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Provider–patient Language Discordance and Cancer Operations: Outcomes from a Single Center Linked to a State Vital Statistics Registry

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Abstract

Introduction

Patterns of worldwide immigration have resulted in high rates of discordance between medical providers and the patients they treat. For example, in the USA, 25 million individuals in the USA self-identified that they speak English less than “very well.” Previous studies have generated mixed results regarding differences in postoperative outcomes between English proficient (EP) and limited English proficient (LEP) patients. Our objective was to determine whether a difference in outcomes exists for non-English-speaking patients compared to English-speaking patients after operations commonly performed to treat cancer.

Study design

A retrospective cohort study was performed in an urban, safety net and tertiary referral medical center over a five-year period. Adult patients undergoing cancer operations were stratified as EP and LEP. We evaluated 30-day revisit to the ED, length of stay (LOS), long-term all-cause mortality, and any major complication on index admission. Regression was used to adjust for baseline comorbidities, case risk, and socioeconomic factors.

Results

A total of 2467 patients were included. There was no difference in case risk between language groups, but EP had a larger proportion of high comorbidity scores. Patients in the non-English group were more likely to be uninsured/self-pay and live in neighborhoods with lower median income. After adjustment, we found no difference in long-term mortality [hazard ratio: 0.87 (95% CI 0.52–1.45)]. LEP patients had the same LOS compared to primary EP patients with an IRR of 0.99 (95% CI 0.88–1.10). There was no difference in the odds of revisit to hospital for LEP versus EP, with an OR of 1.08, 95% CI [0.75–1.53] and no difference in major complication (OR 0.76 (95% CI 0.39–1.45).

Conclusions

We found no association between language and outcomes after cancer operations. This lack of difference may reflect local efficacy at treating non-English-speaking patients, and health systems with fewer services for LEP patients might show different results.

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References

  1. US Census Bureau. Available at: https://www.census.gov/data/tables/2013/demo/2009-2013-lang-tables.html. Accessed May 23, 2019

  2. Angela Potter-Collins. 2013. Available at: https://www.ons.gov.uk/peoplepopulationandcommunity/culturalidentity/language/articles/languageinenglandandwales/2013-03-04#main-language-in-england-and-wales

  3. Hasnain-Wynia R, Yonek J, Pierce D et al. Hospital language services for patients with limited english proficiency: results from a national survey. American Hospital Association: Heatlh Res Edu Trust, 28

  4. Betancourt JR, Green AR, Carrillo JE, Ananeh-Firempong O (2003) Defining cultural competence: a practical framework for addressing racial/ethnic disparities in health and health care. Public Health Rep 118:293–302

    Article  Google Scholar 

  5. John-Baptiste A, Naglie G, Tomlinson G et al (2004) The effect of English language proficiency on length of stay and in-hospital mortality. J Gen Intern Med 19:221–228

    Article  Google Scholar 

  6. Ngai KM, Grudzen CR, Lee R et al (2016) The association between limited english proficiency and unplanned emergency department revisit within 72 hours. Ann Emerg Med 68:213–221

    Article  Google Scholar 

  7. Sarver J, Baker DW (2000) Effect of language barriers on follow-up appointments after an emergency department visit. J Gen Intern Med 15:256–264

    Article  CAS  Google Scholar 

  8. Carrasquillo O, Orav EJ, Brennan TA, Burstin HR (1999) Impact of language barriers on patient satisfaction in an emergency department. J Gen Intern Med 14:82–87

    Article  CAS  Google Scholar 

  9. Feeney T, Cassidy M, Tripodis Y et al (2019) Association of primary language with outcomes after operations typically performed to treat cancer: analysis of a statewide database. Ann Surg Oncol 26:2684–2693

    Article  Google Scholar 

  10. Boston Medical Center. Available at: https://www.bmc.org/about-us

  11. VanderWeele TJ. Principles of confounder selection. [Internet].European journal of epidemiology [Internet].; 2019. Available at: https://link.springer.com/10.1007/s10654-019-00494-6. Accessed March 9, 2019

  12. Harrell Jr FE, Dupont C. Hmisc: Harrell Miscellaneous. 2017. https://CRAN.R-project.org/package=Hmisc

  13. Hadley Wickham. 2017. Tidyverse: Easily Install and Load “Tidyverse” Packages. https://CRAN.Rproject.org/package=tidyverse

  14. Warnes GR, Bolker B, Lumley T, Johnson RC. Gmodels: various R Programming tools for model fitting. [Internet]. In: 2018. Available at: https://CRAN.R-project.org/package=gmodels

  15. Kassambara A, Kosinski M, Biecek P. survminer: Drawing survival curves using “ggplot2”. [Internet]. In: 2017. Available at: https://CRAN.R-project.org/package=survminer

  16. Paredes AZ, Idrees JJ, Beal EW et al (2018) Influence of english proficiency on patient-provider communication and shared decision-making. Surgery 163:1220–1225

    Article  Google Scholar 

  17. Karliner LS, Jacobs EA, Chen AH, Mutha S (2007) Do professional interpreters improve clinical care for patients with limited ENGLISH proficiency? A systematic review of the literature. Health Serv Res 42:727–754

    Article  Google Scholar 

  18. Inagaki E, Farber A, Kalish J et al (2017) Role of language discordance in complication and readmission rate after infrainguinal bypass. J Vasc Surg 66:1473–1478

    Article  Google Scholar 

  19. Grubbs V, Bibbins-Domingo K, Fernandez A et al (2008) Acute myocardial infarction length of stay and hospital mortality are not associated with language preference. J Gen Intern Med 23:190–194

    Article  Google Scholar 

  20. Karliner LS, Kim SE, Meltzer DO, Auerbach AD (2010) Influence of language barriers on outcomes of hospital care for general medicine inpatients. J Hosp Med 5:276–282

    Article  Google Scholar 

  21. Feeney T, Sanchez SE, Tripodis Y et al (2019) The association of primary language with emergency general surgery outcomes using a statewide database. J Surg Res 244:484–491

    Article  Google Scholar 

  22. Clapp B, Jarmillo M, Vigil V et al (2007) Patient comprehension and recall of laparoscopic surgery and outcomes in a non-english speaking population. J Soc Laparoendosc Surg 11(2):242

    Google Scholar 

  23. Mehta SJ (2015) Patient satisfaction reporting and its implications for patient care. AMA J Ethics 17:616–621

    Article  Google Scholar 

  24. Petrullo KA, Lamar S, Nwankwo-Otti O et al (2012) The patient satisfaction survey: what does it mean to your bottom line? J Hosp Adm 2(1):8

    Google Scholar 

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Funding

This study was not funded by external funds of grants and was supported solely by internal departmental funds.

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Authors and Affiliations

  1. Department of Surgery, Boston University School of Medicine, Boston, USA

    Timothy Feeney, Christine Park, Frederick Godley, Michael Cassidy, Teviah Sachs, David McAneny, Jennifer F. Tseng & Frederick Thurston Drake

  2. Department of Surgery, FGH Building, Boston Medical Center, 820 Harrison Ave, Floor 5., Boston, MA, 02118, USA

    Timothy Feeney, Frederick Godley, Michael Cassidy, Teviah Sachs, David McAneny, Jennifer F. Tseng & Frederick Thurston Drake

  3. Department of Internal Medicine, New York Presbyterian Hospital, Cornell University, New York, NY, USA

    Christine Park

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  1. Timothy Feeney
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  2. Christine Park
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  3. Frederick Godley
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  4. Michael Cassidy
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  7. Jennifer F. Tseng
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  8. Frederick Thurston Drake
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Correspondence to Timothy Feeney.

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JFT is on the board of Mauna Kea Technologies and owns stocks in that company. No other authors have conflicts to report.

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Feeney, T., Park, C., Godley, F. et al. Provider–patient Language Discordance and Cancer Operations: Outcomes from a Single Center Linked to a State Vital Statistics Registry. World J Surg 44, 3324–3332 (2020). https://doi.org/10.1007/s00268-020-05614-y

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  • DOI: https://doi.org/10.1007/s00268-020-05614-y

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