Monday, October 19, 2009
Grand Ballroom, Salons 1 & 2 (Renaissance Hollywood Hotel)
Stergios Roussos, PhD, MPH1, Mary-Rose Mueller, PhD, RN2, Linda Hill, MD, MPH3, Nadia Salas, MPH4 and Mel Hovell, PhD, MPH4, (1)San Diego State University, Merced, CA, (2)University of San Diego, San Diego, CA, (3)Ucsd, San Diego, CA, (4)San Diego State University, San Diego, CA

Purpose: Federal and state laws mandate that health care providers provide round-the-clock, free language assistance to all patients with limited English proficiency (LEP) in order to ensure safe, quality and equitable health care. Most health care providers will rely on someone to help them communicate with a patient who does not speak their language. A qualitative study aimed to understand how shared decision making may be influenced by the use of an interpreter to discuss the receipt of a prostate specific antigen (PSA) test with LEP Latino patients at risk for prostate cancer.

Method: One focus group was conducted with three groups of 8-12 participants: providers who use interpreters, bilingual staff who interpret and LEP Latino men eligible for a PSA test and who use interpreters. The semi-structured, 90-minute discussions were designed to understand the context, process and recommendations for decision making during interpreted patient encounters. Professional medical interpreting guidelines informed questions regarding interpreting methods and quality. The discussions were audio-recorded, transcribed and coded by two staff for themes grouped into categories (e.g., interpreting models, methods, barriers, and facilitators).

Results: Findings across providers, interpreters and patients showed that interpreters can influence the meaning of patient-provider dialogue to improve or detract from effective decision making. Common challenges were additions, omissions and modifications in terminology resulting in miscommunication of clinical and cultural concepts, and ethical concerns during conflicting values between providers, interpreters and patients (e.g., sexual preferences). Suggestions to improve decision making included slowing down the dialogue, interrupting the conversation to clarify meaning and terminology, and training on interpreting for providers, patients and bilingual staff. Despite commonly reported challenges in patient-provider communication, participants were not knowledgeable about the roles, responsibilities and best practices for interpreting.

Conclusion: This study represents an early step in the research to clarify the influence of interpreting in medical decision making. Findings suggest that providers, patients and bilingual staff interpreters have a limited understanding of the roles and methods to ensure effective decision making and prevent communication errors during interpreted patient visits. Further research on the function of interpreting in medical decision making can reduce disparities in health and health care and improve policy compliance with language assistance for LEP patients.

Candidate for the Lee B. Lusted Student Prize Competition