Back to 2025 Abstracts
The Impact of English Proficiency on Provider-Patient Communication and Immediate Breast Reconstruction Following Mastectomy
Khu Aten Maaneb de Macedo
*1, Alaina D. Geary
2, Jingtong Huang
3, Alison P. Woods
4, Julia Danford
5, Michael Cassidy
2, Christine D. Gunn
6, Frederick T. Drake
21General Surgery, Boston Medical Center, Boston, MA; 2Surgical Oncology, Boston Medical Center, Boston, MA; 3School of Medicine, Boston University Chobanian & Avedisian School of Medicine, Boston, MA; 4General Surgery, Beth Israel Deaconess Medical Center, Boston, MA; 5Anesthesia, Massachusetts General Hospital, Boston, MA; 6Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, Lebanon, NH
Background: Limited English proficiency (LEP) impacts over 25 million individuals in the US. Disparities in immediate breast reconstruction (IBR) after mastectomy exist among LEP patients, yet experiences remain poorly understood, with little patient-focused research. Effective communication is crucial for shared decision-making. We examined the impact of language on provider-patient communication, hypothesizing that LEP reduces effectiveness of counseling.
Study Design: We purposively sampled and interviewed 24 female mastectomy patients who were IBR candidates (2022-24), including LEP and English-proficient (EP) patients. Semi-structured interviews were conducted in each patient’s primary language, using interpreters as needed. Deductive and inductive coding were used to explore predetermined and emergent themes. Inter-rater reliability (Cohen’s ?) assessed consistency in coding.
Results: Of 24 patients, 16 underwent IBR (37%LEP) and 8 declined (75%LEP). Deductive coding revealed clarity and comprehension were coded positively in 60% of cases (18%LEP vs 81%EP). EP patients expressed mixed sentiments, ranging from "information was provided to make the best decision" to "the full picture of reconstruction wasn’t clear." LEP patients were mostly positive, stating, "they mentioned everything I needed.” Providers were coded as listening well by 72%. Negative responses, in ES and LEP patients without IBR, included "I didn’t feel understood, giving me uncertainty." All respondents stated that providers were available for questions, and 85% indicated comfort in asking questions. However, one LEP patient stated, "I didn’t feel comfortable, and stopped asking questions." Interpreter use was regarded negatively in 81% of cases. One patient stated, “language is a barrier; maybe you're not being understood. It gives you the fear that something different is going to be done.” Inductive coding revealed a need for more discussion of post-op processes, the impact of family/social support, and proactive communication. Regarding post-op processes, patients said, "I wasn’t prepared," and "what comes after needs discussion.” (?=0.01) Family/social support was positively referenced in 88% of responses, but one LEP participant who declined IBR noted her "decision would have been different if I had support.” (?=1) Proactive provider communication was helpful in 76% of cases. A LEP patient who chose IBR recalled, "She told me I shouldn’t be afraid [of implants]. When she said that, I said I’ll do it.” An EP patient said, "my surgeon actually called me.”
Conclusion: Observed disparities in postmastectomy IBR rates among LEP individuals may stem from multifaceted communication barriers (personal, social, and institutional). Many LEP patients reported that the use of an interpreter was a barrier. Our results highlight focus areas that could improve the effectiveness of counseling, such as an emphasis on post-operative expectations and exploring available support systems.
Back to 2025 Abstracts
