TABLE 2.
Barriers to Effective Communication with LEP Patients and Families
| Subthemes | Quotes |
|---|---|
| Barrier 1: Difficulties accessing interpreter services | |
| Process of scheduling interpreters | • “My biggest challenge when using interpreter services is not understanding the scheduling process or availability”…“More transparency around how in-person interpreters are scheduled would help teams troubleshoot better.” (physicians) • “Providers schedule appointment [with interpreters] without confirming with family… [at] the last minute… [and] interpreters are not used when time requested,” … “[and] requests from providers [do not have] a realistic and accurate estimate of the time and need for an in-person interpreter.” (interpreters) |
| Knowledge about system and limitations | • “My biggest challenges when using interpreter services are lack of predictability in when we have rapid access… or need.” (physicians) • “I wish [medical providers] understood the difficulties of obtaining resources for rare languages”… “[and are] more familiar with alternative interpreting platforms and be willing and open to use them.” (interpreters) |
| Using technology | • “Communicating with LEP families goes poorly when technology doesn’t work … poor connection [and] the video/audio goes in and out ” (nursing staff) • “If I could change anything about using phone interpreters, it would be improved directions in how to use… [and] improvement in the wait time… [I] have waited 10 minutes for an interpreter [on the phone].” (physicians) |
| Barrier 2: Uncertainty in communication with LEP families | |
| What to share and how to prioritize information during encounters with LEP families | • “There is a danger in [treating] all the data as equal. By the time we get to the end, which is really important stuff, an interpreter [may need] to run to another appointment… [We] need to make sure [we] get to priorities first.” (physicians) • “Communicating with LEP families goes poorly when providers use… numbers and data with patients the same way they share them with fellow doctors.” (interpreters) |
| What is actually being communicatedduring interpretation | • “Communicating with LEP families goes poorly when I am unsure if information is being delivered correctly [by the interpreter]” … “The most difficult part of taking care of LEP families is feeling frustrated when [information] gets lost in the interpreter conversation.” (physicians) • “When caring for LEP families, physicians need to speak slowly so all [information] can be interpreted … [and] give time for interpreter to interpret.” (interpreters) |
| What families understand | • “The most difficult part about taking care of LEP families is really knowing they are understanding and receiving info the way I think they are.” (physicians) • “Communication with LEP families goes poorly when everyone speaks for a long time [using] very complicated terminology or sentences that are incoherent…” (interpreters) • “When taking care of LEP families, I feel they don’t understand the importance of what [we are] telling them.” (nursing staff) vs “When taking care of LEP families, I [am] worried they don’t fully understand the plan or have unaddressed concerns.” (physicians) vs “I wish LEP families knew … how to express their needs.” (interpreters) |
| Barrier 3: Unclear and inconsistent expectations and roles of team members | |
| Communication regarding expectations from multiple stakeholders | • “It [is] difficult to convey info in a very large group, especially [with] intern [or] new learner [who] are trying first hand at the expense of the family. Communicating goes poorly when multiple medical professionals or family members try to talk at once.” (physicians) • “The way we take care of LEP families would completely change if [medical] providers [communicated] level of seriousness of encounter.” (interpreters) vs “I wish interpreters would [communicate] their style [with the team] prior to going [into] a room… [Some] have different preferences on how much info is too much.” (physicians) vs “Families [don’t know] how rounds go [or what they should expect from rounds].” (interpreters) |
| Roles and scope of practice for each team member | • “I wish interpreters felt empowered to ask us to slow down or clarify… We had an untrained student who was presenting during rounds, but I was astonished that interpreter didn’t stop him to say that it wasn’t working.” (physicians) vs “Interpreters [must] stick to their role … [and] remain within the code of ethics.” (interpreters) • “Both family and interpreter defer authority to physician; if you educate that one person, it will change the entire encounter.” (interpreters) • “I wish interpreters would interpret everything that is said … verbatim… even when providers are discussing among themselves … even if it doesn’t seem as important.” (physicians) vs “[Interpreting in verbatim is difficult] when everyone speaks for a long time [using] very complicated terminology or sentences that are incoherent [or] contradictory … [and] when [there are] distractions during session.” (interpreters) |
| Barrier 4: Unmet family engagement expectations | |
| Provider engagement with the family | • “When providing interpreter services during rounds, I feel [as if] rounding team does not have enough patience to answer families’ questions.” (interpreters) • “When busy, I find it most difficult to provide brief updates that would occur if they were English speaking… if interpreter is not scheduled, [I] shy away from doing what is right.” (physicians) • “When interacting with LEP families, I wish physicians would use a [professional] interpreter and not guess what the family are trying to say.” (interpreters) • “LEP families do not have much contact with their care teams… [and] get as many updates on their child [such as] labs, studies, and assessment as English-proficient families” … “[It feels] like I do them a disservice sometimes due to challenges and time needed to arrange appropriate interpretation.” (physicians) |
| Family engagement with the providers | • “When taking care of LEP families, I feel bad for the family because most of the time they do not ask questions and may not know what I am doing … I feel like work happens around the patient and family instead of with … especially when medical staff is rushed or no interpreter is available.” (nursing staff) • “When taking care of LEP families I feel inefficient … [and] less connected.” (nursing staff) • “I wish LEP families knew their medical rights … and knew how to speak directly to healthcare providers [and didn’t] shy away from asking questions or ask for clarifications.” (interpreters) |
Abbreviation: LEP, limited English proficiency.