How to assess a patient with a language barrier preoperatively?

From the Guidelines

When assessing a patient with a language barrier preoperatively, it is essential to use a medical interpreter rather than a family interpreter to ensure effective communication. This approach is supported by the American Society of Clinical Oncology consensus guideline 1, which strongly recommends using a medical interpreter for families who do not share a common language with the clinician.

Key Considerations

• Using a medical interpreter helps to prevent miscommunication and ensures that the patient receives accurate medical information.
• Family members may inadvertently filter or modify information, which can compromise patient autonomy and confidentiality.
• A medical interpreter can be arranged either in person or through a telephone/video service, making it a feasible option for preoperative assessments.

Best Practices

• Focus on the most important points and use plain language when communicating with patients with low health literacy 1.
• Use pictographs or other visual aids when available to help patients with low health numeracy understand absolute risk rather than relative risk 1.
• Ensure that the patient completes all required preoperative testing to assess surgical risk and provide informed consent. By prioritizing effective communication and using a medical interpreter, healthcare providers can ensure that patients with language barriers receive high-quality care and make informed decisions about their treatment.

From the Research

Assessing Patients with Language Barriers Preoperatively

There are no research papers provided that directly address assessing patients with language barriers preoperatively. However, the following general preoperative assessment criteria can be considered:

• Preoperative assessment criteria include evaluating the patient's American Society of Anesthesiology status, anxiety level, food and drugs to which he or she may be allergic, and skin integrity 2
• Obtaining a medical and surgical history and consent, reviewing laboratory, electrocardiogram, and radiological results, and performing preoperative teaching are also important aspects of preoperative care 2
• Identifying preoperative factors that can predict difficult surgeries, such as history of acute cholecystitis, gall bladder wall thickness, and contracted gall bladder, can help surgeons plan the operation and counsel patients accordingly 3, 4

Preoperative Prediction of Difficult Surgeries

Several studies have developed scoring systems to predict difficult laparoscopic cholecystectomies preoperatively, including:

• A study that found 154 patients with significant factors such as history of hospitalization for acute cholecystitis, body mass index of 25 kg/m2 and more, abdominal scar, palpable GB, GB wall thickness ≥4 mm, pericholecystic collection, and impacted stone to predict difficult LC preoperatively 3
• A study that developed a scoring system using history, physical examination, abdominal ultrasound, and biochemical parameters to predict difficult LC, with a sensitivity of 53.8% and specificity of 89.2% 4
• A study that identified preoperative factors such as duration of acute attack, ultrasound showing largest gallstone size, ultrasound showing gallstone impaction in Hartmann's pouch, history of prior episode(s) of acute attack, and diabetes mellitus as significant predictors of difficult early laparoscopic cholecystectomy among patients with acute calculous cholecystitis 5

Preoperative Care and Patient Teaching

Preoperative care and patient teaching are crucial aspects of preparing patients for surgery, including:

• Providing patient information and conducting preoperative tests and clinical assessments during outpatient appointments 6
• Educating patients on preoperative and postoperative care, such as which medications to take or withhold, when to withhold food and fluids, and catheter care and dressing changes 2