Stories from COVID-19 Reveal Hospitalized Patients with Limited English Proficiency Have Always Been Uniquely Prone to Social Isolation

Kucirek, Natalie; Thomas, Norman; Norman, Joshua; Athavale, Priyanka; Jaradeh, Katrin; Hsiang, Esther Y.; Malevanchik, Lev

doi:10.1007/s11606-020-06383-z

Cited by 16 publications

(14 citation statements)

References 13 publications

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“…Similar disparities have been observed in patient portals, which are used by some health care systems to deliver telehealth [ 53 , 54 ]. Qualitative studies have documented barriers, such as limited access to professional interpreters, lack of bilingual HPPs, and lack of translation of COVID-19–related informational materials [ 55 ]. Additional studies are needed to better understand telehealth access among patients who do not prefer English.…”

Section: Discussionmentioning

confidence: 99%

Health Care Providers’ and Professionals’ Experiences With Telehealth Oncology Implementation During the COVID-19 Pandemic: A Qualitative Study

Turner¹,

Babilonia²,

Naso³

et al. 2022

J Med Internet Res

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Background Rapid implementation of telehealth for cancer care during COVID-19 required innovative and adaptive solutions among oncology health care providers and professionals (HPPs). Objective The aim of this qualitative study was to explore oncology HPPs’ experiences with telehealth implementation during the COVID-19 pandemic. Methods This study was conducted at Moffitt Cancer Center (Moffitt), an NCI (National Cancer Institute)-Designated Comprehensive Cancer Center. Prior to COVID-19, Moffitt piloted telehealth visits on a limited basis. After COVID-19, Moffitt rapidly expanded telehealth visits. Telehealth visits included real-time videoconferencing between HPPs and patients and virtual check-ins (ie, brief communication with an HPP by telephone only). We conducted semistructured interviews with 40 oncology HPPs who implemented telehealth during COVID-19. The interviews were recorded, transcribed verbatim, and analyzed for themes using Dedoose software (version 4.12). Results Approximately half of the 40 participants were physicians (n=22, 55%), and one-quarter of the participants were advanced practice providers (n=10, 25%). Other participants included social workers (n=3, 8%), psychologists (n=2, 5%), dieticians (n=2, 5%), and a pharmacist (n=1, 3%). Five key themes were identified: (1) establishing and maintaining patient-HPP relationships, (2) coordinating care with other HPPs and informal caregivers, (3) adapting in-person assessments for telehealth, (4) developing workflows and allocating resources, and (5) future recommendations. Participants described innovative strategies for implementing telehealth, such as coordinating interdisciplinary visits with multiple HPPs and inviting informal caregivers (eg, spouse) to participate in telehealth visits. Health care workers discussed key challenges, such as workflow integration, lack of physical exam and biometric data, and overcoming the digital divide (eg, telehealth accessibility among patients with communication-related disabilities). Participants recommended policy advocacy to support telehealth (eg, medical licensure policies) and monitoring how telehealth affects patient outcomes and health care delivery. Conclusions To support telehealth growth, implementation strategies are needed to ensure that HPPs and patients have the tools necessary to effectively engage in telehealth. At the same time, cancer care organizations will need to engage in advocacy to ensure that policies are supportive of oncology telehealth and develop systems to monitor the impact of telehealth on patient outcomes, health care quality, costs, and equity.

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Section: Discussionmentioning

confidence: 99%

Health Care Providers’ and Professionals’ Experiences With Telehealth Oncology Implementation During the COVID-19 Pandemic: A Qualitative Study

Turner¹,

Babilonia²,

Naso³

et al. 2022

J Med Internet Res

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“…Spanish-speaking patients primarily using hospital tablets and not personal laptops emphasizes the importance of investing in IP telehealth infrastructure for patients with LEP [ 27 ]. In one paper, narratives of patients with LEP who experience social isolation while hospitalized highlight the importance of careful tablet technology implementation to address communication barriers [ 28 ]. Other hospital systems describe the use of Amazon Echo Show devices, laptops on wheels, and tablets on wheels as part of telehealth [ 25 , 26 ].…”

Section: Discussionmentioning

confidence: 99%

Inpatient Telehealth Experience of Patients With Limited English Proficiency: Cross-sectional Survey and Semistructured Interview Study

Payvandi¹,

Parsons²,

Bourgeois³

et al. 2022

JMIR Form Res

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Background Patients with limited English proficiency (LEP) are at a higher risk of poor health outcomes and are less likely to use telehealth than English-speaking patients. To date, there is no formal evaluation of inpatient (IP) telehealth user experience of patients and their families by language preference during visits with their clinicians. Objective This study aims to compare the experiences of English- and Spanish-speaking patients and their families using IP telehealth, as well as to evaluate the experience of Spanish interpreters providing services through IP telehealth. Methods We prospectively administered a survey to English- and Spanish-speaking patients and their families who used IP telehealth from October 1, 2020, to March 31, 2021. We performed semistructured phone interviews of hospital-based Spanish interpreters who provided services through IP telehealth. Results A total of 661 surveys were administered, with completion rates of 18% (112/621) in English and 62% (25/40) in Spanish. On a 10-point scale, the overall satisfaction of Spanish speakers (median 10, IQR 10-10) was higher than that of English speakers (median 9, IQR 8-10; P=.001). Both English- and Spanish-speaking patients used IP telehealth for visits with their primary IP care team, subspecialty consultants, and other clinicians. Hospital tablets were used more often than personal devices, and only English-speaking patients used personal laptops. Patients and their families encountered challenges with log-in, team coordination with multiple users, and equipment availability. Interpreters encountered challenges with audio and video quality, communication, safety, and Wi-Fi access. Conclusions Both English- and Spanish-speaking patients reported high satisfaction using IP telehealth across multiple disciplines despite the workflow challenges identified by interpreters. Significant investment is needed to provide robust infrastructure to support use by all patients, especially the integration of multiple users to provide interpreter services for patients with LEP.

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“…However, shortly after these policies were enacted, reports surfaced describing hospitalized patients' fear, loneliness, and isolation ( Annear, 2020 ; Goldman, 2020 ; Munshi, Odutayo, et al, 2021 ; Vais, 2021 ). Beyond patients' suffering, family members described negative and even harmful experiences resulting from significant barriers to collaborating with care providers ( Bronsther, 2020 ; Kucirek et al, 2021 ), and communicating with and caring for loved ones in intensive care ( Andrist, Clarke, & Harding, 2020 ; Hochendoner et al, 2022 ; Kentish-Barnes et al, 2021 ). Many hospital providers also reported significant psychological burden and moral distress due to visitor restrictions ( Annear, 2020 ; Goldman, 2020 ; Moss et al, 2021 ; Munshi et al, 2021 ; Munshi, Odutayo, et al, 2021 ; Vais, 2021 ) This moral distress was particularly reported among clinicians caring for very sick and dying patients who, they felt, suffered deeply in the absence of in-person family comfort and support ( Azoulay et al, 2020 ; Jones-Bonofiglio, Nortjé, Webster, & Garros, 2021 ; Wendlandt, Kime, & Carson, 2022 ).…”

Section: Introductionmentioning

confidence: 99%

Restricted family presence for hospitalized surgical patients during the COVID-19 pandemic: How hospital care providers and families navigated ethical tensions and experiences of institutional betrayal

Conn

Coburn

Prospero

et al. 2022

SSM - Qualitative Research in Health

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Stories from COVID-19 Reveal Hospitalized Patients with Limited English Proficiency Have Always Been Uniquely Prone to Social Isolation

Cited by 16 publications

References 13 publications

Health Care Providers’ and Professionals’ Experiences With Telehealth Oncology Implementation During the COVID-19 Pandemic: A Qualitative Study

Health Care Providers’ and Professionals’ Experiences With Telehealth Oncology Implementation During the COVID-19 Pandemic: A Qualitative Study

Inpatient Telehealth Experience of Patients With Limited English Proficiency: Cross-sectional Survey and Semistructured Interview Study

Restricted family presence for hospitalized surgical patients during the COVID-19 pandemic: How hospital care providers and families navigated ethical tensions and experiences of institutional betrayal

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