Increased Access to Professional Interpreters in the Hospital Improves Informed Consent for Patients with Limited English Proficiency

  • Jonathan S. Lee
  • Eliseo J. Pérez-Stable
  • Steven E. Gregorich
  • Michael H. Crawford
  • Adrienne Green
  • Jennifer Livaudais-Toman
  • Leah S. Karliner
Original Research

DOI: 10.1007/s11606-017-3983-4

Cite this article as:
Lee, J.S., Pérez-Stable, E.J., Gregorich, S.E. et al. J GEN INTERN MED (2017). doi:10.1007/s11606-017-3983-4

Abstract

Background

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.

Objective

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.

Design

Prospective, pre-post intervention implementation study using propensity analysis.

Subjects

Hospitalized patients undergoing invasive procedures on the cardiovascular, general surgery or orthopedic surgery floors.

Intervention

Installation of dual-handset interpreter phones at every bedside enabling 24-h immediate access to professional interpreters.

Main Measures

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.

Key Results

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).

Conclusions

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.

KEY WORDS

limited English proficiency informed consent medical interpreters physician-patient relations communication barriers language access 

Supplementary material

11606_2017_3983_MOESM1_ESM.docx (12 kb)
ESM 1(DOCX 12.4 kb)

Copyright information

© Society of General Internal Medicine 2017

Authors and Affiliations

  • Jonathan S. Lee
    • 1
    • 2
  • Eliseo J. Pérez-Stable
    • 3
  • Steven E. Gregorich
    • 1
    • 2
  • Michael H. Crawford
    • 4
  • Adrienne Green
    • 5
  • Jennifer Livaudais-Toman
    • 1
    • 2
  • Leah S. Karliner
    • 1
    • 2
  1. 1.Division of General Internal MedicineUniversity of California San FranciscoSan FranciscoUSA
  2. 2.Multiethnic Health Equity Research CenterUniversity of California San FranciscoSan FranciscoUSA
  3. 3.Office of the Director, National Institute of Minority Health and Health DisparitiesNational Institutes of HealthBethesdaUSA
  4. 4.Division of CardiologyUniversity of California San FranciscoSan FranciscoUSA
  5. 5.Division of Hospital MedicineUniversity of California San FranciscoSan FranciscoUSA

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