Surgeons reported deferring to patient and family preferences when deciding whether to use a professional interpreter

Description #

In open-ended survey responses, surgeons described deferring to patient and family preferences when deciding whether to use a professional interpreter — a theme the study team identified from the qualitative responses. Surgeons reported that patients often did not want an interpreter, and that pressure from an accompanying family member could make offering a professional interpreter socially difficult.

"I always offer the patient an interpreter and very rarely do Spanish speaking patients prefer it." (Patel, 2016, p. 519)

"For some rarer languages where I do not speak the language and no interpreter is readily available a family member usually starts translating. I usually do not feel comfortable with this situation, but even offering the interpreter is difficult since the person translating the request is usually the same family member who is annoyed that you won't use them and get the visit going." (Patel, 2016, p. 519)

"The first was one of deferring to patient and family preferences." (Patel, 2016, p. 519)

Methods Context #

What? #ⓘ

The observable: surgeon-reported reasons, drawn from open-ended responses, for deciding between a professional interpreter and their own non-English skills — coded to the theme of deferring to patient and family preferences.

"Surgeons were also asked to provide open-ended responses to describe other situations in their practice where they needed to decide between using an interpreter or their own non-English language skills." (Patel, 2016, p. 516)

How? #ⓘ

Free-text open-ended survey responses qualitatively analyzed for emerging themes using the constant comparative method by a subset of the research team, with coding disagreements resolved by consensus.

"The study team qualitatively analyzed the open-ended survey responses for emerging themes using the constant comparative method [26]." (Patel, 2016, p. 516)

Who? #ⓘ

Surveyed surgeons across all surgical specialties at a single academic medical center in Boston, MA, who provided open-ended responses (drawn from 158 respondents; 33.1% response rate, 158 of 477).

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

Other Notes #

This is one of two themes the authors identified in the open-ended responses; the other was applying different thresholds for different clinical scenarios (Patel, 2016, p. 519).

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.