Influence of English proficiency on patient-provider communication and shared decision-making

Background: The number of patients in the United States (US) who speak a language other than English is increasing. We evaluated the impact of English proficiency on self-reported patient-provider communication and shared decision-making. Methods: The 2013-2014 Medical Expenditure Panel Survey database was utilized to identify respondents who spoke a language other than English. Patient-provider communication (PPC) and shared decision making (SDM) scores from 4-12 were categorized as "poor" (4-7), "average" (8-11), and "optimal." The relationship between PPC, SDM, and English proficiency was analyzed. Results: Among 13,880 respondents, most were white (n=10,281, 75%), age 18-39 (n=6,677, 48%), male (n=7,275, 52%), middle income (n=4,125, 30%), and born outside of the US (n=9,125, 65%). English proficiency was rated as "very well" (n=7,221, 52%), "well" (n=2,378, 17%), "not well" (n=2,820, 20%), or "not at all" (n=1,463, 10%). On multivariable analysis, patients who rated their English as "well" (OR 1.73, 95% CI 1.37-2.18) or "not well" (OR 1.53, 95% CI 1.10-2.14) were more likely to report "poor" PPC (both P<.01). Similarly, SDM was more commonly self-reported as "poor" among patients who reported English proficiency as "not well" (OR 1.31, 95% CI 1.04-1.65, P=.02). Conclusion: Decreased English proficiency was associated with worse self-reported patient-provider communication and shared decision-making. Attention to patients' language needs is critical to patient satisfaction and improved perception of care. (C) 2018 Elsevier Inc. All rights reserved.