Caring for neurology patients across language differences: a qualitative comparison of interpreter, clinician, patient, and caregiver perspectives

To explore the perspectives of medical interpreters, clinicians, and patients/caregivers to better understand the experiences of patients with neurological illness and language preference other than English (LOE). Hybrid deductive-inductive thematic analysis of 20 interviews with interpreters (n=8), clinicians (n=6), and English and Spanish-speaking patients/caregivers (n=6). We identified multi-level themes at the Individual, Interpersonal, and Hospital System levels of the social ecological model. At the individual-level themes pertained to clinicians’ 1) adjustments according to patient’s neurological illness that challenged interpreter use (e.g., Parkinson’s disease and hypophonia) and 2) accommodations for educational level, linguistic skills, and culture that compounded challenges in neurological assessment, and 3) clinician and interpreter adjustment to caregiver/family members(s). Interpersonal level themes related to 4) preference for in-person interpretation for patients with neurological illness. And hospital level themes relating to 5) greater training on the overlap of neurological illness and interpretation. Cross-cutting across all levels was 6) need for greater implementation of existing best practices for interpreter use. This study highlights the need of better clinical and structural strategies to ensure equitable care for patients with LOE and neurological illness. Meeting the needs of patients with neurological illness and LOE will require multi-level interventions to promote their health communication and equity. This may include specialty-specific training for interpreters, clinician education on effective interpreter use, and broader system-level changes.