Overcoming Communication Barriers Impairing Equitable Access to Advanced Therapies: A Case Study

{"title":"Overcoming Communication Barriers Impairing Equitable Access to Advanced Therapies: A Case Study","authors":"Pablo Da Silva MD MPH,&nbsp;Janet Abrahm MD FACP FAAHPM FASCO","doi":"10.1016/j.jpainsymman.2025.02.028","DOIUrl":null,"url":null,"abstract":"<div><h3>Outcomes</h3><div>1. To highlight the influence of language barriers on patient selection for advanced therapies (e.g., left ventricular assist device (LVAD)).</div><div>2. To identify the role of palliative care team in offering strategies for improving communication between healthcare teams and patients and families for whom English is not the language of choice.</div><div>3. To explore the role of the palliative care team in overcoming barriers to comprehensive patient assessments, including social support, when treatment decisions are made for patients for whom English is not the language of choice.</div></div><div><h3>Key Message</h3><div>This case study examines how language barriers and inadequate exploration of social support can impede equitable access to advanced therapies for non-English-speaking patients and their families. It also explores the role of the palliative care team in overcoming these challenges.</div></div><div><h3>Abstract</h3><div>Language barriers and inadequate communication can contribute to lack of equity in patient care, particularly in complex medical situations. Communicating in the patient's language of choice and exploring their social support system is crucial to overcoming barriers to equitable decisions regarding advanced therapies.</div></div><div><h3>Case</h3><div>A 51-year-old non-English speaking patient presented with multiple chronic conditions, including type 2 diabetes mellitus, chronic pain, arthritis with wheelchair dependency, heart failure with reduced ejection fraction (EF 11%), and a history of cardiogenic shock. He was evaluated for a left ventricular assist device (LVAD) in the cardiac critical care unit, with an interpreter facilitating communication. Palliative care (PC) expressed no reservations about the patient's candidacy for an LVAD. However, the LVAD committee declined the procedure due to concerns about the patient's home care support, ambulation, and his history of not transitioning from oxycodone to Suboxone. The primary team did not inform the patient and his family clearly that he would need to transition from oxycodone to suboxone if he wished to be an LVAD candidate. The team did not explore the family's willingness to take turns caring for him, and incorrect assumptions may have contributed to the committee's denial of the LVAD.</div></div><div><h3>Conclusion</h3><div>We will discuss the significant impact of ineffective communication and language barriers on patient outcomes, particularly in the decision-making process for offering life-altering therapies such as LVADs. We will detail the role of the PC team in (1) sharing effective strategies that healthcare providers (HCPs) can use to ensure patients and their families receive clear, comprehensive information in their language of choice; and (2) teaching HCPs how to explore family support systems effectively, enhancing treatment decisions and eliminating barriers that deny access to advanced therapies to patients and families for whom English is not the language of choice.</div></div>","PeriodicalId":16634,"journal":{"name":"Journal of pain and symptom management","volume":"69 5","pages":"Page e423"},"PeriodicalIF":3.2000,"publicationDate":"2025-04-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of pain and symptom management","FirstCategoryId":"3","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S0885392425000880","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"CLINICAL NEUROLOGY","Score":null,"Total":0}