Lost in translation: A qualitative analysis of facilitators and barriers to collecting patient reported outcome measures for surgical patients with limited English proficiency

Benjamin G Allar; Chukwuma N Eruchalu; Sarah Rahman; Danny Mou; Gezzer Ortega; Amanda J Reich; Andrea L Pusic; Christopher D Brook; Rachel C Sisodia; Regan W Bergmark

doi:10.1016/j.amjsurg.2022.03.005

Lost in translation: A qualitative analysis of facilitators and barriers to collecting patient reported outcome measures for surgical patients with limited English proficiency

Am J Surg. 2022 Jul;224(1 Pt B):514-521. doi: 10.1016/j.amjsurg.2022.03.005. Epub 2022 Mar 10.

Authors

Affiliations

¹ Center for Surgery and Public Health, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States; Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, United States.
² Center for Surgery and Public Health, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States; Harvard Medical School, Boston, MA, United States.
³ Case Western Reserve University School of Medicine, Cleveland, OH, United States.
⁴ Center for Surgery and Public Health, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States; Department of Surgery, Brigham and Women's Hospital, Boston, MA, United States.
⁵ Center for Surgery and Public Health, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States; Patient Reported Outcomes, Value, and Experience (PROVE) Center, Brigham Health Boston, MA, United States.
⁶ Department of Plastic and Reconstructive Surgery, Brigham and Women's Hospital, Boston, MA, United States; Patient Reported Outcomes, Value, and Experience (PROVE) Center, Brigham Health Boston, MA, United States.
⁷ Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, United States; Department of Otolaryngology-Head and Neck Surgery, Boston University Medical Center, Boston, MA, United States.
⁸ Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States; Patient Reported Outcomes, Mass General Brigham, Boston, MA, United States.
⁹ Center for Surgery and Public Health, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States; Patient Reported Outcomes, Value, and Experience (PROVE) Center, Brigham Health Boston, MA, United States; Division of Otolaryngology-Head and Neck Surgery, Brigham and Women's Hospital and Dana Farber Cancer Institute, Boston, MA, United States; Department of Otolaryngology-Head and Neck Surgery, Harvard Medical School, Boston, MA, United States. Electronic address: rbergmark@bwh.harvard.edu.

PMID: 35339269
DOI: 10.1016/j.amjsurg.2022.03.005

Abstract

Background: Patient-reported outcome measures (PROMs) are increasingly being used throughout surgical disciplines, but their use is limited in multilingual patient populations. We aimed to investigate facilitators and barriers to PROMs collection for patients with limited English proficiency (LEP).

Methods: Semi-structured interviews were performed with providers from multiple surgical disciplines across six academic medical centers until thematic saturation was achieved.

Results: Among 24 interviews, respondents noted either systematic exclusion of patients with LEP or significant barriers to implementation. Barriers included lack of valid and translated PROMs, lack of multi-lingual electronic medical record integration, and insufficient time and resources to accommodate patients with LEP. Facilitators to collection included institutional leadership and funding support for validating translations.

Conclusion: These barriers may result in inadvertent but systematic exclusion of patients with LEP from outcomes datasets as well as clinical decision making. Future implementation projects should consider these themes when developing initiatives for more equitable PROMs collection and utilization.

Keywords: Health Disparities; Limited English Proficiency; Patient-centered care; Patient-reported outcome measures; Quality Improvement.

MeSH terms

Electronic Health Records
Humans
Limited English Proficiency*
Patient Reported Outcome Measures
Patients