TIME, HASSLE, AND ENCOUNTER TYPE AS PERCEIVED BARRIERS TO USE OF INTERPRETATION SERVICES FOR PATIENTS WITH LIMITED ENGLISH PROFICIENCY DURING THE COVID-19 PANDEMIC

ABSTRACT

BACKGROUND: Underuse of interpretation services for Limited English Proficiency (LEP) patients has been both widely reported in popularmedia and is increasingly documented in the literature. The COVID-19 pandemic has affected every aspect of healthcare and has directly impacted the use of interpreters with barriers such as strict visitation policies, limited patient interactions with healthcare workers, and withdrawal of in-person interpreters from the hospital setting. In this study we assess the use of interpreter services by healthcare professionals (HCPs) for LEP patients at an academic teaching hospital during the pandemic. METHODS: A combination of quantitative and qualitative data was obtained, and a total of 107 HCPs responded to the survey between August and October 2021. The majority of respondents were physicians (50.4%) and the largest specialties represented were Internal Medicine, Hospital Medicine, and medical subspecialties (36.4%). RESULTS: Study participants reported a preference for digital interpreters. Despite affirming the importance of interpretation services for LEP patients and endorsing the use of telephone and tablet digital methods, many HCPs cite hassle and time constraints as limiting factors for the use of interpreter services. HCPs reported wide variation in use of interpretation services based on type of encounter. Of HCPs who assessed themselves as non-fluent in Spanish, 71% reported patient encounters without interpretation services, with some reporting they “know enough Spanish to get through”. When asked to rank their likely use of interpretation services in different clinical settings, 88% stated they use interpretation in “Goals of Care Meetings”, 87%use them when “Consenting Patients”, and 80% use them for the initial encounters. However, only 47% and 51% stated that they used interpreters for follow-up encounters and consult visits, respectively. Only 25% reported using interpreters for other visits. CONCLUSIONS: The COVID-19 Pandemic has hastened a shift to digital platforms in many arenas, and healthcare interpretation services have been equally affected. However, despite hopes that digital or telephonic means of interpretation would improve interpretation use by HCPs, our study shows that HCPs continue to use these services at inadequate rates. Time constraints, hassle, and encounter type were common explanations for underuse before the pandemic and continue to be widely cited during COVID-19. The legal imperative to use adequate interpretation services at every encounter should be better communicated to HCPs, and health systems should work to decrease barriers to interpreter services use. If third party interpretation presents the same barriers to use, healthcare systems should consider a strategic change to increase the bilingual work force and certify language skills so that patients can receive language-concordant care more consistently.