Heart failure patients with limited English proficiency (LEP) often experience worse outcomes, including higher readmission rates. What can cardiologists and other healthcare professionals do to reverse that trend? A team of researchers hoped to find out, interviewing a variety of professional medical interpreters and sharing its findings in JACC: Heart Failure.
“Given that communication is critical to optimizing heart failure care, it is important to understand the perspectives of the mediators in the conversation—medical interpreters,” wrote lead author Zara Latif, MD, from the department of internal medicine at Beth Israel Deaconess Medical Center in Boston, and colleagues. “Although prior research has focused on patients’ and clinicians’ reported challenges facing LEP heart failure patients, the perspectives of medical interpreters have not been well characterized.”
Latif et al. spoke with 20 different medical interpreters representing a total of nine languages. The group’s experience varied, but their mean time in the industry was more than 16 years. The interpreters emphasized that heart failure patients often have difficulty understanding the specific details of their diagnosis or treatment options.
“Sometimes people have symptoms related to heart failure, but they don’t think it’s their heart that causes the symptoms,” one interpreter explained. “They think, ‘I have leg swelling or edema, but maybe because something has to do with my foot.’ They never think it’s coming from the heart.”
“It’s much more difficult for me to interpret heart failure because it’s more technical,” another interpreter said. “Most of the time the adults are lost. Also, there are a lot of acronyms; for example, they say ‘the LVEF’ instead of saying, ‘the left ventricle ejection fraction.’ A lot of times I know these acronyms, so I break them down, but what if the interpreter doesn’t know those terms?”
The researchers used these interviews to construct a list of ways that communication between physicians and LEP heart failure patients could be improved.
How to boost care for heart failure patients with limited English proficiency
1. Physicians should have a pre-encounter huddle with the interpreter.
This “one-sentence summary” about the patient’s condition can help the interpreter have a better idea of the situation before the actual appointment occurs. Nineteen of the 20 interpreters interviewed for this analysis agreed that this would be a helpful step.
2. Get the family involved at the time of discharge.
When heart failure patients are headed home, they are often asked to start taking new medications or schedule a follow-up appointment. When a family member can be present for such discussions, interpreters explained, it can make a huge difference for the patient, who may be confused or overwhelmed by the information.
“Interpreters recommended family involvement in the HF discharge process,” the authors wrote. “Interpreters were cognizant of the limitations associated with involving family members, such as coordinating family availability with discharge timing. Some interpreters suggested that even having a family member ‘listen in’ on the conversation provides an additional layer of safety for patients at discharge.”
3. Provide more details, better context when discussing the patient’s diet.
Specific dietary choices do not always come up during appointments about heart failure, but things like sodium often come up in conversations. These might seem like straightforward discussion points to cardiologists and other physicians, but many LEP patients get confused at this point.
One way to help these patients, the interpreters explained, is to use the patient’s “native cuisine” to shape these discussions.
4. Provide patients with contact information for interpreter services
It can be difficult for LEP patients to contact their cardiologist’s office. If they could reach out to interpreters for help, instead of relying on a family member who may or may not be available, it could help them get the care they need, when they need it.
5. Integrate medical interpreters into the heart failure care team
“Most interpreters observed that communication with patients would be improved if their role was better incorporated as a critical part of the heart failure team,” the authors wrote. “Failure to stress this point made them feel isolated and discouraged and added to their everyday stressors at work. Interpreters also highlighted the extensive work done by them behind the scenes to ensure that LEP heart failure patients are reminded of their appointments, educated about their medications, and informed of the instructions they were provided by heart failure cardiologists, particularly around discharge.”
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Michael has more than 16 years of experience as a professional writer and editor. He has written at length about cardiology, radiology, artificial intelligence and other key healthcare topics.