When a professional interpreter was not available in a timely manner surgeons more frequently used ad-hoc interpreters or their own nonfluent skills

Description #

In this survey of surgeons at a Boston academic medical center, interpreter availability drove mode of consent: if a professional in-person or telephone interpreter was not available in a timely manner, surgeons more frequently reported using ad-hoc interpreters or their own nonfluent language skills. Across scenarios, professional interpreters were the preferred mode when available within 15 minutes, but when the wait exceeded 15 minutes surgeons preferred their own non-English language skills over waiting.

"We found that if a professional in-person or telephone interpreter was not available in a timely manner, surgeons more frequently reported using ad-hoc interpreters or their own nonfluent language skills." (Patel, 2016, p. 520)

"In all scenarios, when a professional interpreter was available within 15 min, they were more likely to be used than other modes of communication, but when the wait was >15 min, surgeons preferred their own non-English language skills over waiting for an interpreter." (Patel, 2016, p. 517)

Methods Context #

What? #ⓘ

The observable: surgeon-reported mode of consent (professional interpreter, own non-English skills, or ad-hoc interpreter) as a function of professional-interpreter wait time (<15 min vs >15 min).

"To assess whether time constraints and interpreter availability played a role in the surgeons' responses to the scenarios, each hypothetical scenario was presented in two ways: with a professionally trained in-person interpreter arriving in <15 min or >15 min." (Patel, 2016, p. 516)

How? #ⓘ

A 32-item anonymous online (REDCap) self-report survey in which each of three hypothetical LEP consent scenarios was presented twice, with the professional interpreter arriving in <15 min or >15 min; the 15-minute interval was based on prior CLAS-standards compliance studies.

"This time interval was based on previous studies, which measured compliance with the National Standards for Culturally and Linguistically Appropriate Services in Health Care (CLAS standards) [24,25]." (Patel, 2016, p. 516)

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, that offers 25 staff interpreters plus 24/7 telephone interpreting in over 200 languages.

"The survey had a 33.1% response rate (158 of 477)." (Patel, 2016, p. 516)

Other Notes #

The authors note that even when a trained telephone interpreter was available for immediate needs, some practitioners still reported they would use ad-hoc interpreters (Patel, 2016, p. 520).

Caveats #

• Interpreter-mode findings come from responses to hypothetical vignettes not observed consent encounters The scenario-based mode-of-consent findings (including reported willingness to use minors and the effect of interpreter wait time) come from surgeons' reactions to hypothetical LEP patient vignettes, not from observed consent encounters. What surgeons say they "would" do in a constructed scenario may not match what they actually do at the bedside, so these prevalence figures should be read as reported intentions under hypothetical conditions.
• 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.