Wang Yidi, Sudore Rebecca L, Zapata Carly, Martinez Roman, Gonzalez Jasmine, Le Vincent, Quinn Mara, Huang Carrie, Perez-Vaughan Claudia, Pantilat Steven Z, Lyles Courtney R, Ritchie Christine S, Nouri Sarah
School of Medicine, University of California, San Francisco.
Division of Geriatrics, Department of Medicine, University of California, San Francisco.
JAMA Netw Open. 2025 Sep 2;8(9):e2529880. doi: 10.1001/jamanetworkopen.2025.29880.
Telehealth use in outpatient care has increased. Patients who speak preferred languages other than English (PLOE) experience disparities in telehealth use and in care provided via telehealth for serious illnesses (eg, cancer and other illnesses with high mortality risk and negative effects on daily functioning or quality of life). However, little is known about the experiences of people with PLOE receiving serious illness care via telehealth.
To identify facilitators and barriers to providing serious illness care via telehealth to people with PLOE.
DESIGN, SETTING, AND PARTICIPANTS: This qualitative study analyzed semistructured interviews with Cantonese- or Spanish-speaking patients or their caregivers receiving outpatient serious illness care via telehealth at 2 University of California, San Francisco palliative care clinics (one focused on cancer and one on noncancer serious illnesses). The study included participants aged 18 years or older who spoke Spanish or Cantonese (the 2 most prevalent non-English languages in San Francisco). Participants were recruited via telephone outreach conducted by language-concordant study staff. If patients could not communicate by telephone (eg, they had anarthria or advanced dementia), their caregivers were interviewed instead. Semistructured interviews were conducted between June and August 2023.
At least 1 outpatient telehealth visit in the last year.
One-on-one semistructured interviews developed using the Capability, Opportunity, Motivation, and Behavior framework were conducted by telephone to capture patient and caregiver perceptions on facilitators and barriers to serious illness care via telehealth. Interviews were recorded, transcribed, translated, and analyzed using thematic analysis.
This study included 20 participants (mean [SD] age, 64.7 [15.4] years; 14 females [70%]). Three key themes were identified from the transcripts of 9 Cantonese-speaking participants (45%; 3 patients and 6 caregivers) and 11 Spanish-speaking participants (55%; 7 patients and 4 caregivers). First, health system processes determined visit type and impacted telehealth accessibility. Second, between-visit communication using digital health tools (eg, the electronic patient portal) was challenging due to limited availability in non-English languages and digital literacy requirements. Finally, patient-clinician language concordance and longitudinal relationships with certified interpreters facilitated high-quality serious illness communication during telehealth visits, although family interpreters were sometimes required to overcome barriers associated with video interpretation, because patients sometimes had concerns about interpreter privacy and accuracy.
In this qualitative study of 20 semistructured interviews, Cantonese- and Spanish-speaking participants experienced barriers to serious illness care via telehealth before, during, and between visits. These findings underscore the need for interventions to promote equitable telehealth care for people with serious illnesses and PLOE, such as training more language-concordant clinicians, incorporating interpreters into interdisciplinary teams, and ensuring access to patient portals in languages other than English.
门诊护理中远程医疗的使用有所增加。除英语外使用其他首选语言（PLOE）的患者在远程医疗使用以及通过远程医疗接受严重疾病（如癌症和其他具有高死亡风险且对日常功能或生活质量有负面影响的疾病）护理方面存在差异。然而，对于使用PLOE的患者通过远程医疗接受严重疾病护理的经历知之甚少。
确定通过远程医疗为使用PLOE的患者提供严重疾病护理的促进因素和障碍。
设计、设置和参与者：这项定性研究分析了对在加利福尼亚大学旧金山分校的2家姑息治疗诊所（一家专注于癌症，一家专注于非癌症严重疾病）通过远程医疗接受门诊严重疾病护理的讲粤语或西班牙语的患者或其护理人员进行的半结构化访谈。该研究纳入了年龄在18岁及以上、讲西班牙语或粤语（旧金山两种最普遍的非英语语言）的参与者。参与者通过与语言匹配的研究人员进行电话外联招募。如果患者无法通过电话沟通（例如，他们患有构音障碍或晚期痴呆症），则采访其护理人员。半结构化访谈于2023年6月至8月进行。
过去一年中至少进行1次门诊远程医疗就诊。
使用能力、机会、动机和行为框架进行一对一的半结构化访谈，通过电话进行，以了解患者和护理人员对通过远程医疗提供严重疾病护理的促进因素和障碍的看法。访谈进行录音、转录、翻译，并使用主题分析进行分析。
本研究包括20名参与者（平均[标准差]年龄，64.7[15.4]岁；14名女性[70%]）。从9名讲粤语的参与者（45%；3名患者和6名护理人员）和11名讲西班牙语的参与者（55%；7名患者和4名护理人员）的访谈记录中确定了三个关键主题。首先，卫生系统流程决定就诊类型并影响远程医疗的可及性。其次，由于非英语语言的可用性有限和数字素养要求，使用数字健康工具（如电子患者门户网站）进行就诊间沟通具有挑战性。最后，患者与临床医生的语言匹配以及与认证口译员的长期关系促进了远程医疗就诊期间高质量的严重疾病沟通，尽管有时需要家庭口译员来克服与视频口译相关的障碍，因为患者有时担心口译员的隐私和准确性。
在这项对20次半结构化访谈的定性研究中，讲粤语和西班牙语的参与者在就诊前、就诊期间和就诊之间通过远程医疗接受严重疾病护理时遇到了障碍。这些发现强调需要采取干预措施，以促进为患有严重疾病和使用PLOE的患者提供公平的远程医疗护理，例如培训更多语言匹配的临床医生、将口译员纳入跨学科团队以及确保提供非英语语言的患者门户网站。
