Effect of Spanish Language Concordant Care on Shared Decision-Making in Pediatric Otolaryngology.

Abstract

Shared decision-making allows patients and physicians to make choices together by incorporating clinical expertise and patient preference. We sought to describe preferences in medical decision-making and the degree of shared decision-making among Spanish-speaking caregivers receiving pediatric Otolaryngology care. We hypothesized that language-concordant encounters would have higher shared decision-making scores. Cross-sectional study of Spanish-speaking caregivers at a tertiary regional pediatric academic center undergoing consultation with pediatric otolaryngology (May 2022-February 2024). Care was provided in either a language-concordant setting or a language-discordant setting. Following patient encounters in which a decision was made, Spanish-speaking caregivers completed the Control Preferences Scale to determine their preferred roles in medical decision-making (active, active-collaborative, collaborative, passive-collaborative, or passive) and the Shared Decision-Making Questionnaire (scored 0-100) to assess perceived decision-making. Fisher's exact test, Kruskal-Wallis test, and the Mann-Whitney U test were used for analysis, as appropriate. One-hundred-fifty-six caregivers were enrolled. The mean age of the caregivers was 38.14 years (SD = 7.38) and most participants were mothers. The active-collaborative medical decision-making role was the most favored (41.4%) while 7.1% preferred a completely active and 14.3% a completely passive role. Language-concordant encounters had higher scores on the Shared Decision-Making Questionnaire (median [IQR]: 100 [88.89, 100.00]) than language-discordant encounters (median [IQR]: 94.44 [82.22, 100.00]; p = 0.003). More shared decision-making was observed among Spanish-speaking caregivers receiving language-concordant care compared to language-discordant care, many of whom preferred an active-collaborative decision-making style. Language-concordant care appears to facilitate an environment for shared decision-making to thrive during surgical consultation in pediatric otolaryngology. This is a level III study due to the cross-sectional design in conjunction with the use of validated tools and a focus on comparative analysis within the study population.