Association of Language Barriers With Perioperative and Surgical Outcomes

Joo, Hyundeok; Fernández, Alicia; Wick, Elizabeth C.; Moreno Lepe, Gala; Manuel, Solmaz P.

doi:10.1001/jamanetworkopen.2023.22743

Cited by 5 publications

(3 citation statements)

References 57 publications

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“…Given our study design and participant numbers, such granular effects could not have been detected. Nonetheless, we observed moderate to large effects for our main variables (for which the study was statistically well powered), and our study results are cross-validated by other language barrier studies (5,14,32,34,64).…”

Section: Outlook and Limitationssupporting

confidence: 85%

“…Compared to lay interpreters, using professional interpreters significantly improves the uptake of critical information about general anaesthesia. It is therefore first and foremost an ethical imperative to act on these outcomes, as improved information transfer is directly linked to better clinical outcomes (1,7,14,16,19,65). Consequently, it increases patient safety.…”

Section: Discussionmentioning

confidence: 99%

“…Importantly, in addition to the legal ramifications, it is well-established that language barriers are associated with several negative outcomes. Patient safety, healthcare routines, patient and healthcare professional satisfaction, patient compliance, and access to health care are all negatively affected when communication and understanding cannot be properly established (14)(15)(16)(17)(18)(19). Additionally, problems in understanding can be linked to higher costs as language barriers result in the use of more expensive tertiary health services rather than primary services, multiple visits to physicians, and longer hospital stays (5,(20)(21)(22).…”

Section: Introductionmentioning

confidence: 99%

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Prohibiting Babel - A call for professional remote interpreting services in pre-operation anaesthesia information

Gerger,

Graf,

Klager

et al. 2024

Preprint

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Introduction: Language barriers within clinical settings pose a threat to patient safety. As a potential impediment to understanding, they hinder the process of obtaining informed consent. This study investigates the impact of the current use of interpreters, with a particular focus on the efficacy of engaging laypersons as interpreters, rather than professional interpreters. A further objective is to explore the validity and reliability of phone-based telemedicine. Methods: In three groups (N per group = 30), we compared how using lay or professional interpreters affected non-German speaking patients’ subjectively perceived understanding (understood vs. not understood) and recollection (recollected vs. not recollected) of information about general anaesthesia. Fluent German speaking patients served as the control group. Statistical analyses (χ2 tests and binomial) were calculated to show differences between and within the groups. Results: All three groups indicated similar, high self-reported levels of having understood the medical information provided. This was in stark contrast to the assessed objective recollection data. In the lay interpreter group, recollection of anaesthesia facts was low; only around half of participants recalled specific facts. For patients supported by professional interpreters, their recollection of facts about anaesthesia was significantly enhanced and elevated to the same level of the control group (fluent in German). Moreover, for these patients, providing information by means of phone-based telemedicine before anaesthesia yielded high levels of understanding and recollection of anaesthesia facts. Conclusion: Phone-based telemedicine is a safe and reliable method of communication in the professional interpreter group and German speaking control group, but not in the lay interpreter group. Compared to lay interpreters, professional interpreters significantly improve patients’ uptake of critical information about general anaesthesia, thus highlighting the importance of professional interpreters for patient safety and informed consent.

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Section: Outlook and Limitationssupporting

confidence: 85%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Prohibiting Babel - A call for professional remote interpreting services in pre-operation anaesthesia information

Gerger,

Graf,

Klager

et al. 2024

Preprint

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Association of Language Barriers With Perioperative and Surgical Outcomes

Joo,

Fernández,

Wick

et al. 2023

JAMA Netw Open

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ImportanceEnglish language proficiency has been reported to correlate with disparities in health outcomes. Therefore, it is important to identify and describe the association of language barriers with perioperative care and surgical outcomes to inform efforts aimed at reducing health care disparities.ObjectiveTo examine whether limited English proficiency compared with English proficiency in adult patients is associated with differences in perioperative care and surgical outcomes.Evidence ReviewA systematic review was conducted in MEDLINE, Embase, Web of Science, Sociological Abstracts, and CINAHL of all English-language publications from database inception to December 7, 2022. Searches included Medical Subject Headings terms related to language barriers, perioperative or surgical care, and perioperative outcomes. Studies that investigated adults in perioperative settings and involved quantitative data comparing cohorts with limited English proficiency and English proficiency were included. The quality of studies was evaluated using the Newcastle-Ottawa Scale. Because of heterogeneity in analysis and reported outcomes, data were not pooled for quantitative analysis. Results are reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis Protocols guideline.FindingsOf 2230 unique records identified, 29 were eligible for inclusion (281 266 total patients; mean [SD] age, 57.2 [10.0] years; 121 772 [43.3%] male and 159 240 [56.6%] female). Included studies were observational cohort studies, except for a single cross-sectional study. Median cohort size was 1763 (IQR, 266-7402), with a median limited English proficiency cohort size of 179 (IQR, 51-671). Six studies explored access to surgery, 4 assessed delays in surgical care, 14 assessed surgical admission length of stay, 4 assessed discharge disposition, 10 assessed mortality, 5 assessed postoperative complications, 9 assessed unplanned readmissions, 2 assessed pain management, and 3 assessed functional outcomes. Surgical patients with limited English proficiency were more likely to experience reduced access in 4 of 6 studies, delays in obtaining care in 3 of 4 studies, longer surgical admission length of stay in 6 of 14 studies, and more likely discharge to a skilled facility than patients with English proficiency in 3 of 4 studies. Some additional differences in associations were found between patients with limited English proficiency who spoke Spanish vs other languages. Mortality, postoperative complications, and unplanned readmissions had fewer significant associations with English proficiency status.Conclusions and RelevanceIn this systematic review, most of the included studies found associations between English proficiency and multiple perioperative process-of-care outcomes, but fewer associations were seen between English proficiency and clinical outcomes. Because of limitations of the existing research, including study heterogeneity and residual confounding, mediators of the observed associations remain unclear. Standardized reporting and higher-quality studies are needed to understand the impact of language barriers on perioperative health disparities and identify opportunities to reduce related perioperative health care disparities.

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