Parental limited English proficiency in pediatric stem cell transplantation: Clinical impact and health care utilization

Abstract

Background: Limited English proficiency (LEP) is associated with adverse clinical outcomes. The clinical impact of LEP in hematopoietic stem cell transplant (HSCT) has not been studied. The objectives of this study were to compare HSCT outcomes and health care utilization of Hispanic pediatric patients with and without parental LEP. Methods:We conducted a retrospective review of Hispanic/Latino pediatric patients receiving HSCT at a single institution. Families were identified as LEP or English proficient (EP) based on clinicians' notes, social work documentation, or the signature of a Spanish interpreter on treatment consents.Results: A total of 83 Hispanic/Latino patients were identified with 53 (65.1%) having parental LEP. More patients in the LEP group had a documented financial burden at pretransplant psychosocial evaluation (72.2% vs. 41.4%, p = .009). LEP patients were more likely to have health insurance coverage through government-sponsored Medicaid (76.9% vs. 27.6%, p < .001). LEP patients were hospitalized on average 13 days longer than EP patients, and LEP patients were more likely to have pretransplant cytomegalovirus (CMV) reactivity (67.3%) than EP patients (p = .001). Overall survival was lower in LEP than EP, but was not statistically significant (p = .193). Multivariable Cox modeling suggested a potentially higher risk of death in LEP versus EP (hazard

Meeting the needs of the patient with non‐English language preference in the hospital setting

“…Use of a qualified healthcare interpreter promotes justice in information shared and protected. Inequities in pain management, 11 adverse events, 12 hospitalization duration, 13,14 and return visits to the emergency department 15 have affected patients with NELP. With respect to beneficence, professional healthcare interpreter use is associated with improved clinical outcomes, discharge education processes, patient comprehension, and patient satisfaction for those with NELP 4,5,16 .…”

The Fragile Web of Care: Ethnicity, Poverty, and Language in Acute Leukaemia

“…Having LEP is associated with reduced survival in pancreatic cancer 8 and higher risk of treatment failure in head and neck cancers 9 . There are no published studies on LEP and acute leukaemia mortality, but a US study of Hispanic families in a paediatric stem cell transplant setting showed that parental LEP was significantly associated with prolonged hospitalisation 10 …”

“… 9 There are no published studies on LEP and acute leukaemia mortality, but a US study of Hispanic families in a paediatric stem cell transplant setting showed that parental LEP was significantly associated with prolonged hospitalisation. 10 …”

“…9 There are no published studies on LEP and acute leukaemia mortality, but a US study of Hispanic families in a paediatric stem cell transplant setting showed that parental LEP was significantly associated with prolonged hospitalisation. 10 What mediates the relationship between sociodemographic factors such as ethnicity, poverty, and LEP with acute leukaemia outcomes? There is a risk that we return to the balance scale model and try to fit sociodemographic disparities to underlying disease biology or patient fitness for treatment alone.…”

Inequities in Pediatric Palliative Care: Where Are the Consults?*

“…An especially important suggestion that McKee et al (7) discuss is the need for improved language services for patients and families with Limited English Proficiency (LEP), correctly citing that patients of any race or ethnicity with LEP are known to have poor health outcomes and poor access to healthcare services. Specific to pediatric HSCT, parental LEP is directly associated with prolonged hospitalization and cytomegalovirus reactivity, and indirectly associated with posttransplant complications and death (13). As reported in their limitations, the database records used for this study were limited to standard diagnosis and consultation queries (7).…”