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

摘要 患者、口译员和提供者之间的沟通差异导致了健康差异， 特别是对于英语水平有限的美国人群（LEP;定义为无法阅读，书写或阅读）。 （英语：in the context of pain）目前，没有患者-翻译-提供者疼痛沟通 存在解决LEP患者疼痛报告中的文化和语言障碍的干预措施。我的职业目标是 建立一个独立的以病人为导向的研究计划，重点是设计，实施， 测试信息可视化（InfoViz）工具，以改善LEP患者之间的症状沟通， 口译员和提供者，其目标是最终提高生活质量和减少健康差距。 这个K23奖将为我提供（1）InfoViz评估，（2）症状（疼痛）科学，（3） 干预研究，（4）专业发展，成功地过渡到一个独立的 调查员威斯康星大学麦迪逊分校的研究环境和跨学科 Kristine Kwekkeboom博士（疼痛和症状管理，干预研究）， Suzanne Bakken（信息可视化评估），Toby坎贝尔（患者-提供者沟通）， 罗杰布朗（统计方法）和大卫拉戈（疼痛，初级保健），提供了一个特殊的科学 环境和指导。其目的是修改和进行试点测试的定制疼痛评估 InfoViz工具，用于促进患者-口译员-提供者三方就疼痛严重程度、位置和质量进行沟通， 在疼痛评估过程中增加相互理解（MU）。LEP苗族将是本研究的重点 因为疼痛对这个群体来说特别成问题;他们用视觉隐喻来描述疼痛， 与提供者的知识不一致，口译员努力在 患者和供应商。这一创新的InfoViz工具将减少黑社会之间的文化和语言障碍 通过（1）消除患者理解医学语言的需要或要求提供者和口译员 分享苗族文化和语言;（2）减少口译所需的技能。的 具体目标是（1）通过参与式设计方法评估疼痛评估InfoViz工具， 苗族患者（n = 30）和口译员（n = 15）从社区;（2）试点疼痛评估 InfoViz工具在初级保健中的LEP苗族患者中，包括（2a）检查 实施该工具，（2b）探索疼痛严重程度、位置和质量的三重性MU的一致性，以及 (2c)评价选择的结局指标，以获取对沟通、疼痛缓解和疼痛的满意度 干扰和探索InfoViz工具概念框架中确定的变量。目标2将使用静态 组比较设计，从20名接受常规护理的患者收集数据（即，口译员使用口头 疼痛描述），然后在干预条件下从另外20名患者收集数据（即， 口译员使用口头描述和InfoViz工具）。结果将支持R 01疗效研究。

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.