Many surgeons reported relying on bilingual staff and adult family members as ad-hoc interpreters for preoperative consent

Description #

In this survey of surgeons at a Boston academic medical center, many surgeons reported relying on bilingual hospital staff members and adult family members to serve as ad-hoc (untrained) interpreters when obtaining preoperative informed consent, in spite of the hospital's written policy restricting the use of family and friends as interpreters. Use of untrained staff and family members increased when the wait for a professional interpreter exceeded 15 minutes and was reported more in elective than acute scenarios.

"We observed that many surgeons reported relying on bilingual hospital staff members, family members, and/or minors to serve as ad-hoc interpreters when obtaining preoperative informed consent, in spite of their hospital's written policy." (Patel, 2016, p. 520)

"The use of untrained staff and family members also increased when the wait for an interpreter was >15 min. However, surgeons used untrained staff or family members more in elective surgical situations compared with acute surgical scenarios." (Patel, 2016, p. 517)

Methods Context #

What? #ⓘ

The observable: surgeon-reported selection of untrained bilingual staff or adult family members (ad-hoc interpreters) as the mode of communication for obtaining preoperative informed consent.

"The options included using one's own non-English language skills, calling a professional interpreter, using an ad-hoc (untrained) staff member, and, in situations where the patient was accompanied by family, the patient's adult family member or child." (Patel, 2016, p. 515)

How? #ⓘ

A 32-item anonymous online (REDCap) self-report survey in which surgeons chose a mode of language assistance across three hypothetical LEP consent scenarios (patient alone/acute, patient with family/acute, patient with family/elective), each presented with a professional interpreter arriving in <15 min or >15 min.

"Surgeons were asked how they would obtain informed consent from a patient with no English skills who presented in three hypothetical scenarios (See Fig. 1 for schematic)." (Patel, 2016, p. 515)

Who? #ⓘ

The subset of surveyed surgeons who reported using their non-English language skills with patients (n = 48), drawn from 158 respondents (33.1% response rate, 158 of 477) across all surgical specialties at a single academic medical center in Boston, MA, whose interpreter-services policy discourages using family and friends as interpreters in non-life-threatening situations.

"The hospital's policy on interpreter services states that family and friends of patients should not be asked, suggested, or encouraged to interpret for LEP patients in non-life-threatening situations, unless the patient declines a professional interpreter." (Patel, 2016, p. 515)

Other Notes #

Regardless of surgeon fluency, professional interpreters were the most-used mode when available within 15 minutes; ad-hoc staff/family use rose when the interpreter wait exceeded 15 minutes (Patel, 2016, p. 517).

Caveats #

• Findings are surgeon self-report subject to selection bias so reported behavior may diverge from actual consent practice All findings are surgeons' self-reported behaviors, not directly observed consent encounters, and the sample may have been subject to selection bias favoring respondents with a particular interest in the LEP patient population. Such respondents may have given answers aligned with institutional policy rather than their actual practice, so the reported use of ad-hoc interpreters and own-language skills could differ from real behavior. The authors argue this bias likely leads to an understatement of the problem, since respondents still reported policy-contravening behavior (e.g., using minors).
• A single urban academic center with a low response rate and small sample limits representativeness of the surgeon survey The survey had a low response rate (33.1%) and small sample, limiting the strength of associations, and was conducted at a single urban academic medical center, which may not represent national physician and patient demographics or the behavior of surgeons at institutions with different interpreter resources and policies. Prevalence estimates and fluency subgroup comparisons should therefore be generalized cautiously.