Information Visualization to Improve Pain Communication Between Providers, Interpreters, and Patients with Limited English Proficiency

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Abstract Communication differences between patients, interpreters, and providers contribute to health disparities, especially for U.S. populations with limited English proficiency (LEP; defined as being unable to read, write, or speak English), in the context of pain. Currently, no patient-interpreter-provider pain communication interventions exist to address LEP patient culture and language barriers in pain reporting. My career goal is to establish an independent patient-oriented research program that focuses on designing, implementing, and testing information visualization (InfoViz) tools to improve symptom communication among LEP patients, interpreters, and providers, with the goal of ultimately improving quality of life and reducing health disparities. This K23 award will provide me with advanced skills in (1) InfoViz evaluation, (2) symptoms (pain) science, (3) intervention research, and (4) professional development to successfully transition into an independent investigator. The research environment at the University of Wisconsin–Madison and the interdisciplinary mentoring team including Drs. Kristine Kwekkeboom (pain and symptom management, intervention research), Suzanne Bakken (information visualization evaluation), Toby Campbell (patient-provider communication), Roger Brown (statistical methods), and David Rabago (pain, primary care), provide an exceptional scientific environment and mentorship. The purpose is to modify and conduct a pilot test of a tailored pain assessment InfoViz tool to facilitate patient-interpreter-provider triad communication of pain severity, location, and quality to increase mutual understanding (MU) during pain assessment. LEP Hmong will be the focus of this study because pain is particularly problematic for this group; they describe pain using visual metaphors that are inconsistent with providers’ knowledge and interpreters struggle to translate metaphors accurately between patients and providers. This innovative InfoViz tool will reduce cultural and language barriers among the triad by (1) eliminating the need for patients to understand medical language or requiring providers and interpreters to share the Hmong culture and language and (2) reducing the amount of skill needed for interpreting. The specific aims are (1) to evaluate the pain assessment InfoViz tool via a participatory design approach with 45 Hmong patients (n = 30) and interpreters (n = 15) from the community; and (2) to pilot the pain assessment InfoViz tool among LEP Hmong patients in primary care including (2a) to examine the feasibility of implementing the tool, (2b) to explore congruency of the triads’ MU of pain severity, location, and quality, and (2c) to evaluate outcome measures selected to capture satisfaction with communication, pain relief, and pain interference and explore variables identified in the InfoViz tool conceptual framework. Aim 2 will use a static group comparison design, collecting data from 20 patients under the usual care (i.e., interpreters using verbal pain descriptions), followed by data collection from another 20 patients under the intervention condition (i.e., interpreters using verbal descriptions and the InfoViz tool). Findings will support an R01 efficacy study.