Preoperative consent for patients with limited English proficiency

Abstract

Background Informed consent is important for limited English proficient (LEP) patients undergoing surgery, as many surgical procedures are complicated, making patient comprehension difficult even without language barriers. The study objectives were to (1) understand surgeons’ preoperative consenting process with LEP patients, (2) examine how surgeons self assess their non-English language proficiency levels using a standardized scale, and (3) identify the relationship between self assessed non-English language proficiency and surgeons’ self-reported use of interpreters during preoperative informed consent. Materials and methods A thirty-two item survey assessing surgeons’ reported preoperative informed consent process, with questions related to demographics, level of medical training, non-English language skills and their clinical use, language learning experiences, and hypothetical scenarios with LEP patients. Results Surgeons who were not fluent in non-English languages reported they often used those limited skills to obtain informed consent from their LEP patients. Many surgeons reported relying on bilingual hospital staff members, family members, and/or minors to serve as ad-hoc interpreters when obtaining informed consent. If a professional interpreter was not available in a timely manner, surgeons more frequently reported using ad-hoc interpreters or their own nonfluent language skills. Surgeons reported deferring to patient and family preferences when deciding whether to use professional interpreters and applied different thresholds for different clinical scenarios when deciding whether to use professional interpreters. Conclusions Surgeons reported relying on their own non-English language skills, bilingual staff, and family and friends of patients to obtain informed consent from LEP patients, suggesting that further understanding of barriers to professional interpreter use is needed.

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

“…17,18 While federal guidelines mandate the use of qualified interpreters for patients with LEP, 19 this is an unfunded mandate, and multiple studies have demonstrated low rates of professional interpreter utilization during hospital encounters, including during informed consent discussions. [20][21][22][23][24][25][26] Time constraints and lack of immediate availability have been implicated by clinicians as major barriers to use of professional interpreters in the hospital. 27 A recent study demonstrated that surgeons' decisions to use professional interpreters for informed consent discussions depended in large part on the rapid availability of interpreter services.…”

“…27 A recent study demonstrated that surgeons' decisions to use professional interpreters for informed consent discussions depended in large part on the rapid availability of interpreter services. 21 Best practices to overcome these barriers remain unclear; however, it stands to reason that convenient and rapid access to professional interpreter services could be effective. 28 A previous pilot study to increase easy access to professional interpreters demonstrated a substantial increase in professional interpreter utilization via interpreter phones, without a decrement in inperson professional interpreter utilization.…”

Impact of Age on Consent in a Geriatric Orthopaedic Trauma Patient Population

“…Special attention to patients with additional risk for marginalization, such as non-English speaking patients, is necessary to ensure that autonomy is not substituted with provider convenience. 20 In our study, patients with lower socioeconomic status and education levels were less likely to provide surgical consent. Health literacy is an area of concern for older adults, with one study citing 22.7% of patients with normal cognitive function and 40.8% of patients with mild cognitive impairment having inadequate health literacy.…”

Interpretation use for consent to hip fracture surgery in patients with limited English proficiency

“…A patient's English proficiency may be judged sufficient for consent. Ease of access to professional interpretation is an important facilitator of its use, and surgeons report using ad hoc interpretation if wait times for professional interpretation are greater than 15 min 8 …”

“…Ease of access to professional interpretation is an important facilitator of its use, and surgeons report using ad hoc interpretation if wait times for professional interpretation are greater than 15 min. 8 Many institutions, like ours, have policies requiring the use of professional interpretation for informed consent. However, policies are weak levers in motivating change.…”