title: 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.
  
  
  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.
authors.affiliation: Cooper Medical School of Rowan University, Camden, New Jersey.
authors.forename: Darshan N
authors.initials: DN
authors.lastname: Patel
authors.affiliation: Division of General Surgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Elliot
authors.initials: E
authors.lastname: Wakeam
authors.affiliation: Department Psychiatry and Behavioral Sciences, Immigrant Health and Cancer Disparities Service, Memorial Sloan Kettering Cancer Center, New York, New York.
authors.forename: Margaux
authors.initials: M
authors.lastname: Genoff
authors.affiliation: Department Psychiatry and Behavioral Sciences, Immigrant Health and Cancer Disparities Service, Memorial Sloan Kettering Cancer Center, New York, New York.
authors.forename: Imran
authors.initials: I
authors.lastname: Mujawar
authors.affiliation: Division of General and Gastrointestinal Surgery, Department of Surgery, Brigham and Women's Hospital, Boston, Massachusetts.
authors.forename: Stanley W
authors.initials: SW
authors.lastname: Ashley
authors.affiliation: Department Psychiatry and Behavioral Sciences, Immigrant Health and Cancer Disparities Service, Memorial Sloan Kettering Cancer Center, New York, New York; Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York; Department of Healthcare Policy and Research, Weill Cornell Medical Center, New York, New York. Electronic address: diamondl@mskcc.org.
authors.forename: Lisa C
authors.initials: LC
authors.lastname: Diamond
mesh_terms: D000328:Adult; D000368:Aged; D003144:Communication Barriers; D005260:Female; D019538:Health Care Surveys; D006801:Humans; D007258:Informed Consent; D007802:Language; D008297:Male; D008404:Massachusetts; D008875:Middle Aged; D019303:Multilingualism; D010817:Physician-Patient Relations; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D011300:Preoperative Care / Q000379:methods*; D057566:Self Report; D066231:Surgeons; D014175:Translating
keywords: Health disparities; Informed consent; Language barriers; Physician–patient communication