Medical interpreters can improve HF outcomes for patients with limited English proficiency
WASHINGTON — Integrating medical interpreters as part of the HF team and designing practical discharge plans could reduce disparities for patients with HF and limited English proficiency.
Patients with HF and limited English proficiency experience worse HF outcomes including higher readmission rates and ED visits, according to Haider J. Warraich, MD, associate director of the Heart Failure Program at VA Boston Healthcare System, associate physician at Brigham and Women's Hospital and assistant professor of medicine at Harvard Medical School, and colleagues.
In a qualitative study, medical interpreters who participated in semi-structured interviews stressed the need for clinicians to address not only the etiology of HF but also the link between concerning symptoms and worsening progression, as well as anticipated prognosis. The findings were presented at the American College of Cardiology Scientific Session and published in JACC: Heart Failure.
“One of the groups many clinicians struggle with are people who speak English as a second language,” Warraich told Healio. “Many times, busy physicians or medical teams might have a medical student, resident or a family member translate on our behalf. That might work in some situations, but especially for discharge, it is crucial to have a medical interpreter present when we are explaining HF to the patient and family. It must be a team effort, so nothing is lost in translation at such a critical juncture.”
‘A vehicle for cultural exchange’
Warraich and colleagues conducted semi-structured interviews with 20 medical interpreters from nine languages, working at an academic medical center. The mean age of participants was 48 years, 60% were women and mean experience was 16.3 years. Interviews were analyzed using thematic analysis.
The researchers noted common themes regarding the challenges of care delivery to patients with HF and limited English proficiency. Patients with limited English proficiency often had a limited understanding of HF etiology, prognosis and treatment options and the interpreters cited difficulty explaining HF given the complexity.
“Even though we were interested in this area, we were still very surprised at several findings,” Warraich said in an interview. “The one clear theme that emerged was that medical interpreters were not part of the medical team. They were used like an app — they translate a few words, leave and do not contribute to the care the patient receives. Interpreters are not just translating a language. They could be a vehicle for cultural exchange, for connection, for communication. We are underusing and misusing them.”
Interpreters also said practical steps to improve the discharge process for patients with HF and limited English proficiency were lacking; several called for integrating interpreters in the inpatient and outpatient HF teams.
“One of the most crucial steps in the journey is when patients are discharged from hospital to home — and this is especially true in HF,” Warraich said. “They are making this transition quite frequently and are at high risk for readmission to hospital. Now you add in a language barrier. When thinking of discharge, make sure to include the interpreter and outline a plan. Provide the patient with a contact number for the interpreter team in case they have questions.”
Provide room for questions
Warraich said in interviews interpreters mentioned the benefit of a “pre-meeting huddle” with the interpreters to allow time to go over a patient’s condition and discuss what terms and medications will be mentioned.
“This would give them room for questions, so we are all prepared as a team,” Warraich said. “Many hospitals have moved to virtual interpretation; there are opportunities there as well to better set the stage for what is going on and making sure they can see the physicians and the room.”
Use of medical jargon was another common issue, Warraich said.
“HF is a difficult condition to understand as is,” he said. “When physicians do not take the time to explain what they are talking about, they put everyone else at a disadvantage. Communication is so central to the optimal and equitable management of HF. I hope this paper becomes a vehicle for more people to think about the most vulnerable population that we care for. Certainly, this includes people who speak English as a second language or are immigrants.”
Reference:
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Warraich HJ. Abstract 1320-137. Presented at: American College of Cardiology Scientific Session; April 2-4, 2022; Washington, D.C. (hybrid meeting).