Neuro care for those with limited language proficiency requires multimodal approach

Key takeaways:

• Researchers conducted 20 interviews in a qualitative study.
• Themes of individual assistance, better communication and more time for clinical visits emerged.

PHILADELPHIA — Language training, communication among patients, caregivers and clinicians, and limited treatment wait times are needed for those with limited language proficiency to receive required neurological care, according to a poster.

“With interpreters, we found a sense of belonging with the health care team,” Sarika R. Bharil, BS, a medical student at Harvard T.H. Chan School of Public Health, told Healio at the American Neurological Association annual meeting. “And it allowed (patients) to be empowered, to speak up during their encounters, to offer more questions.

Since the number of patients with limited language proficiency (LEP) rose by 80% between 1990 and 2013 according to the U.S. Census, this population faces significant barriers to health care, including access to neurology specialty care and subpar quality of care. Bharil and colleagues explored perspectives of medical interpreters, clinicians and patients/caregivers to understand the unique experiences of those with both neurological illness and LEP status.

Their qualitative study involved conducting 20 interviews from April 2022 to February 2023 with interpreters (n = 8), clinicians (n = 6) and English and Spanish-speaking patients/caregivers (n = 6), recruited from Massachusetts General Hospital (MGH) and MGH Chelsea HealthCare Center. Data were analyzed with a hybrid deductive-inductive thematic analytic approach.

The researchers identified main themes of individual assistance, improved communication among patients, family, medical interpreters and clinicians involved in an encounter as well as systematic changes at the hospital level.

Regarding the individual, data showed patients’ culture, education and socioeconomic status and factors related to their neurological illness influenced how clinicians adjusted neurological exams to meet patients’ needs. Interpreters’ prior experience working with patients with neurological illness and LEP status and their sense of purpose within the health care team were mitigating factors.

Additionally, differences across telemedicine platform modality, including preference for in-person visits across all participants, as well as verbal and nonverbal communication strategies used to mitigate challenges — such as pre- and post-encounter huddles with interpreters — were found as communication obstacles. Finally, challenges with the time allotted for clinical encounters were cited as a barrier once a patient arrived at a hospital setting.

“We found a lot of ways that we can help this population,” Bharil told Healio. “Training with interpreters and clinicians and how to best use each other, how to understand neurological illnesses in this context, as well as (to implement) broader systematic changes.”