Communication After Emergent Surgery by English Proficiency: An Exploratory Qualitative Study

Abstract

Introduction

Older adults with Limited English Proficiency (LEP) comprise a disproportionate number of trauma and emergency general surgery (EGS) patients. In other settings, this group experiences barriers to communication that are likely exacerbated by acute surgical admission. Despite their likely vulnerability, this topic remains understudied. We conducted an exploratory qualitative study to understand communication of older adults with English Proficiency (EP) and LEP hospitalized for trauma or EGS.

Materials and methods

Trauma/EGS service inpatients aged ≥65 with mild or no cognitive impairment were purposively sampled at a safety-net, level one trauma center. Semi-structured interviews were held with patients and family when present, using interpreters for LEP. Interviews transcripts were 20% triple-coded and thematically analyzed using modified grounded theory within an interpretivist paradigm. LEP transcripts were also examined for interpretation errors.

Results

Twenty-three patients enrolled, 8 with LEP (Spanish, Cantonese, Russian). Three themes emerged: 1. Lack of Information – both groups expressed limited knowledge of their care 2. Loss of Autonomy – both groups endorsed reliance on providers. 3. Feedback and Advocacy – Participants with EP and family members of LEP critiqued care and endorsed the importance of self-advocacy; participants with LEP were reluctant to offer critical feedback. All interviews with professional interpreters contained errors.

Conclusions

Differences in EP and LEP participants’ self-advocacy and critiques suggest that language proficiency and communication style contribute to communication barriers after trauma and EGS. Difficulties are likely compounded by professional interpreter errors. Our study generates foundational evidence for further exploration of these factors and their effects on patient outcomes.