Improving pain communication between limited English-speaking Hmong patients, medical interpreters, and health care providers in primary care: A pilot study.
Maichou Lor, Angie Li, Roger Brown and 4 others
PMID 38175545WHAT IT FOUND
A picture-based pain tool with Hmong patients and interpreters was feasible, but pain communication was mixed: severity information matched better, location information got worse, and this pilot does not prove it works.
Key findings
01In the intervention condition, which used an interpreter plus the InfoViz tool, all InfoViz tools were completed, but only 53% of pain location and pain quality sections and 35% of pain severity sections were completed according to instructions.
02Compared with usual care using an interpreter and verbal pain rating, the intervention condition using an interpreter plus the InfoViz tool showed 30% better patient-provider agreement about pain severity, while agreement about pain location was reported as 17.7% lower in one result and unchanged in another.
03Pain severity documentation was 11.11% in usual care with an interpreter and verbal pain rating, and 38.89% in the intervention group using an interpreter plus the InfoViz tool, with an approximately 28% increase reported.
STILL TO COME
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What it does not show
Only 36 visits were analysed, and the groups were not randomized, so the study is too small to show whether the tool works. Pain was not required to be the main reason for the visit; 27% of visits had a primary reason related to pain, with only 4 such visits in the intervention group. The tool was completed, but instructions were followed poorly: only 53% of location and quality sections and 35% of severity sections were completed as instructed. The paper gives contradictory results for pain location: one result says a 17.7% decrease in patient-provider mutual understanding, another says no change. Researchers were present during visits and recorded conversations, which may have changed how patients, interpreters, and providers communicated. Recruitment was affected by appointment cancellations and interpreter availability; patient retention was 81% and interpreter retention was 75%. Most interpreters said helping patients complete the tool was outside their usual role, and family helpers were present in over half of visits, so real-world use may differ. The sample was limited to Hmong patients in one primary care setting, so results may not apply to other languages, cultures, or clinics. Pain relief and interference were follow-up descriptive ratings, not outcomes of a controlled efficacy trial.
Declared interests
The supplied text states that the authors declared no conflicts of interest. It does not report a funding source.
The easy way to misread this
Do not conclude the InfoViz tool alone improves pain communication or pain relief. The intervention was an interpreter plus the InfoViz tool, so the tool's separate contribution cannot be isolated. It was a small non-randomized pilot with mixed mutual understanding results, low adherence to instructions, and pain was not always the main visit reason. The reported 30% severity improvement and higher pain relief scores are descriptive findings from 36 visits, not proof of benefit.