Do Professional Interpreters Improve Clinical Care for Patients with Limited English Proficiency? A Systematic Review of the Literature

Division of General Internal Medicine, Medical Effectiveness Research Center for Diverse Populations, Department of Medicine, University of California, San Francisco, 1701 Divisadero, Suite 500, San Franicsco, CA 94143-1732, USA.
Health Services Research (Impact Factor: 2.78). 05/2007; 42(2):727-54. DOI: 10.1111/j.1475-6773.2006.00629.x
Source: PubMed


To determine if professional medical interpreters have a positive impact on clinical care for limited English proficiency (LEP) patients.
A systematic literature search, limited to the English language, in PubMed and PsycINFO for publications between 1966 and September 2005, and a search of the Cochrane Library.
Any peer-reviewed article which compared at least two language groups, and contained data about professional medical interpreters and addressed communication (errors and comprehension), utilization, clinical outcomes, or satisfaction were included. Of 3,698 references, 28 were found by multiple reviewers to meet inclusion criteria and, of these, 21 assessed professional interpreters separately from ad hoc interpreters. Data were abstracted from each article by two reviewers. Data were collected on the study design, size, comparison groups, analytic technique, interpreter training, and method of determining the participants' need for an interpreter. Each study was evaluated for the effect of interpreter use on four clinical topics that were most likely to either impact or reflect disparities in health and health care.
In all four areas examined, use of professional interpreters is associated with improved clinical care more than is use of ad hoc interpreters, and professional interpreters appear to raise the quality of clinical care for LEP patients to approach or equal that for patients without language barriers.
Published studies report positive benefits of professional interpreters on communication (errors and comprehension), utilization, clinical outcomes and satisfaction with care.


Available from: Elizabeth A Jacobs
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    • "Language barriers lead to poor comprehension of medical treatments [9] [10]. When professional medical interpreters or truly bilingual physicians facilitate communication , LEP patients are more likely to understand their diagnosis and treatment plan and receive care comparable with that of their English-speaking counterparts [9] [11] [12]. "
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    ABSTRACT: Background: Informed consent is important for limited English proficient (LEP) patients undergoing surgery, as many surgical procedures are complicated, making patient comprehension difficult even without language barriers. The study objectives were to (1) understand surgeons' preoperative consenting process with LEP patients, (2) examine how surgeons self assess their non-English language proficiency levels using a standardized scale, and (3) identify the relationship between self assessed non-English language proficiency and surgeons' self-reported use of interpreters during preoperative informed consent. Materials and methods: A thirty-two item survey assessing surgeons' reported preoperative informed consent process, with questions related to demographics, level of medical training, non-English language skills and their clinical use, language learning experiences, and hypothetical scenarios with LEP patients. Results: Surgeons who were not fluent in non-English languages reported they often used those limited skills to obtain informed consent from their LEP patients. Many surgeons reported relying on bilingual hospital staff members, family members, and/or minors to serve as ad-hoc interpreters when obtaining informed consent. If a professional interpreter was not available in a timely manner, surgeons more frequently reported using ad-hoc interpreters or their own nonfluent language skills. Surgeons reported deferring to patient and family preferences when deciding whether to use professional interpreters and applied different thresholds for different clinical scenarios when deciding whether to use professional interpreters. Conclusions: Surgeons reported relying on their own non-English language skills, bilingual staff, and family and friends of patients to obtain informed consent from LEP patients, suggesting that further understanding of barriers to professional interpreter use is needed.
    Journal of Surgical Research 10/2015; DOI:10.1016/j.jss.2015.09.033 · 1.94 Impact Factor
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    • "" Flores and colleagues (2003) found that the errors made were associated with the interpreters' competence and skills: Untrained (ad hoc) interpreters such as family members , relatives, friends, medical and non-medical staff, and strangers produce higher adverse effects than trained professional interpreters on the quality of care and health outcomes . When professional interpreters or bilingual providers are used, fewer communication errors are made, patients are more receptive to their providers' care, and show greater adherence to follow-up and treatment (Karliner et al., 2007). Factors contributing to these positive findings appear to be that patients ask more questions, have better overall information recall (Seijo, Gomez, & Freidenberg, 1995), feel more comfortable discussing sensitive or embarrassing issues (Kuo & Fagan, 1999), and have a better psychological well-being (Pérez-Stable, Napoles-Springer, & Miramontes, 1997). "
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    ABSTRACT: As language may be an important barrier for ethnic minority families to access health care, interpreters can be a valuable aid to reach these families. Little is known, however, about the effects of using interpreters in mental health care. The present study investigated whether the use of interpreters affected treatment outcomes of Multisystemic therapy (MST) in the Netherlands. Ninety-one cases with an interpreter were compared with 91 cases without an interpreter. The two groups were matched regarding age, gender, imposed sanction, and therapist. Each case’s progress, treatment duration, and treatment outcomes were obtained. For 61 of the matched pairs, long-term re-conviction rates were retrieved from official judicial records. Comparing the cases with interpreter and the matched controls revealed no significant differences. Moreover, the treatment outcomes were the same for professional and family interpreters. Although there was a trend toward higher recidivism rates during MST when an interpreter had been used, the long-term judicial data did not reveal any differences between the interpreter group and the matched control group. Thus, it seems that in a highly structured and goal-oriented treatment like MST, both professional and family interpreters can be used to obtain treatment outcomes comparable with those of native speakers.
    Journal of Emotional and Behavioral Disorders 08/2015; DOI:10.1177/1063426615592821 · 1.28 Impact Factor
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    • "Several studies from different provider types in this literature have documented the importance of having professional interpreters during a health encounter for improving health outcomes (Flores, 2005; Karliner et al., 2007), patient comprehension (Cheng et al., 2007; Jacobs et al., 2006), health care utilization (Flores, 2005), and satisfaction with communication and clinical services (Flores, 2005; Karliner et al., 2007). However, patients' perceptions of interpreter services have not been well explored. "
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    ABSTRACT: Language barriers are a large and growing problem for patients in the US and around the world. Interpreter services are a standard solution for addressing language barriers and most research has focused on utilization of interpreter services and their effect on health outcomes for patients who do not speak the same language as their healthcare providers including nurses. However, there is limited research on patients' perceptions of these interpreter services. To examine Hmong- and Spanish-speaking patients' perceptions of interpreter service quality in the context of receiving cancer preventive services. Twenty limited English proficient Hmong (n=10) and Spanish-speaking participants (N=10) ranging in age from 33 to 75 years were interviewed by two bilingual researchers in a Midwestern state. Interviews were audio taped, transcribed verbatim, and translated into English. Analysis was done using conventional content analysis. The two groups shared perceptions about the quality of interpreter services as variable along three dimensions. Specifically, both groups evaluated quality of interpreters based on the interpreters' ability to provide: (a) literal interpretation, (b) cultural interpretation, and (c) emotional interpretation during the health care encounter. The groups differed, however, on how they described the consequences of poor interpretation quality. Hmong participants described how poor quality interpretation could lead to: (a) poor interpersonal relationships among patients, providers, and interpreters, (b) inability of patients to follow through with treatment plans, and (c) emotional distress for patients. Our study highlights the fact that patients are discerning consumers of interpreter services; and could be effective partners in efforts to reform and enhance interpreter services. Copyright © 2015 Elsevier Ltd. All rights reserved.
    International journal of nursing studies 04/2015; DOI:10.1016/j.ijnurstu.2015.03.019 · 2.90 Impact Factor
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