Satisfaction benefit of direct-Spanish care attenuated to nonsignificance at later treatment timepoints

Description #

Although the satisfaction advantage of direct-Spanish care was significant immediately after the initial consultation, it did not persist: when satisfaction was reassessed during the last week of radiation and at the first post-treatment follow-up visit, there were no statistically significant differences between arms in any domain of overall-care or physician-communication satisfaction (Table E1). The authors suggest interpreter-based care may achieve similar results over time.

"When evaluating patient satisfaction during the last week of radiation and the first posttreatment follow-up clinic visit after radiation, we found no statistically significant differences between the direct-Spanish arm and the interpreter services arm in any domain of either patient satisfaction with overall patient care or physician communication (Table E1)." (Seible, 2021, p. 859)

"we also found that the improved satisfaction attenuated as the course of cancer treatment progressed." (Seible, 2021, p. 861)

Methods Context #

What? #ⓘ

The observable: PSQ and ISQ satisfaction domain scores at two later timepoints (last week of radiation; first post-radiation follow-up visit), compared between arms.

"We administered surveys at 3 time points including immediately at the conclusion of the initial physician consultation, during the last week of radiation treatment, and during the first postradiation follow-up clinic visit, typically 1 to 3 months after completing the course of radiation." (Seible, 2021, p. 857)

How? #ⓘ

Same randomized 2-arm design; satisfaction domains at later timepoints compared with Wilcoxon rank-sum tests, P < .05 significant.

"when comparing outcomes between study arms, we used Wilcoxon rank-sum tests for ordinal (Likert scale) data" (Seible, 2021, p. 858)

Who? #ⓘ

Surveyed survivors of the cohort at later timepoints: last-week-of-radiation surveys completed by 31 (interpreter) and 35 (direct-Spanish); first post-radiation visit by 38 and 38 respectively.

"Completed survey during last week of radiation (n=31) ... Completed survey during last week of radiation (n=35)" (Seible, 2021, p. 859)

Other Notes #

The authors interpret the attenuation as possibly indicating that "although language-concordant care more quickly reduces initial barriers between patients and physicians, interpreter-based care can achieve the same results over time" (Seible, 2021, p. 861) — though they note the reason is "not entirely clear."

Caveats #

• HOLA was necessarily unblinded, so awareness of arm allocation could have introduced bias Because the communication modality cannot be hidden, the trial was necessarily conducted unblinded. The authors acknowledge that patients' and physicians' awareness of study-arm allocation could have introduced bias into the patient-reported satisfaction outcomes.