Clinician Perspectives on the Management of Hearing Loss in Patients With Limited English Proficiency

Abstract results

Each result the abstract reports — is it captured as evidence?

• Twenty-nine providers participated in interviews (16 otologists, 13 audiologists).

  Covered Promote Not a result

• The most reported non-English language was Spanish, followed by Chinese languages.

  Covered Promote Not a result

• Four thematic domains were derived: barriers to care, cochlear implant (CI) candidacy evaluation, counseling, and ideal resources.

  Covered Promote Not a result

• Major barriers were patient desire (97%; n = 28), and lack of validated tests (72%; n = 21).

  Covered Promote Not a result

• Methods of CI evaluation included improvising on validated speech perception testing (59%; n = 17) and use of non-speech evaluation (52%; n = 15).

  suggested · 18% In the interviews (n = 29), providers reported two non-exclusive workarounds for cochlear-implant candidacy evaluation in LEP pati

  Covered Promote Not a result

• One-quarter forgoes speech testing in non-Spanish-speaking patients (24%; n = 7).

  Covered Promote Not a result

• Suggestions to improve management include in-person interpreters (62%; n = 18) and testing battery in all languages (31%; n = 9).

  Covered Promote Not a result

• National survey results (n = 87 providers) demonstrated that respondents were significantly less confident in the methods of speech perception testing and in counseling on surgical hearing rehabilitation in LEP.

  Covered Promote Not a result

• Clinicians encounter challenges in managing LEP patients with HL, including limitations in audiometric and CI candidacy assessment, communication barriers, information accessibility, and cultural competency.

  Covered Promote Not a result

• Opportunities for improving care include developing language-specific test batteries, linguistically and culturally appropriate education materials, and cultural competency training.

  Covered Promote Not a result

Tables & figures

Map each object to the evidence it grounds (one object can ground several), add anything missed, or flag a gap.

• Figure 1 — Top non-English languages seen by respondents (n = 29).

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  • Audiologists were significantly less confident testing speech discrimination in non-English non-Spanish speakers than Spanish speakers (3.65 vs 2.35)
  • Clinicians improvised on validated speech-perception testing or used non-speech evaluation for CI candidacy in LEP patients (59 and 52 percent)
  • Interpretation resources were the most frequently cited ideal resource with in-person interpreters preferred (72 and 62 percent)
  • Most clinicians reported inability to accurately assess hearing loss in LEP patients hindered treatment (93 percent)
  • Providers reported significantly greater effort treating non-English non-Spanish speakers than Spanish speakers
  Add evidence Flag gap Nothing to capture
• 

  Figure 2 — (A) Flowchart depicting modified grounded theory analysis of structured interviews: CI candidacy evaluation (n = 29). The

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  • Audiologists were significantly less confident testing speech discrimination in non-English non-Spanish speakers than Spanish speakers (3.65 vs 2.35)
  • Clinicians improvised on validated speech-perception testing or used non-speech evaluation for CI candidacy in LEP patients (59 and 52 percent)
  • Interpretation resources were the most frequently cited ideal resource with in-person interpreters preferred (72 and 62 percent)
  • Most clinicians reported inability to accurately assess hearing loss in LEP patients hindered treatment (93 percent)
  • Providers reported significantly greater effort treating non-English non-Spanish speakers than Spanish speakers
  Add evidence Flag gap Nothing to capture
• 

  Figure 3 — Box and whisker plots depicting reported confidence levels in various clinical practices for Spanish and non-English nor Spanish

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  • Audiologists were significantly less confident testing speech discrimination in non-English non-Spanish speakers than Spanish speakers (3.65 vs 2.35)
  • Clinicians improvised on validated speech-perception testing or used non-speech evaluation for CI candidacy in LEP patients (59 and 52 percent)
  • Interpretation resources were the most frequently cited ideal resource with in-person interpreters preferred (72 and 62 percent)
  • Most clinicians reported inability to accurately assess hearing loss in LEP patients hindered treatment (93 percent)
  • Providers reported significantly greater effort treating non-English non-Spanish speakers than Spanish speakers
  Add evidence Flag gap Nothing to capture
• 

  Figure 4 — Box and whisker plots depicting the reported amount of effort required in various clinical practices for Spanish and non-English

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  • Audiologists were significantly less confident testing speech discrimination in non-English non-Spanish speakers than Spanish speakers (3.65 vs 2.35)
  • Clinicians improvised on validated speech-perception testing or used non-speech evaluation for CI candidacy in LEP patients (59 and 52 percent)
  • Interpretation resources were the most frequently cited ideal resource with in-person interpreters preferred (72 and 62 percent)
  • Most clinicians reported inability to accurately assess hearing loss in LEP patients hindered treatment (93 percent)
  • Providers reported significantly greater effort treating non-English non-Spanish speakers than Spanish speakers
  Add evidence Flag gap Nothing to capture

• Table 1 — Number of Audiologists and Neurotologists Interviewed and Average Number of Years in Practice by Region (n = 29)

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  • Audiologists were significantly less confident testing speech discrimination in non-English non-Spanish speakers than Spanish speakers (3.65 vs 2.35)
  • Clinicians improvised on validated speech-perception testing or used non-speech evaluation for CI candidacy in LEP patients (59 and 52 percent)
  • Interpretation resources were the most frequently cited ideal resource with in-person interpreters preferred (72 and 62 percent)
  • Most clinicians reported inability to accurately assess hearing loss in LEP patients hindered treatment (93 percent)
  • Providers reported significantly greater effort treating non-English non-Spanish speakers than Spanish speakers
  Add evidence Flag gap Nothing to capture

• Table 2 — Demographics and Practice Characteristics of Survey

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  • Audiologists were significantly less confident testing speech discrimination in non-English non-Spanish speakers than Spanish speakers (3.65 vs 2.35)
  • Clinicians improvised on validated speech-perception testing or used non-speech evaluation for CI candidacy in LEP patients (59 and 52 percent)
  • Interpretation resources were the most frequently cited ideal resource with in-person interpreters preferred (72 and 62 percent)
  • Most clinicians reported inability to accurately assess hearing loss in LEP patients hindered treatment (93 percent)
  • Providers reported significantly greater effort treating non-English non-Spanish speakers than Spanish speakers
  Add evidence Flag gap Nothing to capture
• 

  Table 3 — Reported Confidence Levels by Clinicians in the Counseling and Management of Spanish Speakers and Non-English Nor Spanish

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  • Audiologists were significantly less confident testing speech discrimination in non-English non-Spanish speakers than Spanish speakers (3.65 vs 2.35)
  • Clinicians improvised on validated speech-perception testing or used non-speech evaluation for CI candidacy in LEP patients (59 and 52 percent)
  • Interpretation resources were the most frequently cited ideal resource with in-person interpreters preferred (72 and 62 percent)
  • Most clinicians reported inability to accurately assess hearing loss in LEP patients hindered treatment (93 percent)
  • Providers reported significantly greater effort treating non-English non-Spanish speakers than Spanish speakers
  Add evidence Flag gap Nothing to capture
• 

  Table 4 — Reported Amount of Effort Required by Clinicians in the Treatment of Spanish Speakers and non-English Nor Spanish

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  • Audiologists were significantly less confident testing speech discrimination in non-English non-Spanish speakers than Spanish speakers (3.65 vs 2.35)
  • Clinicians improvised on validated speech-perception testing or used non-speech evaluation for CI candidacy in LEP patients (59 and 52 percent)
  • Interpretation resources were the most frequently cited ideal resource with in-person interpreters preferred (72 and 62 percent)
  • Most clinicians reported inability to accurately assess hearing loss in LEP patients hindered treatment (93 percent)
  • Providers reported significantly greater effort treating non-English non-Spanish speakers than Spanish speakers
  Add evidence Flag gap Nothing to capture