June 2023 Communication Tip

June 2023 Communication Tip

Language Concordance and Professional Interpreters

 

As this academic year comes to a close (and after nearly 4 years of Communication Tips), I find myself increasingly coming back to the basics—simple but vital ideas and skills that can have a profound impact on the success of our communication efforts. 

This month: Language Concordance and Professional Interpreters.  Literally… are we speaking the same language?

UCSF’s own Leah Karliner, MD, (an excellent researcher and clinician from General Internal Medicine) co-authored an important paper entitled “Exploring the Impact of Language Concordance on Cancer Communication” [Bregio C, JCO, 2022,  Access this article on PubMed]. 

From Dr. Karliner’s work and that of others, we recognize that language discordance is a significant social determinant of health.  There are about 65 million people in the US that speak a language other than English, with 38% of them speaking English “less than very well”—what we label as Low English Proficiency (LEP).  As Dr. Karliner and colleagues summarize: evidence suggests that because of communication challenges, our patients with LEP get lower quality care and suffer worse clinical outcomes. Because of communication challenges, there is less satisfaction, understanding of care goals, and treatment adherence.  In cancer care specifically, patients with LEP tend to have poorer knowledge of their cancer diagnosis, get delayed cancer treatment, and are excluded from clinical trials.  Even oncologists themselves feel they provide less patient-centered treatment discussions in these situations.

In her 2022 study, Dr. Karliner and colleagues conducted a multi-site analysis of various levels of language concordance between patients with cancer and their physicians (mostly oncologists).   The groups were: English language concordant; professionally interpreted; partially language concordant (partially bilingual clinicians speaking Spanish or using ad hoc interpreters); and Spanish language concordant. 

Among their findings:

  • “Spanish language-concordant clinicians had almost two-fold greater number of statements about biomedical information than English language-concordant clinicians” [interesting!]
  • “Spanish language-concordant patients had a higher tendency to engage in positive talk such as expressing agreement” [super interesting]
  • “The number of partnership/facilitation-related statements was equivalent for English and Spanish language-concordant groups but lower in professionally interpreted and partially language-concordant dyads.” 
  • The use of ad hoc interpreters is “inadequate and potentially dangerous in health-related conversations.”

Language concordance is the ideal, but professional interpreters are the next best thing.  Language concordance and, in its absence, the use of professional interpreters, reduce health care disparities.

Moving forward, let’s all pay close attention to speaking clearly in the same language as our patients, or using professional interpreters when we and our patients do not speak the same language well. 

Among other things, Dr. Karliner’s study reminds me that I’m LSP (Low Spanish Proficiency) and, given that, I must do the best I can with my Spanish-speaking patients.

All My Best,

Mike

P.S. You can find an archive of past communication tips on the MERI website: https://meri.ucsf.edu/meri-center-communication-tips.