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The present paper addresses the challenges of the delivery process of the informed process to patients with limited English proficiency in the field of radiation sciences. Limited English proficiency (LEP) is defined as reporting the command of the English language to be less than “very well” for individuals over the age of five (Zong & Batalova, 2015). In the United States, the population with LEP has grown by 80%, from 14 million to 25.1 million between 1990 and 2013 (Zong & Batalova, 2015).
Given the current migration tendencies and enhanced global mobility, it is projected that the United States will welcome even more migrants, including those whose English proficiency creates barriers to seeking medical help. It is readily imaginable how seeing a patient with LEP may be frustrating for both the patient and the health worker. The need to communicate clearly and precisely, at times using proper medical terms that require advanced English comprehension, is especially relevant in radiology. Many radiological and radiographic procedures have side effects and health considerations of which patients should be aware. The question arises as to how radiologists and other health workers in this field should handle language discordance when obtaining consent from patients with LEP.
According to Zong and Batalova (2015), the growth rate in populations with LEP is at 8.5% per annum – a tendency that has the potential to aggravate the situation even further. Yet, literature on the topic is scarce and primarily focuses on the outcomes of the negligence of language discordance. As of now, it is evident that patients with LEP suffer from a lack of expertise in handling bilingual spaces. As stated by Raynor (2015), 62% of LEP patients report not having all their questions answered by their health provider. What is more, half of them were not even sure about the rationale behind their treatment plan or whether they understood the prescriptions correctly. The main reason behind miscommunication was the language barrier.
Parsons, Baker, Smith-Gorvie, and Hudak (2014) show that health workers are as frustrated as LEP patients. When researching Canadian hospitals in cities with diverse populations, Parsons (2014) discovered that health workers were more inclined to try to resolve the situation on their own rather than get help. As the study participants admitted, in a clinical setting where time might be the most valuable resource, getting help meant slowing down the process. The question arises as to what kind of help would be the most efficient and accessible. Lee et al. (2017) demonstrate that the introduction of phone translation systems significantly facilitates communication. While the study’s findings are optimistic, it is unclear how exactly hospitals could make it happen. Probably, the most challenging aspect would be finding interpreters, especially given their shortage in the workforce (example: ten interpreters per LEP population of 40,000 in Texas (Diño (2017)). Perhaps, there are other ways to overcome the language barrier.
As seen from the literature review, the issue of informed consent in patients with LEP needs further investigation. Ideally, the topic needs to be researched in terms of both theoretical frameworks and practical implications. First, through scientific inquiry, the best strategies for handling language discordance should be outlined, be it hiring an interpreter or using remote interpretation services. Second, policy-makers and healthcare leaders should estimate the costs of implementation as well as tackle the issue of translators and interpreters shortages. As of now, the only fact that is certain is poor health outcomes in patients with LEP due to their inability to understand the doctor and follow through with the prescribed treatment. Future research needs to compare and contrast the efficiency of hiring an interpreter, using phone services, machine translation, and “getting by” when communicating with radiology patients with LEP.
Diño, G. (2017). Demand in the US for Legal and Healthcare Interpreters Gets Increasing Media Attention. Slator. Web.
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.
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Parsons, J. A., Baker, N. A., Smith-Gorvie, T., & Hudak, P. L. (2014). To ‘get by’ or ‘get help’? A qualitative study of physicians’ challenges and dilemmas when patients have limited English proficiency. BMJ Open, 4(6), e004613.
Raynor, E. M. (2016). Factors affecting care in non-English-speaking patients and families. Clinical Pediatrics, 55(2), 145-149.
Zong, J., & Batalova, J. (2015). The limited English proficient population in the United States. Migration Policy Institute. Web.