expand access to genetic counseling. Given the increased utilization of telehealth for the delivery of genetic counseling services including telephone and video communication, it is imperative to adapt practices to avoid exacerbating disparities among underserved communities. This qualitative study explores strategies used by experienced genetic counselors (GCs) in telehealth sessions with interpreters. Participants were board-certified GCs and had high-volume of patients with LEP seen via telehealth. Semi-structured interviews (n = 11) were conducted virtually and recorded. Interviews were coded for themes using descriptive coding. Development of the codebook was done with study team members reviewing 1-2 transcripts against the initial codebook for feedback. Codes and the codebook were refined through an iterative process. Thematic analysis revealed two major themes: how GCs gained their knowledge, and strategies GCs used during interpreted telehealth appointments. Experienced GCs gained their knowledge through on-the-job experience, learning from interpreters, and from bilingual colleagues. Results also indicated that when providing services over telehealth for patients with LEP, experienced GCs employ strategies to overcome difficulties in educating, assessing patient understanding, and meeting psychosocial needs. These strategies build on GC core competencies and best practices for working with interpreters to adapt for telehealth delivery. As such, this study offers practical guidance for GCs and trainees with suggestions before, during, and after an interpreted telehealth appointment. GCs can make strides for equity in the quality of telehealth sessions for patients regardless of language by leveraging these insights, learning about the cultures of the communities they frequently serve, and willingness to adapt sessions.
美国英语水平有限（LEP）的患者难以获得语言匹配的遗传咨询师服务。由于先前确定的因素，如时间限制、遗传咨询师缺乏正规培训以及口译员在遗传学术语方面的培训有限，LEP患者在预约时处于劣势。如果做得好，口译服务可以改善医疗保健并扩大获得遗传咨询的机会。鉴于远程医疗在提供遗传咨询服务（包括电话和视频通信）中的使用增加，必须调整做法以避免加剧服务不足社区之间的差距。这项定性研究探讨了经验丰富的遗传咨询师（GC）在与口译员进行远程医疗会诊时使用的策略。参与者均为获得委员会认证的GC，且通过远程医疗接待过大量LEP患者。研究以线上方式进行了11次半结构化访谈并录音。访谈采用描述性编码方式进行主题编码。通过研究团队成员对照初始编码手册审查1-2份访谈记录以获取反馈意见，从而完成编码手册的制定。通过迭代过程对编码和编码手册进行完善。主题分析揭示了两个主要主题：GC如何获取知识，以及GC在有口译员参与的远程医疗预约中所使用的策略。经验丰富的GC通过在职经验、向口译员学习以及向双语同事学习来获取知识。结果还表明，在为LEP患者提供远程医疗服务时，经验丰富的GC会采用策略来克服在教育患者、评估患者理解情况以及满足心理社会需求方面的困难。这些策略基于GC的核心能力以及与口译员合作的最佳实践，以适应远程医疗服务的提供。因此，本研究为GC和实习生在有口译员参与的远程医疗预约之前、期间和之后提供了实用建议。通过利用这些见解、了解他们经常服务的社区的文化以及愿意调整会诊方式，可以为患者提供高质量的远程医疗服务，无论其语言如何，从而在远程医疗服务质量方面实现公平。
