Direct-Spanish consultations had more physician history-verification and partnering utterances

Description #

Coded transcripts of the initial consultation showed that, relative to interpreter-based encounters, direct-Spanish encounters had significantly more physician speech devoted to patient history verification (mean utterances 13 vs 8.9; P = .01) and to partnering activities (16 vs 5; P < .001) (Table 3). Relationship-building speech trended higher but did not reach significance (9 vs 5; P = .07); history solicitation, procedural speech, and patient education did not differ. This identifies a mechanism — language concordance changes the content of the clinical conversation.

"Specifically, when considering physician speech, the direct-Spanish arm had more physician speech related to patient history verification and partnering activities" (Seible, 2021, p. 858)

"with the direct-Spanish arm having more physician speech related to patient history verification (mean number of utterances, 13 vs 9; P = .01) and partnering activities (mean utterances, 16 vs 5; P <.001)." (Seible, 2021, p. 856)

Methods Context #

What? #ⓘ

The observable: mean number of physician "utterances" by speech category (history verification, partnering, etc.) coded from transcribed initial-consultation audio.

"Coding the consultation transcripts identified "utterances" which were defined as the smallest unit of speech reflecting a complete thought or phrase, ranging from a single word to a sentence." (Seible, 2021, p. 858)

How? #ⓘ

Audio of the initial consultation translated, transcribed, and coded in MAXQDA per the Roter Interaction Analysis System by 2 coders (kappa 0.84); utterance counts compared between arms.

"Utterances were categorized into different themes following the Roter Interaction Analysis System, which represents a well-validated coding system for characterizing verbal exchanges between patients and physicians." (Seible, 2021, p. 858)

Who? #ⓘ

The final 43 enrolled patients had audio captured for content analysis; speech-content table reports interpreter-services n = 19 and direct-Spanish n = 24 initial consultations.

"For the final 43 enrolled patients, we obtained audio recordings of the initial consultation to enable analysis of communication content." (Seible, 2021, p. 858)

Other Notes #

Physician verbal-dominance score did not differ between arms (ratio 5.0 both; P = .79) (Table 3).

Caveats #

• HOLA interpreter arm used bilingual physicians speaking English, which may not represent a typical interpreter encounter To provide an internal control, the same 2 bilingual physicians delivered both arms — meaning the interpreter-services arm consisted of bilingual physicians speaking English through an interpreter. The authors note this may not represent an average interpreter-based encounter, since a non-bilingual physician might face greater communication challenges than a bilingual one even when both use translation. This could bias the comparison toward the null (understating the true direct-Spanish advantage over typical interpreter care).
• HOLA findings come from one community subspecialty clinic with only 2 bilingual physicians, limiting generalizability The trial's data were generated at a single community radiation oncology subspecialty clinic, using specifically video and telephonic interpreter services, and delivered by only 2 bilingual physicians. The authors note this makes it difficult to know whether the satisfaction and communication-content findings generalize to other clinical settings, interpreter modalities, or providers.
• HOLA's small sample raises possibility of arm heterogeneity influencing the findings The trial enrolled a small number of participants (83 total; 40 vs 43 per arm), which introduces the possibility of heterogeneity between study arms. Although observed patient characteristics did not statistically differ between groups, the authors note that unmeasured differences in participants could potentially influence the findings.