In the United States, Hispanics with limited English proficiency (LEP) experience disproportionate disparities in health services, a phenomenon that relates to communication and decision making. After a quality improvement review identified a disparity in obstetric services for Hispanic women with LEP, a pilot study discussed here explored how LEP and the presence of a medical interpreter affected shared decision making in comparisons of monolingual (English) and bilingual (English-Spanish) encounters with the same physician. A series of 16 prenatal encounters between physicians, patients, and medical interpreters were recorded. First, medical visits were recorded with eight Spanish-speaking mothers using a hospital interpreter to speak with their physician. The same physician was then recorded discussing a similar prenatal agenda with a primary language English-speaking patient. Discourse analysis was used to categorize discursive practices in social interaction. Both encounters were rated using the OPTION shared decision-making scale. Results portray how shared decision making shifts in second-language situations and the associated practices that distinguish monolingual and bilingual encounters. Examples of discursive practices suggest strategies that may mark ethnolinguistic identity and membership categorization indirectly during health encounters.
Cancer Counseling of Low-Income Limited English Proficient Latina Women Using Medical Interpreters: Implications for Shared Decision-Making
