Language-discordant care in pediatric neurosurgery: parent and provider perspectives on challenges and multilevel solutions to reduce disparities

Author:

Ruiz Colón Gabriela D.1,Bereknyei Merrell Sylvia23,Poon Diana C.4,Mahaney Kelly B.14,Maher Cormac O.14,Prolo Laura M.14

Affiliation:

1. Departments of Neurosurgery and

2. Pediatrics, Stanford University School of Medicine, Stanford;

3. Office of Child Health Equity, Stanford University School of Medicine, Stanford; and

4. Division of Pediatric Neurosurgery, Lucile Packard Children’s Hospital, Stanford, California

Abstract

OBJECTIVE In the United States, Spanish is the second most spoken language, with nearly 42 million individuals speaking Spanish at home. Spanish speakers have been noted to have higher rates of unfavorable neurosurgical outcomes; however, to the authors’ knowledge, no study has explored the experiences of patients, caregivers, and providers receiving or delivering neurosurgical care in language-discordant settings. In this study, the authors sought to identify challenges faced by pediatric neurosurgery providers and Spanish-speaking parents communicating with a language barrier and propose solutions to address those challenges. METHODS Spanish-speaking parents and pediatric neurosurgery providers were invited to participate in semistructured interviews. Purposeful sampling was used to recruit Spanish-speaking parents whose child had recently undergone neurological surgery at the authors’ institution and to identify pediatric neurosurgery clinical team members to interview, including physicians, advanced practice providers, and interpreters. Codes were inductively developed and applied to transcripts by two researchers. Thematic analysis was conducted to identify challenges faced by parents and providers. RESULTS Twenty individuals were interviewed, including parents (n = 8), advanced practice providers (n = 5), physicians (n = 3), interpreters (n = 2), a social worker (n = 1), and a nurse (n = 1). Three challenges were identified. 1) Compared with English-speaking parents, providers noted that Spanish-speaking parents were less likely to ask questions or raise new concerns. Concurrently, Spanish-speaking parents expressed a desire to better understand their child’s future medical needs, care, and development. 2) There is a dearth of high-quality resources available in the Spanish language to supplement patient and parent neurosurgical education. 3) Both parents and providers invariably prefer in-person interpreters; however, their availability is limited. CONCLUSIONS Three challenges were identified by Spanish-speaking parents of pediatric neurosurgery patients and providers when receiving or delivering care through a language barrier. The authors discuss multilevel solutions that, if deployed, could directly address these shared challenges. Furthermore, optimizing communication may help mitigate the disparities experienced by non–English-speaking Hispanic/Latino individuals when receiving neurosurgical care.

Publisher

Journal of Neurosurgery Publishing Group (JNSPG)

Reference31 articles.

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5. Association of language barriers with process outcomes after craniotomy for brain tumor;Manuel SP,2022

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