title: Increased Access to Professional Interpreters in the Hospital Improves Informed Consent for Patients with Limited English Proficiency.
abstract: BACKGROUND
  Language barriers disrupt communication and impede informed consent for patients with limited English proficiency (LEP) undergoing healthcare procedures. Effective interventions for this disparity remain unclear.
  
  
  OBJECTIVE
  Assess the impact of a bedside interpreter phone system intervention on informed consent for patients with LEP and compare outcomes to those of English speakers.
  
  
  METHODS
  Prospective, pre-post intervention implementation study using propensity analysis.
  
  
  METHODS
  Hospitalized patients undergoing invasive procedures on the cardiovascular, general surgery or orthopedic surgery floors.
  
  
  METHODS
  Installation of dual-handset interpreter phones at every bedside enabling 24-h immediate access to professional interpreters.
  
  
  METHODS
  Primary predictor: pre- vs. post-implementation group; secondary predictor: post-implementation patients with LEP vs. English speakers. Primary outcomes: three central informed consent elements, patient-reported understanding of the (1) reasons for and (2) risks of the procedure and (3) having had all questions answered. We considered consent adequately informed when all three elements were met.
  
  
  RESULTS
  We enrolled 152 Chinese- and Spanish-speaking patients with LEP (84 pre- and 68 post-implementation) and 86 English speakers. Post-implementation (vs. pre-implementation) patients with LEP were more likely to meet criteria for adequately informed consent (54% vs. 29%, p = 0.001) and, after propensity score adjustment, had significantly higher odds of adequately informed consent (AOR 2.56; 95% CI, 1.15-5.72) as well as of each consent element individually. However, compared to post-implementation English speakers, post-implementation patients with LEP had significantly lower adjusted odds of adequately informed consent (AOR, 0.38; 95% CI, 0.16-0.91).
  
  
  CONCLUSIONS
  A bedside interpreter phone system intervention to increase rapid access to professional interpreters was associated with improvements in patient-reported informed consent and should be considered by hospitals seeking to improve care for patients with LEP; however, these improvements did not eliminate the language-based disparity. Additional clinician educational interventions and more language-concordant care may be necessary for informed consent to equal that for English speakers.
authors.affiliation: Division of General Internal Medicine, University of California San Francisco, San Francisco, CA, USA.|Multiethnic Health Equity Research Center, University of California San Francisco, San Francisco, CA, USA.
authors.forename: Jonathan S
authors.initials: JS
authors.lastname: Lee
authors.affiliation: Office of the Director, National Institute of Minority Health and Health Disparities, National Institutes of Health, Bethesda, MD, USA.
authors.forename: Eliseo J
authors.initials: EJ
authors.lastname: Pérez-Stable
authors.affiliation: Division of General Internal Medicine, University of California San Francisco, San Francisco, CA, USA.|Multiethnic Health Equity Research Center, University of California San Francisco, San Francisco, CA, USA.
authors.forename: Steven E
authors.initials: SE
authors.lastname: Gregorich
authors.affiliation: Division of Cardiology, University of California San Francisco, San Francisco, CA, USA.
authors.forename: Michael H
authors.initials: MH
authors.lastname: Crawford
authors.affiliation: Division of Hospital Medicine, University of California San Francisco, San Francisco, CA, USA.
authors.forename: Adrienne
authors.initials: A
authors.lastname: Green
authors.affiliation: Division of General Internal Medicine, University of California San Francisco, San Francisco, CA, USA.|Multiethnic Health Equity Research Center, University of California San Francisco, San Francisco, CA, USA.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Livaudais-Toman
authors.affiliation: Division of General Internal Medicine, University of California San Francisco, San Francisco, CA, USA. leah.karliner@ucsf.edu.|Multiethnic Health Equity Research Center, University of California San Francisco, San Francisco, CA, USA. leah.karliner@ucsf.edu.
authors.forename: Leah S
authors.initials: LS
authors.lastname: Karliner
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001213:Asian; D003144:Communication Barriers; D005260:Female; D006297:Health Services Accessibility / Q000639:trends; D006630:Hispanic or Latino; D006761:Hospitals; D006801:Humans; D007258:Informed Consent / Q000592:standards*; D007802:Language; D008297:Male; D008875:Middle Aged; D010817:Physician-Patient Relations; D011446:Prospective Studies; D014175:Translating
keywords: communication barriers; informed consent; language access; limited English proficiency; medical interpreters; physician-patient relations