Comprehension on family-centered rounds for limited English proficient families

Abstract

Objective: To describe communication with limited English proficient (LEP) families during family-centered rounds (FCR); to examine differences in family understanding of diagnosis and plan by English proficiency and provider and interpreter rounding behaviors.

Methods: Forty-one English proficient (EP) and 40 LEP parents of pediatric inpatients participated in a prospective cohort study from January to October 2011. Eligible LEP families self-reported a preference for medical communication in Spanish, Somali, or Vietnamese. Rounds were observed; families were interviewed afterward. Parent- and provider-reported diagnosis and plan were compared and classified as correct, incorrect, or incomplete by 3 blinded investigators. Logistic regression adjusted for potential confounders.

Results: Fifty percent of LEP rounding encounters involved interpreters filtering information conveyed to families; 43% involved initial medical discussions without families present (vs 12% for EP, P = .002). Providers more frequently provided a plain language summary for LEP families (88% vs 56%, P = .001). LEP and EP families had similar ability to correctly name the child's diagnosis (70% vs 83%, P = .17) and all plan elements (38% vs 39%, P = .88). Results were unchanged after adjusting for parental characteristics and hospital day. Among LEP families, naming the correct diagnosis was positively associated with experience with a hospitalized child (odds ratio 5.11, 95% confidence interval 1.04-24.9) and may be negatively associated with interpreter filtering (odds ratio 0.22, 95% confidence interval 0.05-1.13).

Conclusions: Having initial medical discussions without the family and information filtering are common for LEP patients; filtering may be associated with poorer diagnosis comprehension. Experience with a hospitalized child is associated with increased comprehension among LEP parents.