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， 尤其是对于英语水平有限的美国人群(LEP；定义为不能读、写或 说英语)，在痛苦的背景下。目前，没有患者-口译员-提供者之间的痛苦交流 在疼痛报告中，存在解决LEP患者文化和语言障碍的干预措施。我的职业目标是 建立独立的以患者为中心的研究计划，专注于设计、实施和 测试信息可视化(InfoViz)工具，以改善LEP患者之间的症状沟通， 口译员和服务提供者，目标是最终提高生活质量和减少健康差距。 这个K23奖项将为我提供(1)InfoViz评估，(2)症状(疼痛)科学，(3)高级技能 干预研究，以及(4)专业发展，成功过渡到独立的 调查员。威斯康星大学麦迪逊分校的研究环境和跨学科 指导团队包括Kristine Kwekkeom博士(疼痛和症状管理、干预研究)、 Suzanne Bakken(信息可视化评估)、Toby Campbell(患者-提供者交流)、 罗杰·布朗(统计学方法)和大卫·拉巴戈(疼痛、初级保健)提供了一种特殊的科学 环境和导师关系。其目的是修改并进行量身定制的疼痛评估的试点测试 InfoViz工具，方便患者-口译员-提供者三方就疼痛严重程度、位置和质量进行沟通 在疼痛评估期间增加相互了解(MU)。黎族将是这项研究的重点 因为疼痛对这一群体来说特别有问题；他们使用视觉隐喻来描述疼痛，这些隐喻 与提供者的知识不一致，口译员很难准确地在 患者和提供者。这一创新的InfoViz工具将减少三合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。这个 具体目标是(1)通过参与式设计方法评估疼痛评估InfoViz工具，45 来自社区的苗族患者(n=30)和口译员(n=15)；以及(2)试点疼痛评估 InfoViz工具在初级保健苗族LEP患者中的应用，包括(2a)，以检查以下项目的可行性 实施该工具，(2b)探索三合会的疼痛严重程度、位置和质量的MU的一致性，以及 (2C)评估为获取沟通满意度、疼痛缓解和疼痛而选择的结果衡量标准 干扰和探索在InfoViz工具概念框架中确定的变量。Aim 2将使用静态 分组比较设计，收集来自20名接受常规护理的患者的数据(即，口译员使用口头 疼痛描述)，然后从干预条件下的另外20名患者收集数据(即， 使用口头描述和InfoViz工具的口译员)。研究结果将支持R01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.