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Patient Reported Outcomes in Non-English Speaking Patients Undergoing Emergency General Surgery
Pawan Mathew
*, Samantha Linhares, Kurt S. Schultz, Kevin Schuster
Surgery, Yale School of Medicine, New Haven, CT
Background: Emergency general surgery (EGS) often occurs in an unplanned setting, requiring rapid decision-making. Collecting and interpreting patient-reported outcome measures (PROMs) in this context may differ from elective surgery, particularly for non-English speaking patients who may face language barriers that may limit shared decision-making. Understanding these patients’ experiences is essential for developing inclusive and equitable PROMs.
Study Design: We conducted a qualitative study of non-English speaking patients who required a translator and underwent EGS procedures at an academic medical center between 2023 and 2024. Semi-structured interviews were conducted during the index hospitalization to explore their perioperative experiences and perspectives on decision-making. Each interview lasted approximately one hour. Interviews were recorded and then transcribed verbatim. Transcripts were analyzed by four individuals using thematic analysis to identify recurring patterns and concerns.
Results: Among 20 enrolled patients, 50% felt they had no choice but to proceed with emergency surgery. Overall, 80% (16/20) reported feeling either a lack of choice or that their decision-making was constrained by pain, with no statistically significant difference between males and females. Additionally, 30% (6/20) described unclear communication, while 30% (6/20) expressed confusion regarding the necessity of surgery. Dissatisfaction with translator services was reported in 30% (6/20) of patients of whom 67% (4/6) relied on alternative translation methods, such as family members or electronic devices. Patients dissatisfied with translator services did not differ in gender distribution from those who were satisfied but were significantly older, with a mean age of 71.2 years compared to 47.8 years among satisfied patients (p<0.05). These thematic findings were independent of clinical outcomes in this underpowered sample.
Conclusions: Non-English speaking EGS patients frequently report exclusion from decision-making, pain limiting decision making, and unclear communication. PROMs designed for this population should incorporate measures of patient autonomy, communication clarity, and satisfaction with language services, especially for older patients.
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