399 - Bidirectional information Sharing by Patient Language in Pediatric Serious Illness Care Conferences

Publication Number: 399.3596

Melissa Martos, University of Washington School of Medicine, Seattle, WA, United States; Aleksandra Olszewski, UPMC Childrens Hospital of Pittsburgh, Pittsburgh, PA, United States; Clarissa N. Sofian, Seattle Children's, Mukilteo, WA, United States; Blanca Fields, Seattle Children's, Bellevue, WA, United States; Maya JH. Scott, Seattle Children's Hospital, Seattle, WA, United States; K. Casey Lion, University of Washington/ Seattle Children's Hospital, Seattle, WA, United States; Amy C. Trowbridge, University of Washington School of Medicine, Seattle, WA, United States

Background: Children and families using a language other than English (LOE) are known to experience poorer communication and worse medical care, including at end-of-life. Information sharing between providers and caregivers is essential in serious illness communication to achieve value-aligned, optimal outcomes. Little is known about how caregiver language affects these discussions.

Objective: We explored differences in quantity and complexity of bidirectional information sharing in English and interpreted care conferences for seriously ill pediatric patients.

Design/Methods: We conducted a transcript analysis of audio-recorded care conferences of pediatric patients with serious illness from linguistically diverse families at a single institution. Two coders employed content analysis to categorize provider and caregiver information-sharing statements as biomedical, logistical, or psychosocial; caregiver categories also included patient wellness and values/goals (Table 1). Additional information-sharing features, including speech duration and complexity by Flesch-Kincaid grade level, were tabulated. Descriptive analyses summarized code counts and Mann-Whitney-U tests or Wilcoxon signed-rank tests compared median quantity of information shared, duration of speech, and complexity by conference language.

Results: We analyzed 29 care conferences from 2018-2021, including 11 (39%) professionally interpreted conferences (8 Spanish, 2 Vietnamese, 1 Somali). On average (median), providers made 156 statements per conference while parents made 69 (p <.001). Providers made significantly fewer biomedical statements in interpreted conferences than in English ones (105 vs 176, p=0.02, Figure 1); providers also made fewer statements overall in interpreted conferences (149 vs 194, p=.06), though this did not reach statistical significance. Caregivers made a similar number of statements per conference, regardless of language (78 vs 65, p=.98). After removing interpreter talk time, interpreted conferences may have been shorter (30 minutes vs 44 minutes, p=.16) and were lower in complexity (grade level 4.6 vs 5.7, p< 0.001) than English ones.

Conclusion(s): Providers spoke far more than caregivers, regardless of language. Providers shared significantly fewer biomedical statements in interpreted conferences than English ones. Differences in the quantity of information families hear from providers may contribute to known disparities in communication. Strategies to reduce disparities in information sharing may support equitable outcomes for patients and families from all language backgrounds.

Table 1: Example Excerpts by Statement and Speaker Type
Provider statements were categorized as Biomedical, Logistical, or Psychosocial; caregiver statements were additionally categorized as Patient Wellbeing or Values/Goals.

Figure 1: Median Statements Per Conference by Language
Median number of statements per conference by providers and caregivers. Provider statements were categorized as Biomedical, Logistical, or Psychosocial; caregiver statements were additionally categorized as Patient Wellbeing or Values/Goals. Significant values designated with asterisk.

Table 1: Example Excerpts by Statement and Speaker Type
Provider statements were categorized as Biomedical, Logistical, or Psychosocial; caregiver statements were additionally categorized as Patient Wellbeing or Values/Goals.

Figure 1: Median Statements Per Conference by Language
Median number of statements per conference by providers and caregivers. Provider statements were categorized as Biomedical, Logistical, or Psychosocial; caregiver statements were additionally categorized as Patient Wellbeing or Values/Goals. Significant values designated with asterisk.