title: Comprehension on family-centered rounds for limited English proficient families.
abstract: OBJECTIVE
  To describe communication with limited English proficient (LEP) families during family-centered rounds (FCR); to examine differences in family understanding of diagnosis and plan by English proficiency and provider and interpreter rounding behaviors.
  
  
  METHODS
  Forty-one English proficient (EP) and 40 LEP parents of pediatric inpatients participated in a prospective cohort study from January to October 2011. Eligible LEP families self-reported a preference for medical communication in Spanish, Somali, or Vietnamese. Rounds were observed; families were interviewed afterward. Parent- and provider-reported diagnosis and plan were compared and classified as correct, incorrect, or incomplete by 3 blinded investigators. Logistic regression adjusted for potential confounders.
  
  
  RESULTS
  Fifty percent of LEP rounding encounters involved interpreters filtering information conveyed to families; 43% involved initial medical discussions without families present (vs 12% for EP, P = .002). Providers more frequently provided a plain language summary for LEP families (88% vs 56%, P = .001). LEP and EP families had similar ability to correctly name the child's diagnosis (70% vs 83%, P = .17) and all plan elements (38% vs 39%, P = .88). Results were unchanged after adjusting for parental characteristics and hospital day. Among LEP families, naming the correct diagnosis was positively associated with experience with a hospitalized child (odds ratio 5.11, 95% confidence interval 1.04-24.9) and may be negatively associated with interpreter filtering (odds ratio 0.22, 95% confidence interval 0.05-1.13).
  
  
  CONCLUSIONS
  Having initial medical discussions without the family and information filtering are common for LEP patients; filtering may be associated with poorer diagnosis comprehension. Experience with a hospitalized child is associated with increased comprehension among LEP parents.
authors.affiliation: Department of Pediatrics, University of Washington, Seattle, Washington, USA. casey.lion@seattlechildrens.org
authors.forename: K Casey
authors.initials: KC
authors.lastname: Lion
authors.forename: Rita
authors.initials: R
authors.lastname: Mangione-Smith
authors.forename: Molly
authors.initials: M
authors.lastname: Martyn
authors.forename: Patty
authors.initials: P
authors.lastname: Hencz
authors.forename: Juan
authors.initials: J
authors.lastname: Fernandez
authors.forename: Glen
authors.initials: G
authors.lastname: Tamura
mesh_terms: D000328:Adult; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D003142:Communication; D003144:Communication Barriers; D032882:Comprehension; D005260:Female; D006776:Hospitals, Pediatric; D006801:Humans; D007223:Infant; D007802:Language; D008297:Male; D010290:Parents; D010817:Physician-Patient Relations; D011368:Professional-Family Relations; D011446:Prospective Studies; D056164:Teaching Rounds / Q000379:methods*; D014175:Translating