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Los acontecimientos que hemos vivido en los últimos años como la pandemia sanitaria por la COVID-19 o la guerra entre Rusia y Ucrania han conllevado cambios en el trabajo de los traductores e intérpretes en los servicios públicos. En el ámbito médico, donde los límites del papel del intérprete siempre han estado difusos, la inmediatez en la comunicación de las noticias que iban ocurriendo durante la pandemia, la comprensión de las restricciones y las nuevas vías de intercambios multilingüísticos y multiculturales forzaron una rápida adaptación a las nuevas condiciones de trabajo de los traductores e intérpretes médicos. De ahí que la interpretación profesional en el ámbito médico-sanitario ya necesitase –y ahora todavía más por los movimientos migratorios- una legislación concreta para la adecuada provisión de intérpretes que ponga fin a las barreras de acceso y lingüístico-culturales con las que se encuentran los pacientes alófonos. El presente artículo analiza la experiencia de los pacientes alófonos para poner de manifiesto la realidad con la que se encuentran y mostrar las consecuencias derivadas de la ausencia de intérpretes profesionales o el uso de intérpretes ad-hoc en los servicios médico-sanitarios. Además, también se reflexiona sobre los beneficios del uso de intérpretes profesionales para ofrecer una atención de calidad y los retos y desafíos de la situación actual de la interpretación profesional en todo el territorio español, The events we have experienced in recent years, such as the COVID-19 health pandemic or the Russia and Ukraine war, have led to changes in the work of translators and interpreters in public services. In the medical field, where the limits of the interpreter’s role have always been blurred, the immediacy of the communication of news as it happened during the pandemic, the understanding of the restrictions and the new ways of multilingual and multicultural exchanges forced a rapid adaptation to the new working conditions of medical translators and interpreters. Hence, professional interpreting in healthcare needed -and needs due to migratory movements- a specific legislation for an adequate provision of interpreting services to put an end to access, linguistic and cultural barriers encountered by non-Spanish speaking patients. This paper focuses on the experience of non-Spanish speaking patients to explore the reality they face and to show the consequences of not using interpreters or using ad-hoc interpreters in healthcare services. This study also draws attention to the benefits of using professional interpreters to provide an adequate quality care and to describe the challenges of the current professional interpreting situation in Spain.

Disparities following traumatic injury by race/ethnicity and insurance status are well-documented. However, the relationship between limited English proficiency (LEP) and outcomes after trauma is poorly understood. This study describes the association between LEP and morbidity and mortality after traumatic injury.A retrospective cohort study was conducted of adult trauma patients admitted to a level 1 trauma center from 2012 to 2018. Morbidity (length of stay [LOS], intensive care unit admission, intensive care unit LOS, discharge destination) and in-hospital mortality for LEP and English proficient (EP) patients were compared using univariate and multivariable logistic and generalized linear models controlling for patient demographics (age, sex, race/ethnicity, insurance) and clinical characteristics (mechanism, activation level, Glasgow Coma Scale, Injury Severity Score, traumatic brain injury).Of the 13,104 patients, 16% were LEP patients. LEP languages included Chinese (44%) and Spanish (38%), and 18% categorized as "Other," including 33 languages. In multivariable models, LEP was statistically significantly associated with increased hospital LOS (P = 0.003) and increased discharge to home with home health services (P = 0.042) or to skilled nursing facility/rehabilitation (P = 0.006). Mortality rate was 7% for LEP versus 4% for EP patients (P 0.0001). In multivariable analysis, speaking an LEP language other than Chinese or Spanish was statistically significantly associated with increased mortality compared to EP (P = 0.006).Following traumatic injury, LEP patients experience increased hospital LOS and are more frequently discharged to home with home health services or to skilled nursing facilities/rehabilitation. LEP patients speaking languages other than Chinese or Spanish experience increased mortality compared to EP patients.

To evaluate patient access to Spanish-language-concordant care on a postpartum unit and to identify facilitators and barriers to the use of interpretation services.Mixed-methods research study, comprising a cross-sectional chart review from September to December 2019 and semistructured interviews from June to December 2020.A tertiary academic medical center in the southeastern United States where individuals with limited English proficiency are at risk for poor health outcomes when they are unable to communicate with clinicians in their preferred language.We conducted a chart review of 50 randomly selected birthing parent-newborn couplets and interviews with 14 inpatient health care team members.The chart review examined patient characteristics, health care team composition including Spanish language proficiency, length of stay, number of interpreter requests, and time between clinician interpreter requests and interpreter arrival on the unit. Interviews evaluated facilitators and barriers to interpreter use.Access to a clinician certified in medical Spanish or an interpreter was offered to 12 of 50 (24%) couplets upon admission to the unit and to 7 of 50 (14%) of couplets for daily maternal and newborn medical rounds. Clinicians reported long and unpredictable wait times to access interpreters, which led them to rely on hand gestures, broken Spanish, and smartphone apps to "get by" when communicating with patients without certified interpretation services. Participants described low usage of interpreters for "noncritical" encounters.Interpreters and other forms of Spanish-language-concordant care were underused on the postpartum unit. This deviation from national standards may put families at risk for harm. Recommendations from this study include advancing a culture of respectful care, improving the interpreter request workflow, addressing safe staffing, facilitating direct patient access to interpreters, and providing ongoing evaluation and support.

PURPOSE: Patients with cancer who have limited English proficiency are more likely to experience inequities in cancer knowledge, timely care, and access to clinical trials. Matching patients with language-concordant clinicians and working with professional interpreters can effectively reduce language-related disparities, but little data are available regarding the impact of language-concordant interactions in oncology care. This study aimed to assess the use of the Roter Interaction Analysis System (RIAS) in language-concordant and -discordant interactions for patients with non-English language preference presenting for an initial oncology visit at four New York City hospitals. METHODS: We used the RIAS, a validated tool for qualitative coding and quantitative analysis, to evaluate interactions between 34 patients and 16 clinicians. The pairings were stratified into dyads: English language-concordant (n = 12); professionally interpreted (n = 11); partially language-concordant (n = 4, partially bilingual clinicians who communicated in Spanish and/or used ad hoc interpreters); and Spanish language-concordant (n = 7). A trained Spanish-speaking coder analyzed the recordings using established RIAS codes. RESULTS: Spanish language-concordant clinicians had almost two-fold greater number of statements about biomedical information than English language-concordant clinicians. Spanish language-concordant patients had a higher tendency to engage in positive talk such as expressing agreement. The number of partnership/facilitation-related statements was equivalent for English and Spanish language-concordant groups but lower in professionally interpreted and partially language-concordant dyads. CONCLUSION: Language concordance may facilitate more effective biomedical counseling and therapeutic relationships between oncology clinicians and patients. Future research should further explore the impact of language concordance on cancer-specific health outcomes.

Purpose: It is known that interpreter-mediated aphasia assessments may not provide the linguistic information that speech-language pathologists (SLPs) need to provide accurate diagnoses and determine treatment goals. The purpose of our study was to understand the perceptions of SLPs and interpreters who collaborate in a medical setting and to develop a checklist to categorize and quantify the errors interpreters make. Interpreter training may lead to unintentional errors that impact the information the SLP gains from the assessment session. Method: In Phase 1 of the study, 38 hospital SLPs and 26 interpreters responded to survey questions about their experiences working with the other discipline. In Phase 2, eight Spanish-speaking interpreters and two Spanish-speaking participants with fluent aphasia took part in a standardized interpreter-mediated aphasia assessment. A bilingual SLP and a Spanish-speaking interpreter analyzed and coded the assessments for errors in the interpreters’ behaviors. Results: Results from the survey demonstrated that both SLPs and interpreters would like the interpreters to have more education regarding the diagnosis of aphasia and an understanding of the SLP's goals during an aphasia assessment. A lack of time was considered the primary hindrance to educating interpreters during an evaluation session. The checklist included interpreter behaviors that could significantly impact the SLP’s ability to diagnose aphasia: omission of speech/language information, meaning errors, and cueing. Positive behaviors noted were calling attention to patient error and pointing out potential confusing items. Conclusions: Education for both disciplines will enhance the accuracy of interpreter-mediated aphasia assessments. A checklist tool with specific examples of errors may be useful in educating not only experienced interpreters and SLPs but also students in both disciplines.

PURPOSE: Limited English-proficient (LEP) patients with non–small-cell lung cancer (NSCLC) may receive less palliative care services and more likely to receive aggressive end-of-life (EoL) care. Goals of this retrospective cohort study are to compare access to community palliative home care (CPHC), do not resuscitate (DNR) form completion, place of death, and health resource utilization at EoL between English-proficient (EP) and LEP patients with NSCLC in Vancouver, Canada. METHODS: All patients with advanced NSCLC referred in 2016 and received medical care were included. Patients were classified as LEP if seen with a medical interpreter. Descriptive statistics and univariate and multivariate analyses were used to compare the outcomes between the two groups. RESULTS: One hundred eighty-six patients were referred, 66% EP. Rates of CPHC referral and DNR form completion were the same for both groups (84% and 92%, P = 1.00). LEP patients received earlier access to CPHC (15 v 10 weeks before death, P = .039). Rates of ER visits within 6 months and 30 days of death were 0.89 for EP patients and 0.7 for LEP patients, P = .374, and 0.1 for EP patients and 0.13 for LEP patients, P = .244. Hospitalization rates within 6 months and 30 days of death were 1.4 for EP patients and 1.59 for LEP patients, P = .640, and 0.67 for EP patients and 0.81 for LEP patients, P = .091. EP patients were more likely to have a home death (26% v 14%), whereas LEP patients died in acute care (23% v 14%) or a tertiary palliative care unit (24% v 19%). This was not statistically significant ( P = .335). LEP patients had better median overall survival (8.5 v 5.4 months, P < .001), but when controlled by age, mutation, and EP status, only receipt of palliative-intent systemic therapy was statistically significant. CONCLUSION: EP and LEP patients with NSCLC have similar referral rates to CPHC, DNR form completion, and EoL health resource utilization. The measured EoL variables did not demonstrate significant disparities between EP and LEP patients.

Medical interpreters are the primary facilitators of effective communication between clinical providers and patients with limited English proficiency. They can assist in managing complex meetings in which patients, families, and clinicians decide on next steps in care. Palliative care (PC) clinicians inherently work in an interdisciplinary manner, which enables them to learn and model the effective integration of medical interpreters into the PC team. Rather than using an interpreter as a language tool, this article encourages PC clinicians to cultivate a partnership with the interpreter as a team member. We describe 10 tips for effective partnering with interpreters: the importance of including the interpreters in preencounter huddles and post-encounter debriefs, agreeing on strategies for interpreting "untranslatable" words and managing the encounters, using the "teach back" method to ensure understanding, acknowledging interpreters as cultural mediators, understanding the potential emotional impact of family meetings on interpreters, and enhancing follow-up with the PC team by providing contact information for PC staff to patients.

Communication is a determining factor for the success of organizations, which helps to achieve efficient and effective management, makes its members feel like an active part, increases their motivation and establishes a better interrelation between all organizational levels, which invigorates Commitment to and with the organization. Therefore, through this essay, the need to investigate current organizational communication systems is raised, as well as the obstacles that may arise to maintain it effectively and efficiently, emphasizing those that have emerged or have gained greater strength in recent years, due to the Coronavirus pandemic. The inquiry has been developed under the interpretative paradigm, using the qualitative technique of documentary research, of the informative type, for which a series of documents acquired in electronic browsing were analyzed. Finally, the need to create new models of organizational communication is raised, with an inclusive, transformative character that exalts the human being and his quality of life, based on some proposals that have emerged in the context of the pandemic that affects everything in the world, with a latent danger of becoming an endemic disease, and that will serve as the basis for these times of organizational uncertainty., La comunicación es un factor determinante para el éxito de las organizaciones, la cual coadyuva a alcanzar una gestión eficiente y eficaz, hace sentir a sus integrantes como parte activa, incrementa su motivación y establece una mejor interrelación entre todos los niveles organizacionales, lo que vigoriza el compromiso para y con la organización. Por tanto, a través de este ensayo, se plantea la necesidad de investigar los sistemas de comunicación organizacional actuales, los obstáculos que se puedan presentar para mantenerla de forma eficaz y eficiente, haciendo énfasis en aquellos que han surgido o han tomado mayor fuerza en los últimos tiempos, debido a la pandemia del Coronavirus. La indagación se ha desarrollado bajo el paradigma interpretativo, utilizando la técnica cualitativa de investigación documental, del tipo informativa, para lo cual se analizaron una serie de documentos adquiridos en el navegar electrónico. Finalmente, se plantea la necesidad de crear nuevos modelos de comunicación organizacional, con un carácter incluyente, transformador, que exalte al ser humano y su calidad de vida, tomando como base algunas propuestas que han surgido en el contexto de la pandemia que afecta a todo el mundo, con un peligro latente de transformarse en una enfermedad endémica, y que servirá de base para estos tiempos de incertidumbre organizacional.

This study aims to investigate nursing interns’ training experiences in emergency departments (EDs) in Saudi Arabia and explore the factors influencing their experiences. A descriptive research design was employed utilizing a survey distributed to nursing interns who completed their ED rotation within the last three months. The data were analyzed using SPSS version 27, and principal component analysis (PCA) was conducted to identify the challenges encountered by the interns. This study analyzed the responses of 126 nursing internship students in various regions of Saudi Arabia to assess their training experiences in emergency departments. The principal component analysis revealed two significant factors: (1) “Emergency Department Training and Skill Development”, which focused on challenges faced during training, and (2) “Integrated Emergency Department Training and Competence Development”, which provided a holistic view of nursing internship students’ experiences and preparedness for their careers. The results indicated moderately below-average challenges and a moderately positive overall training experience. The findings suggest a need to address these challenges to improve the training experience and better prepare nursing internship students for careers in emergency departments. This study recommends enhancing the nursing curricula alignment with practical training objectives, focusing on technical and interpersonal skills development. A supportive learning environment in emergency departments is crucial, including effective communication and collaboration. Diverse clinical experiences and reflection on training can guide students in exploring potential career paths in emergency departments or other specialized nursing areas.

Due to COVID-19, education transitioned to online mode because e-learning is the best option for continuous education. Changes in the communication space and time of communication created barriers in the communication environment. Though online learning seems like the best study method, communication barriers are inevitable as the interaction between students and teachers is a vital part of learning. Hence, this study aimed to determine the perception of the Grade 12 students of Saint Mary’s University Senior High School on experiencing communication barriers during distance education. The research utilized a mixed-method design, involving both quantitative and qualitative methods. The survey questionnaire was participated in by 213 randomly selected Grade 12 students from all strands. The data were gathered and analyzed through descriptive, inferential statistics, and thematic analysis. This study found that the respondents’ experiencing a slight communication barriers. The results obtained revealed that sex and general weighted average were significant indicators of the students’ perception. In the thematic analysis, self-studying was the most preferred way on how they managed to learn despite experiencing communication barriers during distance education. Henceforth, the gathered body of knowledge could contribute to improving the quality of distance education for students, teachers, future generations, and the future researchers.

IMPORTANCE: Patients with language barriers have a higher risk of experiencing hospital safety events. This study hypothesized that language barriers would be associated with poorer perceptions of hospital safety climate relating to communication openness. OBJECTIVE: To examine disparities in reported hospital safety climate by language proficiency in a cohort of hospitalized children and their families. DESIGN, SETTING, AND PARTICIPANTS: This cohort study conducted from April 29, 2019, through March 1, 2020, included pediatric patients and parents or caregivers of hospitalized children at general and subspecialty units at 21 US hospitals. Randomly selected Arabic-, Chinese-, English-, and Spanish-speaking hospitalized patients and families were approached before hospital discharge and were included in the analysis if they provided both language proficiency and health literacy data. Participants self-rated language proficiency via surveys. Limited English proficiency was defined as an answer of anything other than “very well” to the question “how well do you speak English?” MAIN OUTCOMES AND MEASURES: Primary outcomes were top-box (top most; eg, strongly agree) 5-point Likert scale ratings for 3 Children’s Hospital Safety Climate Questionnaire communication openness items: (1) freely speaking up if you see something that may negatively affect care (top-box response: strongly agree), (2) questioning decisions or actions of health care providers (top-box response: strongly agree), and (3) being afraid to ask questions when something does not seem right (top-box response: strongly disagree [reverse-coded item]). Covariates included health literacy and sociodemographic characteristics. Logistic regression was used with generalized estimating equations to control for clustering by site to model associations between openness items and language proficiency, adjusting for health literacy and sociodemographic characteristics. RESULTS: Of 813 patients, parents, and caregivers who were approached to participate in the study, 608 completed surveys (74.8% response rate). A total of 87.7% (533 of 608) of participants (434 [82.0%] female individuals) completed language proficiency and health literacy items and were included in the analyses; of these, 14.1% (75) had limited English proficiency. Participants with limited English proficiency had lower odds of freely speaking up if they see something that may negatively affect care (adjusted odds ratio [aOR], 0.26; 95% CI, 0.15-0.43), questioning decisions or actions of health care providers (aOR, 0.19; 95% CI, 0.09-0.41), and being unafraid to ask questions when something does not seem right (aOR, 0.44; 95% CI, 0.27-0.71). Individuals with limited health literacy (aOR, 0.66; 95% CI, 0.48-0.91) and a lower level of educational attainment (aOR, 0.59; 95% CI, 0.36-0.95) were also less likely to question decisions or actions. CONCLUSIONS AND RELEVANCE: This cohort study found that limited English proficiency was associated with lower odds of speaking up, questioning decisions or actions of providers, and being unafraid to ask questions when something does not seem right. This disparity may contribute to higher hospital safety risk for patients with limited English proficiency. Dedicated efforts to improve communication with patients and families with limited English proficiency are necessary to improve hospital safety and reduce disparities.

To explore whether the relationship between mental health diagnosis (i.e., mood or neurotic, stress-related, or somatoform disorder) and pain is moderated by language in patients with limited English proficiency (LEP). Southeast Asian languages (i.e., Hmong, Lao, Khmer) and Spanish were compared with English.A retrospective data mining study was conducted (n = 79,109 visits). Pain scores, language, mental health diagnoses, age, sex, race, ethnicity, and pain diagnosis were obtained from electronic medical records. Cragg two-equation hurdle regression explored: (1) the effect of patient language and mental health diagnosis on pain and (2) the interaction between language and mental health diagnosis on pain.Visits were primarily for female (62.45%), White (80.10%), not Hispanic/Latino (96.06%), and English-speaking (97.85%) patients. Spanish or Southeast Asian language increased chances of reporting any pain (i.e., pain score of 0 versus ≥1) and pain severity in visits with pain scores ≥1, whereas mental health diagnosis decreased chances of reporting any pain and pain severity. The combination of Southeast Asian language and mood disorder contributed to higher chances of reporting any pain (odds ratio [OR] = 1.78, p.001) but no difference in severity. A similar trend was observed for Southeast Asian language and neurotic disorder (OR = 1.29, p=.143). In contrast, the combination of Spanish language and mood (p = .066) or neurotic (p = .289) disorder contributed to lower pain severity but did not change the chances of reporting any pain.LEP and patient language should be considered during pain assessment within the context of mental health.

The objective of this study is to identify factors associated with receiving surgical menopause counseling in gynecologic cancer patients, as well as patient and provider perspectives, regarding surgical menopause counseling and management.We conducted a single-institution mixed-method study combining retrospective chart review and patient and provider surveys. Patients younger than 51 years who experienced surgical menopause after gynecologic cancer treatment from January 2017 to December 2019 were surveyed in April 2021 about experiences with menopause counseling, barriers to care, and quality of life. We then reviewed charts of only patients who fully completed surveys. All gynecologic oncology providers were surveyed about surgical menopause practices. Logistic regression identified factors associated with receiving counseling.Sixty-six of 75 identified met inclusion criteria and received survey invitations. Thirty-five (53%) completed surveys. Sixty percent had documented surgical menopause counseling. Patients who were counseled were younger (43 vs 48.5 years, P = 0.005), more likely to have referrals for menopause care (12 vs 9, P = 0.036), more likely to have menopause providers other than oncology providers (14 vs 8, P = 0.001), and had fewer comorbidities. Decreasing age at surgery increased odds of counseling. Most reported continued menopause symptoms and quality of life disturbances. Half were satisfied with menopause care. Majority preferred counseling from oncology providers. Most providers always counseled on surgical menopause but cited lack of time as the primary obstacle for complete counseling.Younger age at surgery increased odds of receiving surgical menopause counseling. Gynecologic cancer patients experienced significant menopause-related disturbances. Improved understanding of patient and provider preferences and greater emphases on surgical menopause and survivorship will improve care for gynecologic oncology patients.

Little is known about the independent association of language barriers on postoperative process outcomes after craniotomies.To evaluate the association of limited English proficiency (LEP) with length of stay (LOS), discharge disposition, hospitalization costs, and rate of 30-day readmission after craniotomy for brain tumor.This is a retrospective cohort study of adult patients who underwent craniotomies for brain tumor from 2015 to 2019 at a high-volume neurosurgical center. Multivariable logistic regression was used to evaluate the association of LEP with discharge disposition and 30-day readmission. Negative binomial regression was used to evaluate the association of LEP with LOS and hospitalization cost.Of the 2232 patients included, 7% had LEP. LEP patients had longer LOS (median [IQR] 5 [3-8] days vs 3 [2-5] days, Plt; .001), higher costs of hospitalization (median [IQR] $27 000 [$21 000-$36 000] vs $23 000 [$19 000-$30 000], Plt; .001), and were more likely to be discharged to skilled care facilities (37% vs 21%, Plt; .001) compared with English proficient patients. In multivariable models, the association between LEP and longer LOS (incidence rate ratio 1.11, 95% CI 1.00-1.24), higher hospitalization costs (incidence rate ratio 1.13, 95% CI 1.05-1.20), and discharge to skilled care (OR 1.76, 95% CI 1.13-2.72) remained after adjusting for confounders. There was no difference in 30-day readmission rates by language status.LEP is an independent risk factor for extended LOS, higher hospitalization cost, and discharge to skilled care in neurosurgical patients who undergo craniotomy for brain tumor. Future research should seek to understand mediators of these observed disparities.

Background Primarily Spanish-speaking cancer patients and caregivers often experience non-congruence with healthcare providers about beliefs, values, and knowledge of cancer. Our goal was to describe how communication related to the diagnosis of cancer was influenced by culture and language among primarily Spanish-speaking caregivers of pediatric cancer patients. Methods Caregivers participated in three focus groups about their experiences with their child's diagnosis, communication issues, and understanding of their child's diagnosis and treatment plan. Focus groups were audio recorded, transcribed, and qualitatively analyzed using interpretive description. Results Three themes emerged: 1) Negative experiences and barriers during the cancer diagnosis and treatment, 2) Miscommunication and system complexity, and 3) Language barriers throughout the diagnostic process. Due to barriers and negative experiences, some caregivers reported that their child's diagnosis was delayed, that providers sometimes used dehumanizing language, and that they were confused about diagnostic testing and treatment. Conclusion Cultural and linguistic disparities in pediatric oncology must be systematically addressed at the provider, clinic, and system level. Practice implications High-quality cancer care delivered by oncologists and cancer care teams should include cultural humility when discussing the cancer diagnosis and prognosis.

Objectives In this study, we aimed to describe and evaluate the codesign of an intervention in general practice setting to help address navigation problems faced by the patients from the culturally and linguistically diverse (CALD) community in Australia. Methods An experience-based codesign (EBCD) methodology was adopted using the Double Diamond design process. Two codesign workshops were conducted online with 13 participants including patients, their caregivers, health service providers, researchers, and other stakeholders. Workshops were audio-recorded, transcribed, and thematically analyzed. Results The codesign participants identified several navigation problems among CALD patients such as inadequate health literacy, cultural and language barriers, and difficulties with navigating health and social services. They believed that bilingual community navigators (BCNs; lay health workers from the same language or cultural background) could help them address these problems. However, this depended on BCNs being trained and supervised, with a clear role definition and manageable workloads, and not used as an interpreter. In undertaking the codesign process, we found that pre-workshop consultations were useful to ensure engagement, especially for consumers who participated more actively in group activities with service providers after these and their own separate small group discussions during the workshop. Conclusion Overall, participants identified that BCNs could offer help in addressing the problems faced by the CALD patients in accessing care in general practice setting. The codesign process provided new insights into the navigation problems faced by CALD patients in accessing care and collaboratively developed a strategy for further testing and evaluation.

Globalisation and migration trends are reflected in emergency departments (EDs), which increasingly care for patients and employ staff from diverse cultural and/or ethnic backgrounds. EDs are busy, pressured and unpredictable environments where effective communication with patients and families is challenging at the best of times. This is compounded by language and cultural barriers experienced by patients and families whose background differs from the prevailing culture. Cultural differences and language comprehension may also be a challenge for overseas nurses recruited to the ED, who may need support from colleagues and organisations. ED nurses therefore need to be competent in intercultural communication. This involves combining optimal interpersonal skills with cultural awareness, knowledge and sensitivity.

Aims and objectives To explore the perspectives of family members of Aboriginal children about a) their involvement in recognising clinical deterioration in a hospital setting and b) the effectiveness of a poster designed to promote family involvement. Background To assist in the early recognition and response to clinical deterioration for hospitalised children, many escalation of care processes now include family involvement. Little is currently known about the perspectives of Australian Aboriginal families in recognising deterioration in their child and raising the alarm, or if current escalation of care systems meet the needs of Aboriginal families. Design Qualitative pragmatist approach using semi-structured interviews. Methods Seven interviews were conducted with five mothers and two grandmothers of Aboriginal children who were inpatients at a children's hospital. Thematic analysis was undertaken. Findings Two themes were identified: Theme one was: Family role in recognising and responding to clinical deterioration, with two subthemes of knowing when to worry and communicating concerns. Participants reported that some families needed more knowledge to recognise clinical deterioration. Communication barriers between families and clinicians were identified. Theme two was: Effective visual communication with three subthemes of linguistic clarity, visual appeal and content. Conclusions Additional strategies are needed to promote effective communication between clinicians and families of Aboriginal children in hospital. Posters were considered effective, particularly if including a cultural connection, images and simplified language. Practice implications These insights provide important information for health professionals and health service managers to be aware that additional communication strategies are required to support Aboriginal family involvement in recognising clinical deterioration and escalation of care.

Background : As the COVID-19 pandemic continues, health care systems around the world have changed care delivery in significant ways. Racial and ethnic disparities have emerged for COVID-19 infection rates, morbidity, and mortality. Inequities in care and underutilization of interpretation for patients who use a language other than English (LOE) for care existed prior to this era. We sought to evaluate interpreter use in a pediatric emergency department (ED) as changes associated with COVID-19 were implemented. Methods : ED records were reviewed from December 1, 2019 to July 31, 2020. Patients were classified as having LOE if they preferred a language other than English and consented to interpretation. We used statistical process control to analyze changes in interpreter use over time, relative to the onset of COVID-19–related operational changes. Beginning March 1, 2020, in-person interpreters were no longer available and staff were encouraged to communicate from outside the patient room when possible; this change served as our exposure of interest. Interpreter use for LOE patients, overall and by triage acuity level, was our outcome. Results : A total of 26,787 encounters were included. The weekly mean proportion of encounters that used interpretation for patients with LOE increased from 59% to 73% after the onset of COVID-19; this increase met criteria for special cause variation. Interpretation modality changed to being mostly by phone from previously by video or in-person. Conclusions : Operational changes in the ED related to COVID-19 were associated with increased interpreter use. Possible explanations include lower patient volumes or changes in model of care that encouraged interpreter use by a variety of modalities.

Effective communication is crucial in cancer care due to the sensitive nature of the information and the psychosocial impact on patients and their families. Patient-centered communication (PCC) is the gold standard for providing quality cancer care, as it improves patient satisfaction, treatment adherence, clinical outcomes, and overall quality of life. However, doctor–patient communication can be complicated by ethnic, linguistic, and cultural differences. This study employed the ONCode coding system to investigate PCC practices in oncological visits (doctor’s communicative behavior, patient’s initiatives, misalignments, interruptions, accountability, and expressions of trust in participants’ talk, Markers of uncertainty in doctor’s talk, markers of emotions in doctor’s talk). Forty-two video-recorded patient–oncologist encounters (with 22 Italian and 20 foreign patients), including both first and follow-up visits, were analyzed. Three discriminant analyses were conducted to assess differences in PCC between patient groups (Italian or foreign patients) according to the type of encounter (first visit or follow-up) and the presence or absence of companions during the encounters. Multiple regression analyses were performed to evaluate the PCC differences by oncologist age, patient age, and patient sex, controlling for the type of encounter, the presence of a companion during the visit, and patient group on ONCode dimensions. No differences were found in PCC by patient group in discriminant analyses and regressions. Doctor communication behavior, interruptions, accountability, and expressions of trust were higher in first visits than in follow-ups. The disparities in PCC were primarily linked to the type of visit and the age of the oncologist. However, a qualitative analysis showed notable differences in the types of interruptions during visits with foreign patients compared to Italian patients. It is essential to minimize interruptions during intercultural encounters to foster a more respectful and conducive environment for patients. Furthermore, even when foreign patients demonstrate sufficient linguistic competence, healthcare providers should not solely rely on this factor to ensure effective communication and quality care.

Limited English proficiency (LEP) is defined as individuals in whom English is not the primary language and who have limited ability to read, speak, write, or understand the English language. Cardiovascular (CV) team members routinely encounter language barriers in their practice. These barriers have a significant impact on the quality of CV care that patients with LEP receive. Despite evidence demonstrating the negative association between language barriers and health disparities, the impact on CV care is insufficiently known. In addition, older adults with CV disease and LEP are facing increasing risk of adverse events when complex medical information is not optimally delivered. Overcoming language barriers in CV care will need a thoughtful approach. Although well recognized, the initial step will be to continue to highlight the importance of language needs identification and appropriate use of professional interpreter services. In parallel, a health system-level approach is essential that describes initiatives and key policies to ensure a high-level quality of care for a growing LEP population. This review aims to present the topic of LEP during the CV care of older adults, for continued awareness along with practical considerations for clinical use and directions for future research.

Los acontecimientos que hemos vivido en los últimos años como la pandemia sanitaria por la COVID-19 o la guerra entre Rusia y Ucrania han conllevado cambios en el trabajo de los traductores e intérpretes en los servicios públicos. En el ámbito médico, donde los límites del papel del intérprete siempre han estado difusos, la inmediatez en la comunicación de las noticias que iban ocurriendo durante la pandemia, la comprensión de las restricciones y las nuevas vías de intercambios multilingüísticos y multiculturales forzaron una rápida adaptación a las nuevas condiciones de trabajo de los traductores e intérpretes médicos. De ahí que la interpretación profesional en el ámbito médico-sanitario ya necesitase –y ahora todavía más por los movimientos migratorios- una legislación concreta para la adecuada provisión de intérpretes que ponga fin a las barreras de acceso y lingüístico-culturales con las que se encuentran los pacientes alófonos. El presente artículo analiza la experiencia de los pacientes alófonos para poner de manifiesto la realidad con la que se encuentran y mostrar las consecuencias derivadas de la ausencia de intérpretes profesionales o el uso de intérpretes ad-hoc en los servicios médico-sanitarios. Además, también se reflexiona sobre los beneficios del uso de intérpretes profesionales para ofrecer una atención de calidad y los retos y desafíos de la situación actual de la interpretación profesional en todo el territorio español. The events we have experienced in recent years, such as the COVID-19 health pandemic or the Russia and Ukraine war, have led to changes in the work of translators and interpreters in public services. In the medical field, where the limits of the interpreter’s role have always been blurred, the immediacy of the communication of news as it happened during the pandemic, the understanding of the restrictions and the new ways of multilingual and multicultural exchanges forced a rapid adaptation to the new working conditions of medical translators and interpreters. Hence, professional interpreting in healthcare needed -and needs due to migratory movements- a specific legislation for an adequate provision of interpreting services to put an end to access, linguistic and cultural barriers encountered by non-Spanish speaking patients. This paper focuses on the experience of non-Spanish speaking patients to explore the reality they face and to show the consequences of not using interpreters or using ad-hoc interpreters in healthcare services. This study also draws attention to the benefits of using professional interpreters to provide an adequate quality care and to describe the challenges of the current professional interpreting situation in Spain.

Underrepresentation of individuals with limited English proficiency (LEP) who speak Spanish is ongoing in phase 3 biomedical clinical trials and exacerbates health inequity. This article suggests strategies for increasing representation of Spanish speakers in clinical rials by emphasizing the importance of early engagement with Spanish language communities, inclusive participant recruitment, and collaborative trial design and implementation. Although investigators and institutions administering government-funded research must meet federal requirements for language assistance, journal editors, peer reviewers, institutional review board members, academic health centers, and all beneficiaries of the biomedical and behavioral research enterprise in the United States must motivate linguistic inclusion.Todavía continúa la subrepresentación de personas con un dominio limitado del inglés (LEP, por sus siglas en inglés) que hablan español en los ensayos clínicos biomédicos de fase 3 y esto exacerba la inequidad sanitaria. Este artículo propone estrategias para aumentar la representación de los hispanohablantes en los ensayos clínicos al resaltar la importancia del compromiso temprano con las comunidades de habla hispana, el reclutamiento inclusivo de participantes y el diseño e implementación de ensayos colaborativos. Aunque los investigadores y las instituciones que realizan las investigaciones financiadas por el gobierno deben cumplir con los requisitos federales respecto de la asistencia lingüística, los editores de revistas, los revisores inter pares, los miembros de las juntas de revisión institucionales, los centros académicos de salud y todos los beneficiarios de las empresas de investigación biomédica y conductual en los Estados Unidos deben motivar la inclusión lingüística.

OBJECTIVE: This study examined the proportion of U.S. mental health facilities and organizational correlates of providing non-English language services. METHODS: Using data from the 2018 National Mental Health Services Survey, differences between mental health facilities that provided non-English language services and those that did not were examined across 23 organizational characteristics. Further analyses compared facilities by their method of language service provision. RESULTS: Of 7503 facilities, 5,186 (69.1%) provided non-English language services. Facilities that offered these services were more likely than others to have high-patient-volume, to be publicly-owned, and to be located in the ten states with the highest percentage of residents with limited English proficiency. Among facilities with language services, 592 (11.4%) relied on multilingual staff, 2532 (48.8%) on external on-call interpreters, and 2062 (39.8%) on both. CONCLUSIONS: Most mental health facilities provide language services, and they tend to be large public organizations located in areas of greatest need.

Global problems require global scientific solutions, but the dominance of the English language creates a large barrier for many non-English-proficient researchers to make their findings and knowledge accessible globally. Here, we propose integrating peer language proofing and translation systems in preprint platforms as a solution for promoting equity, diversity, and inclusion in science.

Despite advances in healthcare and improved chemotherapy, disparities in breast cancer outcomes continue to persist. Our aim was to evaluate socioeconomic factors that may impact timing of treatment for patients receiving chemotherapy in underserved communities.A review of patients with breast cancer who received neoadjuvant or adjuvant chemotherapy from 2015-2019 was conducted at a safety-net hospital. The primary outcomes were times from diagnosis to chemotherapy and surgery. Clinicodemographic factors including race, age, clinical stage, primary language, comorbidities, and median income by zip code were collected. Multivariable regression analysis was performed to evaluate for factors associated with the primary outcomes.One hundred patients were identified. For the neoadjuvant group, median time from diagnosis to chemotherapy and surgery was 52 ± 34 days and 256 ± 59 days, respectively. For the adjuvant group, median time from diagnosis to surgery and chemotherapy was 24.5 ± 18 days and 94.5 ± 53 days, respectively. Non-English language and older age were associated with increased time to chemotherapy in the adjuvant group (p 0.05). Language and age were not associated with increased time to surgery in both groups. Race, age, comorbidities, and income were not associated with delay in treatment in either groups.Older age and non-English language were associated with prolonged time from surgery to adjuvant chemotherapy. Targeted interventions directed at patient education and decreasing language barriers especially post-operatively may decrease delays in treatment and subsequently reduce disparities seen in the breast cancer population.

Since the onset of the COVID-19 pandemic, virtual care solutions have been rapidly adopted across the country to provide safe, quality care to diverse patient populations. The objective of this qualitative case study was to understand patient and caregiver experiences of virtual care to identify barriers and gather suggestions to address them.In this patient-oriented project, we sought to understand gaps in virtual care experienced by patients and caregivers, using virtual focus groups. With the assistance of a patient research liaison, we engaged 2 patient partners as full partners; they participated in study conception, data collection, data analysis and knowledge translation. Recruitment was done through email by disseminating the study poster to 30 community organizations and health units in Ontario and British Columbia. We conducted a constructivist, qualitative study guided by grounded theory methodology. One researcher employed in-vivo coding, followed by axial coding with focus group participants, followed by selective coding with the study team. The study took place from November to December 2020.We conducted 6 focus groups with 13 patients and 5 caregivers. The analysis resulted in 6 major themes and 17 minor themes. Key findings showed that barriers related to access to technology and Internet, language and cultural differences were challenges to virtual care. Participants identified special considerations surrounding caregiver and family involvement; privacy, consent and confidentiality; and the patient-physician relationship. Participants suggested that technology and the Internet be universally accessible and that virtual care modalities be integrated (e.g., consolidated patient portal) to improve virtual care.There are multiple patient-identified barriers to accessing virtual care in Canada; patients can provide insights into ways to address these barriers. Future research should include robust patient engagement to explore ways to address these challenges and barriers to ensure that virtual care can be equitable, accessible and safe for all users.Although virtual care has been rapidly adopted and scaled up in health care institutions across the country, few improvements informed by patient and caregiver experiences have been made. Driven by concerns expressed by patient partners, our study team undertook a patient-partnered qualitative study to understand the barriers of virtual care from the perspectives and experiences of patients and caregivers. Our study team created the interview guide drawing from our previous patient-oriented qualitative studies and designed an orientation package to provide resources related to the focus groups and to introduce participants to the study team. Drawing from local health teams, clinics and patient advisory groups, the study team recruited 13 patients and 5 caregivers to participate in 6 focus group interviews. An analysis based on grounded theory was undertaken, with participation from both the study team and participants. Lack of access to technology or Internet and language barriers were determined to be the primary challenges in virtual care. Special considerations to caregiver and family involvement, privacy and confidentiality, as well as the patient-physician relationship were considered priorities to improving access to virtual care. Participants offered recommendations and potential solutions to address barriers and challenges in virtual care, which can serve to encourage large-scale policy and programmatic changes in patient-centred ways.

BACKGROUND Racial and ethnic disparities in healthcare safety have persisted for decades, particularly for patients with language barriers. Previous studies have investigated the frequency and nature of safety events impacting patients with language barriers; others have proposed solutions to fix them. A gap analysis, however, of how we are currently addressing safety issues and why these efforts have not been effective is lacking. METHOD This analysis uses reports from a patient safety event reporting system. Reports contain information regarding no-harm (near miss) events and events where harm may have reached the patient. Reports occurring with patients with a preferred language other than English were extracted and analyzed to determine whether the language barrier contributed to the safety event, the language barrier was mentioned in the resolution, and themes were mentioned for addressing language barriers. RESULTS A subset of 1553 events pertaining to non-English-speaking patients were first categorized as "likely" (3%), "plausibly" (10%), or "unlikely" (87%) related to the patient's language barrier. Second, events related to the patient's language barrier were categorized as directly addressing (19%), indirectly addressing (3%), not mentioning (69%) the language barrier, or containing insufficient information to determine whether the language barrier was addressed (7%). Third, thematic analysis revealed that the most common methods for addressing language barriers included presenting issues to interpreter services and subsequent use of interpreter services. CONCLUSIONS This study found that it is challenging to determine the direct role of certain social determinants of health (e.g., language barriers) in safety events. In many cases, the language barrier was not addressed in the event report. Furthermore, when the language barrier was addressed, solution themes typically involved weaker, less sustainable suggested actions.

Aims and objectives To trial three mobile translation apps in the healthcare setting to address language barriers in everyday care between healthcare staff and older people with limited English proficiency (LEP). Design A mixed‐methods exploratory study. Methods A two‐month trial of three translation apps was conducted across four aged‐care hospital wards. Observed interactions during use of translation apps were recorded, and staff surveys regarding the use of translation apps were collected at the end of the trial. Data were analysed using descriptive statistics and thematic content analysis of open‐ended responses in the surveys and observations. Findings from the thematic content analysis are reported using the Standards for Reporting of Qualitative Research (SRQR) checklist. Results Translation apps were mostly used for identifying pain and assisting with activities of daily living. Qualitative findings revealed that translation apps aided staff in providing care and improved rapport; however, practical shortcomings were identified.

Background Over 41 million people in the United States speak Spanish as their primary language, of which 16 million have limited English proficiency (LEP). It is well-established that language barriers contribute to health disparities and that the use of ad-hoc interpretation by untrained family members results in substandard care. We developed a novel interpreter training program for medical students to serve as in-person interpreters at a charitable, resident continuity clinic so as to overcome the language barrier in the delivery of healthcare to LEP patients. Methods The Medical Student Interpreter Training Program (MSITP) consists of three steps. First, fluent Spanish-speaking students shadowed a licensed interpreter. Second, students took a standardized phone exam to demonstrate language proficiency. Finally, students completed a three-hour training on the methodology and ethics of interpreting conducted by the Department of Interpreter Services. Results Pre- and post-tests were administered to assess students’ familiarity with the Interpreter Code of Ethics and interpreter skills. Familiarity with the Interpreter Code of Ethics increased significantly with all students reporting feeling comfortable (47%) or very comfortable (53%) after training. The pre- and post-tests included free response questions, which were administered to assess competence in the methodology and ethics of interpreting. The cohort’s aggregate score increased by 35% after the training (Wilcoxon signed rank z-score = 2.53; p = .01). Conclusions Implementing the MSITP resulted in an increased number of trained, Spanish-speaking interpreters available to provide their services to LEP patients at an affiliated charitable clinic and throughout the university hospital. Unlike other program models which are time and resource-intensive, this program is replicable and easily managed by volunteers. The MSITP is an effective model for training students as medical interpreters to ensure the delivery of quality healthcare for LEP patients.

This report presents two cases of successful telerehabilitation delivery for patients quarantined due to COVID-19. One of the patients did not speak the therapists' language, whereas the other presented complete deafness.We assembled a telerehabilitation system using commercial applications, including a remote-control application that minimizes the need for patient's input. The telerehabilitation comprised a combination of video calls with a physical therapist and a 20-minute exercise video. The first case was of a 72-year-old man who could only speak Cantonese, a language that none of the service providers could speak, making communication difficult. Therefore, telerehabilitation was provided using Google Translate to simultaneously translate the therapist's instructions in Japanese to Cantonese. The second case involved a 49-year-old man with neurofibromatosis and complete deafness. In this case, communication during the exercise programme was achieved using 25 cue cards that were prepared in advance and used to convey instructions. The patients' satisfaction was assessed using either of a simple three-item questionnaire (Case 1) or the Telemedicine Satisfaction Questionnaire with five additional items (Case 2).In both cases, the exercise programme was successfully conducted, and the patients reported being highly satisfied with the programme.Communication barriers can impede telerehabilitation therapy; this problem is aggravated when the recipients cannot receive on-site education for device operation and exercise performance in advance due to COVID-19 restrictions. However, the use of supplementary methodologies may contribute to solving these issues, further expanding the coverage and applicability of telerehabilitation.IMPLICATIONS FOR REHABILITATIONWe provided telerehabilitation for two patients with communication difficulties who were quarantined due to COVID-19.Telerehabilitation was carried out using a system with a remote-control mechanism to minimise patient input and avoid problems caused by their unfamiliarity in operating the devices.In addition, an online translation mechanism was used to overcome language differences, while cue cards were used for a patient with a hearing impairment.Telerehabilitation was performed without any technical issues. Both patients reported being highly satisfied with the intervention.This experience of providing telerehabilitation and overcoming communication difficulties may help develop a strategy to expand the coverage of telerehabilitation in the treatment of patients in isolation due to highly transmissible diseases, such as COVID-19.

Objective: There is evidence to suggest adverse outcomes on patients’ medical and surgical care when there is language discordance in patient-physician relationships. No studies have evaluated the impact of limited English proficiency (LEP) on complications after common surgical procedures in otolaryngology. Furthermore, no studies have evaluated how patients with LEP utilize remote resources to connect with otolaryngology providers to better triage such complications. The purpose was to evaluate the incidence of post-tonsillectomy hemorrhage (PTH) comparing patients with LEP to those with English proficiency (EP). Patients with PTH were retrospectively evaluated to identify preceding telephone encounters, a marker of resource utilization. Methods: Demographics, English proficiency, and PTH management (surgical vs non-surgical) were evaluated in addition to PTH-associated triage telephone encounters with otolaryngology providers. Results: Of 2466 tonsillectomies, there were 141 episodes of reported hemorrhage (50 LEP vs 91 EP) in the 5 years studied. Rates were not significantly different between LEP and EP patients (4.9% vs 6.3%, P = .127). There was no statistically significant difference in rate of preceding telephone encounters between LEP and EP patients (24% vs 40%, P = .062). Of patients presenting directly to the Emergency Department without a triage telephone encounter, there was no difference in operative versus non-operative management when comparing LEP versus EP patients. However, patients presenting directly to the Emergency Department were nearly twice as likely to undergo operative intervention compared to patients with preceding telephone encounters (RR = 1.79). Conclusion: Patients with limited English proficiency are not at increased risk for developing PTH. There is equitable access to remote otolaryngologic triage care, although overall the utilization rate of this resource was low for both cohorts.

BackgroundPatients with limited English proficiency (LEP) experience worse outcomes following hospital discharge. Care transition programs are common, yet little is known about the disparities in quality (process and outcome measures) experienced by patients with LEP.MethodsWe conducted a retrospective cohort study to determine the association of LEP and care transition quality at an urban, US academic hospital. We examined all adults discharge home from the hospital from May 2018 through April 2019. All patients received a multilingual, automated telephone call three days after discharge to assess and address patient-reported issues. We determined care transition quality using process measures (reach rate, time to resolve reported issue) and outcome measures (discharge instructions questions, difficulty obtaining prescriptions, medication concerns, follow up care questions, new or worsening symptoms, any other clinical issues). All results were adjusted for measured confounders; we used predicted probabilities and average marginal effect (AME) to describe associations.Results13,860 patients were included in the study; 11% had LEP. The program reached most patients regardless of LEP status but was less likely to reach patients with LEP (AME 3.3%; 95% CI, 1.4% to 5.1%). After adjustment, patients with LEP reported high rates of all measured patient-reported outcomes: discharge instruction (AME 4.8%; 95% CI, 2.7% to 6.9%), obtaining prescriptions (AME 2.9%; 95% CI, 0.6% to 5.1%), medications concerns (AME 2.3%; 95% CI, 0.0% to 4.6%), follow up questions (AME 2.8%; 95% CI, 0.3% to 5.3%), new or worsening symptoms (AME 3.2%; 95% CI, 0.7% to 5.8%), and any other clinical issues (AME 3.6%; 95% CI, 1.1% to 6.1%). When issues were identified, the association between LEP and time to resolution of an issue was statistically, but not clinically, significant.Conclusion and RelevanceAmong patients with LEP, substantial disparities exist in patient-reported post-discharge outcome measures indicating a need for better discharge processes that focus on quality and health equity. Following discharge, relatively minor disparities were observed in the processes of a care transitions program that supports non-English languages.

Background and aims The Australian Deaf Community face barriers that impede their access to, and communication within, primary health care settings. This study aimed to identify barriers and facilitators to access and communication for deaf individuals and Auslan interpreters in Australian general practice settings. Methods Semi-structured interviews were conducted with eight Auslan interpreters and four deaf participants recruited from interpreter organisations and social media. Transcripts of interviews were coded inductively and deductively based on a model of access to health care. Results Patient, provider and contextual factors were reported. Patient barriers included English and Auslan fluency levels within the Australian Deaf Community. GP clinics varied in the degree of accommodation to the needs of deaf people. There were barriers related to the communication methods used by health care providers and their use of interpreters. Visual aids and flexibility in terms of the GP clinics' appointment systems facilitated access. Contextual barriers included the shortage of Auslan interpreters and the complexity of the National Disability Insurance Scheme. Conclusion The main barriers identified concerned the availability of interpreters, accommodation by health providers, cultural sensitivity and the adequacy of communication methods. Research is needed to explore the limitations of the National Disability Insurance Scheme and interventions to improve GPs' skills in communicating with Deaf individuals. Patient or public contribution A researcher with a hearing impairment and experience in working with people with hearing impairments was consulted on study design and interview questions. Recruitment was assisted by Auslan interpreter agencies and a Deaf Community Facebook group.

PURPOSE: Race and ethnicity have been shown to affect quality of cancer care, and patients with low English proficiency (LEP) have increased risk for serious adverse events. We sought to assess the impact of primary language on health care engagement as indicated by clinical trial screening and engagement, use of genetic counseling, and communication via an electronic patient portal. METHODS: Clinical and demographic data on patients with breast cancer diagnosed and treated from 2013 to 2018 within the Stanford University Health Care system were compiled via linkage of electronic health records, an internal clinical trial database, and the California Cancer Registry. Logistic and linear regression models were used to evaluate for association of clinical trial engagement and patient portal message rates with primary language group. RESULTS: Patients with LEP had significantly lower rates of clinical trial engagement compared with their English-speaking counterparts (adjusted odds ratio [OR], 0.29; 95% CI, 0.16 to 0.51). Use of genetic counseling was similar between language groups. Rates of patient portal messaging did not differ between English-speaking and LEP groups on multivariable analysis; however, patients with LEP were less likely to have a portal account (adjusted OR, 0.89; 95% CI, 0.83 to 0.96). Among LEP subgroups, Spanish speakers were significantly less likely to engage with the patient portal compared with English speakers (estimated difference in monthly rate: OR, 0.43; 95% CI, 0.24 to 0.77). CONCLUSION: We found that patients with LEP had lower rates of clinical trial engagement and odds of electronic patient portal enrollment. Interventions designed to overcome language and cultural barriers are essential to optimize the experience of patients with LEP.

The COVID-19 pandemic forced cystic fibrosis (CF) care programs to rapidly shift from in-person care delivery to telehealth. Our objective was to provide a qualitative exploration of facilitators and barriers to: 1) implementing high-quality telehealth and 2) navigating reimbursement for telehealth services.We used data from the 2020 State of Care CF Program Survey (n=286 U.S. care programs) administered in August-September to identify two cohorts of programs, with variation in telehealth quality (n=12 programs) and reimbursement (n=8 programs). We conducted focus groups and semi-structured interviews with CF program directors and coordinators in December 2020, approximately 9 months from onset of the pandemic. We used the Consolidated Framework for Implementation Research to identify facilitators and barriers of implementation, and inductive thematic analysis to identify facilitators and barriers of reimbursement.Factors differentiating programs with greater and lower perceived telehealth quality included telehealth characteristics (perceived advantage over in-person care, cost, platform quality); external influences (needs and resources of those served by the CF program), characteristics of the CF program (compatibility with workflows, relative priority, available resources); characteristics of team members (individual stage of change), and processes for implementation (engaging patients and teams). Reimbursement barriers included documentation to optimize billing; reimbursement of multi-disciplinary team members, remote monitoring, and telephone-only telehealth; and lower volume of patients.A number of factors are associated with successful implementation and reimbursement of telehealth. Future efforts should provide guidance and incentives that support telehealth delivery and infrastructure, share best practices across CF programs, and remove barriers.

Novel therapies have dramatically changed cystic fibrosis (CF) and innovative care delivery systems are needed to meet future patient needs. Telehealth has been shown to be an efficient and desirable form of care delivery. The COVID-19 pandemic caused a rapid shift to telehealth, and this presented a unique opportunity to study facilitators, barriers, and satisfaction with this mode of care delivery. We aim to report survey methods, demographics and telehealth use among CF care programs, patients, and families during the pandemic.CF programs completed two surveys between July 29 and September 18, 2020, and between April 19 and May 19, 2021. Patients and families completed a similar survey between August 31 and October 30, 2020. The surveys addressed topics assessing the pandemic's financial impact, telehealth modes and experiences, licensure and reimbursement issues, health screening, and remote monitoring. Quantitative data were analyzed with descriptive statistics and were compared to the CF Foundation Patient Registry.Most programs (278 at timepoint one and 274 at timepoint two) provided telehealth during the pandemic. The percent of visits containing either telephone or video components changed from 45% to 25% over the time periods. Additionally, 424 patients and families from various ages and backgrounds responded to the survey and 81% reported having a telehealth visit.The pandemic accelerated telehealth adoption and these datasets are a valuable source for exploring telehealth barriers and facilitators, the quality-of-care experience, financial and workforce implications, the impact on underrepresented populations, and implications for coverage and reimbursement.

South Africa is a multicultural society characterised by a rich diversity of languages. As a result, many healthcare providers and their patients often do not speak the same language, which makes communication challenging. The language barriers, when present, require an interpreter to ensure accurate and effective communication between the parties. In addition to assisting in a clear exchange of information, a trained medical interpreter also acts as a cultural liaison. This is especially true when the provider and the patient come from different cultural backgrounds. Based on the patient’s needs, preferences, and available resources, clinicians should select and engage with the most appropriate interpreter. The effective use of an interpreter requires knowledge and skill. Patients and healthcare providers can benefit from several specific behaviours during interpreter-mediated consultations. This review article provides practical tips on when and how to use an interpreter effectively during clinical encounters in primary healthcare settings in South Africa.

Māszinības Veselības aprūpe Nursing Studies Health Care Bakalaura darba tēma ir „Komunikāciju traucējošie faktori starp māsām un pacientiem internā profila nodaļās”. Bakalaura darba tēmas aktualitāti nosaka tas, ka māsas un pacienta komunikācija internā profila nodaļās ir nepārtraukts, mainīgs, diādisks process, kas ietver verbālās un neverbālās informācijas, vajadzību un jūtu apmaiņu. Sarežģīta vai neveiksmīga komunikācija ir būtisks kļūdu cēlonis un var radīt sekas, kas ietekmē pacientu aprūpes nodrošināšanu internā profila nodaļās. Bakalaura darba mērķis: noskaidrot māsu un pacientu komunikāciju traucējošos faktorus internā profila nodaļās. Veiktais pētījums kopumā ļauj secināt, ka izvirzīta hipotēze: „komunikāciju starp māsām un internā profila nodaļu pacientiem vairāk ietekmē māsu darba slodze”, neapstiprinājusies. Komunikāciju starp māsām un internā profila nodaļu pacientiem vairāk ietekmē ar vidi saistītie faktori. Bakalaura darbā ir 8 tabulas, izmantots 69 literatūras avots. Darba apjoms bez pielikumiem ir 34 lapaspuses, pielikumi 7 lapaspuses. The topic of the bachelor's thesis is "Factors interfering with communication between nurses and patients in internal profile departaments". The topicality of the subject of the bachelor's work is determined by the fact that the communication between the nurse and the patient in the departments of the internal profile is a continuous, changing, dyadic process, which includes the exchange of verbal and non-verbal information, needs and feelings. Difficult or unsuccessful communication is a major cause of errors and can have consequences that affect the provision of patient care in internal departments. The aim of the bachelor's thesis: to find out the factors interfering with the communication between nurses and patients in internal profile departaments. The conducted research allows us to conclude that the hypothesis put forward: "the communication between nurses and the patients of the internal profile department is more influenced by the nurses' workload", has not been confirmed. Communication between nurses and internal profile department patients is more influenced by environmental factors. The bachelor thesis has 8 tables, 69 literature sources are used. The volume of work without appendix is 34 pages, appendix are 7 pages.

Background: Refugees and migrants face suboptimal involvement in spaces for primary healthcare decision‐making. Given the rising numbers of resettled refugees and migrants in primary care settings in the United States, there is an urgent need for patient‐centred outcome research in practice‐based research networks (PBRNs) with diverse ethnolinguistic communities. This study explored whether researchers, clinicians and patients would achieve consensus on (1) a common set of clinical problems that were applicable across a PBRN and (2) potential clinical interventions to address those problems to inform a patient‐centred outcomes research (PCOR) study in a similar research network. Methods: In this qualitative participatory health research study, patients from diverse ethnolinguistic communities and clinicians from seven practices in a US PBRN discussed preferences for PCOR responsive to patients and the clinicians who serve them in language‐discordant settings. Researchers and an advisory panel that included patients and clinicians from each participating practice held regular advisory meetings to monitor progress on project milestones and solve emerging problems. Participants took part in 10 sessions using Participatory Learning in Action and the World Café methods to identify and prioritise their ideas, using questions set for them by the advisory panel. Data were analysed based on principles of qualitative thematic content analysis. Results: Participants identified common barriers in language‐discordant healthcare settings, principally patient‐clinician communication barriers and suggestions to overcome these barriers. A key finding was an unanticipated consensus about the need for attention to healthcare processes rather than a clinical research priority. Negotiation with research funders enabled further analysis of potential interventions for care processes to improve communication and shared decision‐making in consultations and the practice as a whole. Conclusion: PCOR studies should examine interventions for improving communication between patients from diverse ethnolinguistic communities and primary care staff if the sorts of harms experienced by patients experiencing language‐discordant healthcare are to be reduced or prevented. Flexibility and responsiveness from funders to unanticipated findings are key structural supports for participatory health research in primary care clinical settings with this population and others who experience marginalisation and exclusion. Patient or Public Contribution: Patients and clinicians participated in the study both in the formulation of the study question, data collection, analysis and dissemination of these results; consented to their individual participation; and reviewed early drafts of the manuscript.

RESUMO Objetivo O objetivo deste estudo foi obter a visão do fonoaudiólogo brasileiro a respeito da utilização da mentira terapêutica como estratégia de comunicação no manejo de pacientes com demência. Método Trata-se de uma pesquisa quantitativa e qualitativa, transversal, de caráter descritivo. A coleta de dados foi realizada de modo online através de um questionário contendo questões de múltipla escolha e resposta aberta. Resultados Os resultados quantitativos indicaram que a maioria dos fonoaudiólogos já fizeram uso da estratégia e desejam aprender mais sobre, julgando a técnica como relativamente válida, ética e adequada. Os dados qualitativos indicaram os motivos para o uso da técnica, sendo estes: tranquilizar o paciente em situação de agitação; estimular o engajamento na terapia; evitar estresse relacionado à perda de memória; manejar dificuldade ou recusa alimentar; manejar dificuldade ou recusa ao tratamento medicamentoso; evitar que paciente evada o local; manejar situações de delírio, confusão e/ou paranoia; garantir a segurança; e quando outras estratégias não funcionam. Conclusão A maioria dos fonoaudiólogos brasileiros utilizam a mentira terapêutica em sua prática clínica e o fazem levando em consideração o benefício da pessoa com demência, embora reconheçam a falta de conhecimento e preparo acerca do assunto. Consideraram essa estratégia de comunicação relativamente ética, válida e adequada. O artigo chama atenção para a necessidade de formação e de recomendações sobre o uso da mentira terapêutica entre pessoas com demência pelos fonoaudiólogos. ABSTRACT Purpose The objective of this research was to obtain the speech and language therapists’ point of view about the use of therapeutic lying as a communication strategy in dementia care. Methods The present research was a quantitative, qualitative, and descriptive cross-sectional study. Data was collected through an online survey with multiple choices and open answer questions. Results The quantitative results indicated that the majority of the speech and language therapists have already used therapeutic lying as a communicative strategy and wish to learn more about it, considering the technique as relatively valid, ethical and adequate. The qualitative results indicated the reasons for the usage of the technique: to reassure the patient in case of agitation; to encourage engagement in therapy; to avoid stress-related to memory loss; to manage difficulty or refusal to eat; to manage difficulty or refusal for drug treatment; to prevent patients from leaving the building; to manage delirium, confusion and/or paranoia; to ensure safety; and for use when other strategies do not work. Conclusion The majority of speech and language therapists use therapeutic lying in their clinical practice, taking into consideration the best interest of the person with dementia, although professionals recognize their lack of knowledge on the subject. They have considered the communication strategy as relatively ethical, valid and adequate. The article calls attention to the necessity of education and guidelines for speech and language therapists in the use of therapeutic lying among people with dementia.

This bachelor thesis is devoted to communication between a patient and a nurse during the collection of biological material. Aims of the thesis: To explore communication barriers from the nurses' side during biological material collection. To learn about the patients' experience with communication techniques used by nurses during the selected biological material collections. To find out which communication techniques are used by nurses during the collection of biological material. Methodology and research population: For the fulfillment of set goals, a qualitative research in the form of semi-structured interviews aided with observation was implemented. The interview-based data were then analysed using open coding and Pen-and-Paper method (PAPI). The research population consisted of 11 nurses and 6 patients from hospitals in the South Bohemian Region and Vysočina Region. The research was carried out from February to March 2023. The criteria for the selection of nurses for our research was the execution of collecting biological material as part of their work at the selected workplace. The minimal experience of the nurses was 5 years for interviews and 2 years for observations. The patients were to undergo a selected biological material collection. Three categories and six sub-categories were found during the data analysis. Results: The research through observation showed us that many nurses communicate with patients professionally and adequately but some nurses omit or unsuitably use certain elements of verbal and non-verbal communication. Those include inappropriate addressing, violation of hygienic guidelines, lack of patient identification or failure to divert attention during procedures. Of course, no communication with the patient throughout the material collection is easy and comes with many barriers, be it language, space, misunderstanding, patient's unwellness or staff shortage at the workplace. Patients' experience with positive and negative attitude of the nurses varies in each facility. The results of the interviews revealed that smiling, eye to eye contact, empathy, attention diversion or verbal communication during material collection are essential for the patients. Recommendations for practice: The results of this work can be used as study material or guidance for nurses already working in the healthcare sector, but also for non-medical students. This will enable nurses to develop patient-centred communication skills that are essential for the provision of quality nursing care.

The often-invisible access barriers to public transport encountered by people with communication disabilities, who have sensory, language or cognitive impairments have gained little attention. This study investigated the experiences of people with communication disabilities on a rail network in Victoria, Australia to identify the barriers they encountered.Twenty-one passengers with communication disabilities participated in either an individual interview or a focus group. They talked about their experiences of train travel, factors that made travelling difficult and suggestions for making travelling easier. A six-phase approach to thematic analysis was conducted to identify themes.The difficulties identified in travelling fell into three themes: (a) variable accessibility of information, (b) negative impact of a large and complex service system, and (c) an uncertain culture of help seeking and giving. Only two passengers had ever complained but all identified ways to improve the service. They suggested, better staff training, more use of communication tools, mechanisms to enable passengers to seek help, and attention to making information easier to understand.For transport to be accessible to people with communication disabilities many different types of adjustment are required. Using multiple modes of communication with attention to understandability and consistent responses from public contact staff skilled to interact in multiple ways, may be the most flexible and effective means of responding to difficulties posed by the complex and unpredictable nature of train services. Implications for Rehabilitation People with communication disabilities are a diverse group which includes people with physical, sensory, speech, language, and cognitive impairments. Public transport services need to provide a range of communication adjustments to enable people with communication disabilities to travel successfully. Transport services must retain and refine accessible alternatives to online information and booking systems for people with cognitive impairments to avoid widening the digital divide. Frequent and unavoidable changes to train services mean that skilled public contact staff, access to information and a culture of help seeking and giving are particularly important in facilitating access for people with communication disabilities.

In global, multinational or multicultural organizations, cross-cultural communication barriers can have a significant effect on the efficiency of organizational communication. Communication barriers can consequently lead to conflicts within organization, the creation of various power groups, misunderstandings with stakeholders and profit loss. The aim of this paper is to present how language differences, nonverbal misinterpretations, assumption of similarity, preconceptions and stereotypes, tendency to evaluate and high anxiety affect managers and employees in cross-cultural context. Developing intercultural competences is regarded as the solution to overcoming the abovementioned barriers, and the role of education, emotional intelligence and the development of reliable digital tools is emphasized., U globalnim, multinacionalnim ili multikulturalnim organizacijama, međukulturalne komunikacijske barijere mogu imati značajan učinak na učinkovitost organizacijske komunikacije. Komunikacijske barijere posljedično mogu dovesti do sukoba unutar organizacije, stvaranja različitih grupa moći, nesporazuma s dionicima i gubitka dobiti. Cilj ovog rada je prikazati kako razlike u jeziku odnosno verbalnoj komunikaciji, pogrešne interpretacije neverbalne komunikacije, pretpostavke sličnosti, predrasude i stereotipi, sklonost procjeni i visoka anksioznost utječu na menadžere i zaposlenike u međukulturalnom kontekstu. Razvijanje interkulturalnih kompetencija smatra se rješenjem za prevladavanje navedenih prepreka, a ističe se uloga obrazovanja, emocionalne inteligencije i razvoja pouzdanih digitalnih alata.

The article was submitted on 13.11.2022. Проблемное поле статьи определяется рассмотрением механизмов моделирования и считывания кодов языковой игры в аспекте их эмоционально-оценочного (в том числе негативного) воздействия на сознание личности. Материалом анализа является выборка игровых эргономинаций г. Екатеринбурга, представленная объектами самого разного назначения. В качестве теоретического постулата принимается положение о сложной поликодовой (многомодальной) природе человеческих эмоций, что определяет необхдимость комплексного (собственно лингвистического, психологического и психолингвистического) подхода к анализу дискурсивных практик речевой деятельности. В фокусе внимания находится феномен языковой игры, понимаемый как особая форма лингвокреативного мышления, основанного на ассоциативных механизмах ломки и переключения стереотипов восприятия, порождения, употребления вербальных знаков. Декодирование интенции номинатора – адресанта игремы – предполагает опознание реципиентом лежащего в ее основе прототипа и приема его трансформации. С этой точки зрения дешифровка игровых эргонимов предстает как рефлексивный акт, в котором проявляются эмоционально-оценочные проекции их восприятия. В свете лингвистической техники различаются эргонимические лингвокреатемы, акцентирующие в названии эмоционально-оценочный заряд соответствующих узуальных мотиваторов, и собственно игровые эргонимы, эффект которых связан с использованием конструктивных принципов ассоциативной провокации, ассоциативного отождествления, ассоциативной выводимости и ассоциативного наложения. Эргонимические игремы и лингвокреатемы, соответственно, рассматриваются в свете прагматических установок и эмоционально-оценочных векторов влияния на сознание разных групп городского социума. Предметом специального анализа становится эмоционально-оценочный негатив как запланированная или не запланированная номинатором реакция на игровой эргоним или эргонимическую лингвокреатему. Примерами первого типа являются провокативные эргонимы, намеренно вызывающие эффект эмоционального шока (при первичном восприятии); второй тип игровых эргонимов и лингвокреатем не предполагает негативной реакции адресата, однако их восприятие наталкивается на коммуникативные барьеры – собственно языковые, социальные, ролевые, психологические, мировоззренческие, эстетические и т. п. Для верификации удачности/неудачности, креативности/некреативности, положительной или негативной оценки соответствующих номинаций к анализу привлекаются данные психолингвистических экспериментов, проведенных путем анкетирования рандомной выборки респондентов из числа городских жителей разного пола и возраста, социального и профессионального статуса. Делается вывод относительно зон эмоционального негатива в игровом эргонимическом континууме и намечается перспектива углубленного экспериментального исследования психологической реальности восприятия номинаций данного рода в опоре на показания обыденного сознания носителей городской культуры. The problem field of this article lies in the examination of the mechanisms of modelling and reading the codes of language game in the aspect of their emotional and evaluative impact (including negative) on an individual’s consciousness. The author refers to game nominations of different objects in Yekaterinburg. She proceeds from the theoretical provisions on the complex polycode (multimodal) nature of human emotions, which determines the need for a comprehensive (linguistic, psychological, and psycholinguistic) approach to the analysis of discursive practices of speech activity. The author focuses on the phenomenon of language game understood as a form of lingua-creative thinking based on associative mechanisms of destruction and switching of perception stereotypes, modelling, and using verbal signs. The decoding of the linguistic game unit involves the identification of its prototype and the awareness of a special linguistic technique for its transformation. From this point of view, decoding game ergonyms appears as a reflexive act in which emotional and evaluative projections of their perception manifest themselves. In the light of linguistic technique, the author distinguishes ergonymic linguistic createmes emphasising the emotional and evaluative charge of the motivators used, and game ergonyms modelled using the principles of associative provocation, associative identification, associative derivability, and associative overlay. The article considers ergonymic game units and linguistic createmes, respectively, in the light of pragmatic attitudes and emotional-evaluative vectors of influence on the consciousness of various urban population groups. Additionally, the author pays special attention to emotional-evaluative negative attitudes as planned or unplanned reactions of the nominee to the game ergonym or ergonymic linguistic createmes. Examples of the first type are provocative ergonyms that intentionally cause emotional shock (at primary perception); the second type of game ergonyms and ergonymic linguistic createmes does not imply a negative reaction of the addressee, but their perception encounters communicative barriers – linguistic, social, role-playing, psychological, ideological, aesthetic, etc. To check the positive or negative assessment of the respective nominations, the analysis uses data from psycholinguistic experiments conducted by the author by interviewing random respondents of different gender and age and social and professional status among urban residents. Finally, the author makes a conclusion regarding the zones of negative emotions in the game ergonymic continuum and outlines the prospects of an in-depth experimental study of the psychological reality of the perception of such nominations by bearers of urban culture. Исследование выполнено при финансовой поддержке Российского научного фонда и Правительства Свердловской области, грант № 22–28–20075.

Background The Covid-19 pandemic and associated visiting restrictions have challenged communication with others for older people residing in nursing homes. Aim The aim of this study was to explore residents’ experiences of encounters and communication with staff and relatives and friends during the Covid-19 pandemic. Design An exploratory study with an inductive approach. Methods Semi-structured telephone interviews with 16 Swedish nursing home residents were conducted. Data were analyzed using qualitative content analysis; the study reports according to the COREQ checklist. Results Three main categories emerged: (1) Mixed feelings and experiences of encounters with nursing staff, (2) Adapting to hampered communication and finding strategies to overcome language barriers, and (3) Facing pandemic restrictions and living an adjusted life. Nine subcategories are reported within these categories. Residents mainly reported good encounters with staff and receiving the care they needed, but unhelpful encounters were also reported. To manage communication with staff with limited Swedish language skills, residents developed several strategies. During the visiting ban, residents felt secure but also lonely. Staying connected with the outside world required residents to use the phone and handle other digital aids, such as video calls, but lack of technical skills among staff hindered frequent use of video calls. Conclusion This study highlights how residents can feel safe in extreme situations, but increased competence, including digital literacy and language skills, among staff is required. Care providers should provide relevant information to residents and staff and employ competent staff. Findings indicate that communication plans need to include enabling communication for residents both within and outside nursing homes, taking staff language skills into consideration.

The objective was to identify the consequences of restrictions and security measures on the deaf community, as well as communication limitations and discuss the psychological impacts due to the pandemic context of COVID-19 in this community. This work is a bibliographic study with a qualitative, descriptive and exploratory approach, of the integrative literature review type, carried out through a search in the VHL and PUBMED databases, including works published in the last 5 years and that had been carried out with the theme addressed, excluding paid, incomplete or duplicate studies. The use of a face mask harmed the community both in terms of communication and the inability to read lips, and accessibility to information about pandemic care proved precarious and inaccessible, as well as the incipient scientific production on psychological aspects in the deaf community has been identified. Communication barriers and social isolation during the pandemic proved to be harmful for the deaf, mainly due to the need to wear a mask and the lack of knowledge of sign language by professionals working in the health area. Therefore, there is a need for continuing education aimed at teaching sign language, health professionals and the hearing population, in addition to adapting news and communication platforms that can use subtitles and interpreters. El objetivo fue identificar las consecuencias de las restricciones y medidas de seguridad en la comunidad sorda, así como las limitaciones de comunicación y discutir los impactos psicológicos debido al contexto de pandemia de COVID-19 en esta comunidad. El presente trabajo es un estudio bibliográfico con enfoque cualitativo, descriptivo y exploratorio, del tipo revisión integradora de literatura, realizado a través de una búsqueda en las bases de datos de la BVS y PUBMED, incluyendo trabajos publicados en los últimos 5 años y que habían sido realizados con el tema abordado, excluyendo estudios pagados, incompletos y duplicados. El uso de cubrebocas perjudicó a la comunidad tanto en la comunicación como en la imposibilidad de leer los labios, y la accesibilidad a la información sobre la atención de la pandemia resultó precaria e inaccesible, así como se ha identificado la incipiente producción científica sobre aspectos psicológicos en la comunidad sorda. Las barreras de comunicación y el aislamiento social durante la pandemia resultaron perjudiciales para los sordos, principalmente por la necesidad de uso de mascarilla y el desconocimiento de la lengua de señas por parte de los profesionales que actúan en el área de la salud. Por lo tanto, existe la necesidad de una educación continua dirigida a la enseñanza de la lengua de signos, a los profesionales de la salud y a la población oyente, además de adecuar las plataformas de noticias y comunicación que puedan utilizar subtítulos e intérpretes. Objetivou-se identificar as consequências das restrições e medidas de segurança sobre a comunidade surda, bem como as limitações de comunicação e discutir os impactos psicológicos devido contexto pandêmico de COVID-19 nesta comunidade. O presente trabalho trata-se de um estudo bibliográfico com abordagem qualitativa, descritiva e exploratória, do tipo revisão integrativa de literatura, realizada através de busca nas bases BVS e PUBMED, incluindo trabalhos publicados no período dos últimos 5 anos e que tivesse realização com a temática abordada, excluindo os estudos pagos, incompletos ou duplicados. O uso de máscara facial prejudicou a comunidade tanto na forma de comunicação quanto na incapacidade de leitura labial, e a acessibilidade a informação sobre os cuidados da pandemia se mostrou precária e inacessível, assim como a incipiência da produção científica sobre os aspectos psicológicos na comunidade surda foi identificada. As barreiras de comunicação e o isolamento social durante a pandemia se mostraram prejudiciais para os surdos, principalmente devido à necessidade do uso de máscara e ao desconhecimento da língua de sinais por parte dos profissionais atuantes na área da saúde. Portanto, salienta-se a necessidade da educação continuada voltada ao ensino de língua de sinais, aos profissionais de saúde e a população ouvinte, além da adaptação das plataformas de veiculação de notícias e comunicação que podem utilizar legendas e intérpretes.

Introduction The Haemophilia Experiences, Results and Opportunities (HERO) Study identified sexual health as an important psychosocial issue affecting people with haemophilia (PWH) worldwide. However, sexual health is inadequately addressed at haemophilia treatment centres (HTCs), because PWH and healthcare professionals (HCPs) experience barriers to broaching the subject. There is a clear need for HCP training to support communication in this area and improve comprehensive care. Aim The Sexual Health: Strategies for Effective Communication pilot programme was trialled in Canada to assess HCP readiness and ability to discuss sexual health issues with PWH and test communication tools to facilitate these conversations. Methods The pilot programme consisted of two 3-h sessions attended by seven HCPs from Calgary's Alberta Children's and Foothills Hospitals. The sessions included lectures and case scenarios and explained the check-in-affirm-clarify-answer and head-heart-body tools designed by the Centre for Sexuality to aid communication. The pilot was evaluated through discussions and an online questionnaire. Results The pilot was well received by all HCP participants. Questionnaire data showed improvements in participants' knowledge, skills and comfort level in conducting sexual health discussions. Greatest improvements were noted in knowledge (100% 'good' or 'excellent' after the pilot, compared with 29% beforehand). Importantly, 86% felt that the material presented would be applicable in clinical practice. Conclusion The Canadian pilot demonstrated the effectiveness of the proposed educational programme. The underlying principles could be adapted to similar programmes for other HTCs to facilitate sexual health discussions.