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Introduction/ Literature Review
Informed consent is a serious ethical issue in the medical field, and a good understanding of prescribed procedures and their effects are associated with better patient outcomes, satisfaction, and lower readmission rates. As for limited English proficiency (LEP) patients, effective interventions to tackle the language discordance remain unclear. With their study, Lee et al. (2017) aimed at answering the following research question: “What would be the outcomes for LEP patients as compared to patients fluent in English if a hospital introduced a bedside interpreter phone system?” Lee et al. put forward the hypothesis that translation aid would benefit both health practitioners and patients struggling with the language.
The study does not pertain to the radiological field directly since the subjects were hospitalized patients on cardiovascular, orthopedic surgery, and general surgery floors. Yet, it is safe to assume that since the authors embarked on a quite broad topic – language disparity in medicine – the findings might be of use for radiology professionals as well. The literature review clarified the rationale behind conducting the study. The sources that Lee et al. used highlighted the language issues and their prevalence in the medical field. The researchers succeeded in communicating the gravity of the problem by naming common consequences of poor communication, for instance, higher error and readmission rates. Lastly, Lee et al. concluded that while the theory of language discordance had been receiving attention from researchers, practical ways to solve the issue are yet to be outlined.
Methods/ Research Design
Since the objective of the study was to evaluate the benefits of a certain intervention technique, the authors implemented the pre-post intervention study design in which the outcomes before and after an intervention are measured in the same subject group. The choice might be justified by the fact that conducting a randomized controlled trial would not be precisely feasible in the given setting. The sample size for the study was rather small: 84 participants at the pre-implementation phase and 68 post-implementation. However, the subject group was relatively diverse with two native languages (Spanish and Chinese), different educational backgrounds, and varying levels of English proficiency. At both stages, Lee et al. conducted surveys and followed through with propensity data analysis later. The main variable was the positive outcome which was operationalized as contrasting results in four categories: adequately informed consent, understanding of reasons, risk awareness, and information availability.
Lee et al. answered the research question, and their findings confirmed the main hypothesis. The researchers observed positive tendencies in all four categories: 54% of the participants were able to give informed consent as opposed to 29% pre-intervention. Another example of improved outcomes is the fact that 77% of the patients understood why a certain procedure was necessary as compared to 44% before the implementation. Lee et al. presented the descriptive and inferential data with the use of histograms, tables, and text descriptions interpreting the findings. The study results were consistent with those mentioned in the literature review where Lee et al. assumed that rapid access to translation services could be effective based on available research.
Lee et al. emphasized the fact that their study was the first known attempt to evaluate the benefits of the phone interpretation system. Given the positive outcomes of the intervention for patients undergoing invasive procedures, the researchers suggested that more hospitals consider introducing bedside translation aids. For all the advantages of hiring an interpreter, many patients still preferred a fluent family member to be a mediator between him or her and their clinician. Thus, Lee et al. highlighted the need for patient education and a cultural shift to communicate the importance of working with a professional. Overall, the researchers acknowledged the study’s limitations: they mentioned that it was small and non-randomized, and the data was subject to possible confounding. As for future research, Lee et al. would like to gather more objective data on patient outcomes other than based merely on patient perceptions.
Lee, J. S., Pérez-Stable, E. J., Gregorich, S. E., Crawford, M. H., Green, A., Livaudais-Toman, J., & Karliner, L. S. (2017). Increased access to professional interpreters in the hospital improves informed consent for patients with limited English proficiency. Journal of General Internal Medicine, 32(8), 863-870.