The impact of language discordance on genetic counselors' ability to establish a working alliance with patients

We explored the impact of language discordance (LD) on quality of care by asking genetic counselors (GCs) about their perception of how their lack of proficiency in a patient's language affects their sessions. We hypothesized that contracting, which relies on ongoing, bidirectional communication between GC and patient, is particularly vulnerable to LD. Specifically, we evaluated the impact of dialogue engagement (whether GCs ranked dialogue as more one-sided/rigid or more interactive/conversational), time sufficiency (how adequate the GCs ranked the time allotted for the session), and interpreter-related factors (experience and relationship with interpreters; perceived ability and knowledge of how to work with interpreters) on GCs' perceived ability to contract in LD sessions. Forty-five GCs recruited from the NSGC listserv completed a 42-item survey exploring these topics through reflection on their most recent LD and language concordant (LC) sessions. The outcome measure of "perceived contracting success" was defined based on five practice-based competencies. Results were analyzed using Wilcoxon signed ranks tests and linear regressions and found that GCs' perceived (1) contracting success, (2) dialogue engagement, and (3) time sufficiency were significantly lower in LD sessions (p < 0.001 for all 3). Perceived contracting success in LD sessions had a positive relationship with both perceived dialogue engagement and perceived time sufficiency (r² = 0.312, 0.103). Also, perceived dialogue engagement increased with higher perceived time sufficiency and trust in the interpreter (r² = 0.235, 0.27). Our study is the first to quantitatively explore factors impacting perceived contracting success in LD GC sessions and suggests that LD may hinder communication and session tailoring. This highlights the importance of GCs being more intentional about having interactive dialogue with patients in LD sessions, considering allotting more time for LD sessions, and meeting with the interpreter prior to LD sessions to establish a trusting relationship.