Visualizations to Improve Pain Communication Between Patients, Interpreters, and Providers

Pain Clinical Trial

Official title:

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

Clinical Trial Details — Status: Completed

Administrative data

• NCT number: NCT04975789
• Other study ID #: 2020-1256
• Secondary ID: A545000NUR/FACUL
• Status: Completed
• Phase: N/A
• Start date: October 7, 2021
• Est. completion date: February 23, 2023

Study information

• Verified date: June 2024
• Source: University of Wisconsin, Madison
• Contact: n/a
• Is FDA regulated: No
• Study type: Interventional

Clinical Trial Summary

The purpose of this study is to pilot test a pain assessment information visualization (InfoViz) tool to facilitate communication about pain severity, location, and quality to increase mutual understanding between patients with limited English proficiency (LEP), interpreters, and providers during pain assessment. 40 participants will be enrolled and can expect to be on study for up to 4 weeks.

Description:

The purpose of this study is to pilot test a pain assessment information visualization (InfoViz) tool to facilitate communication about pain severity, location, and quality to increase mutual understanding between patients with limited English proficiency (LEP), interpreters, and providers during pain assessment.

The investigators focus on the LEP Hmong because pain is particularly problematic for this group. The Hmong describe pain using visual metaphors that are inconsistent with providers' knowledge and interpreters struggle to translate metaphors accurately between patients and providers. The goals of the study are (1) to examine the feasibility of implementing the pain InfoViz tool, (2) to explore congruency of patient-interpreter-provider triads' mutual understanding (MU) of pain severity, location, and quality, and (3) to evaluate outcome measures selected to capture satisfaction with communication, pain relief, and pain interference with life and explore variables identified in the InfoViz tool conceptual framework (MU of pain assessment information, satisfaction with communication, pain diagnosis and treatment).

The investigators will first collect data from 20 participants under the usual care control condition (i.e., interpreters verbally interpreting and communicating pain descriptions), followed by data collection from another 20 participants under the intervention condition (i.e., interpreters using verbal descriptions and the InfoViz tool).

The investigators believe that the pain assessment InfoViz tool will increase mutual understanding of pain severity, location, and quality between patients, interpreters, and providers, and consequently lead to increased satisfaction with communication, greater pain relief and reduced pain interference with daily life through better-informed diagnosis and treatment.

Recruitment information / eligibility

• Status: Completed
• Enrollment: 61
• Est. completion date: February 23, 2023
• Est. primary completion date: January 6, 2023
• Accepts healthy volunteers: No
• Gender: All
• Age group: 13 Years and older

Eligibility

Inclusion Criteria:

• age 18 and up

• Hmong patients that indicate they do not speak English well (LEP)

• self reported pain

Exclusion Criteria:

• indicate that they speak English well

Interpreter Inclusion Criteria:

• 13 years old or greater

• self-identify as interpreting for a Hmong individual in the health care setting

Interpreter Exclusion Criteria:

• telephone interpreters as they are unable to view and use the InfoViz tool

Related Conditions & MeSH terms

• Communication
• Pain

Intervention

Other:
• InfoViz
The pain InfoViz tool is a two-page paper tool that consists of an explanation of how to use the tool in both Hmong and English, a culturally-appropriate Faces pain severity scale, pain body diagram, and 13 pain qualities in the form of icons representing each pain quality metaphor. The interpreter explains the instructions in Hmong, then marks the body areas corresponding to the location of pain reported by the participant, and marks the pain qualities expressed by the metaphors selected by the Hmong patient. In the clinic appointment, the interpreter communicates to the physician, in English, the pain location and qualities identified by the participant, using the medical terms identified on the InfoViz tool.

Locations

Country	Name	City	State
United States	Access Community Health Center	Madison	Wisconsin
United States	University of Wisconsin	Madison	Wisconsin

Sponsors (2)

Lead Sponsor	Collaborator
University of Wisconsin, Madison	National Institute of Nursing Research (NINR)

Country where clinical trial is conducted

United States, 

References & Publications (1)

Lor M, Li A, Brown R, Swedlund MP, Hawkins JG, Nolander ET, Chewning B. Improving pain communication between limited English-speaking Hmong patients, medical interpreters, and health care providers in primary care: A pilot study. Res Nurs Health. 2024 Jun — View Citation

Outcome

Type	Measure	Description	Time frame	Safety issue
Primary	Percentage of Eligible Patients Enrolled	Feasibility with respect to recruitment will be measured by the percent of eligible patients who enroll.	up to 1 day
Primary	Proportion of Patients Who Complete the Study	Feasibility with respect to retention will be measured by the proportion of patients who complete the study.	up to 4 weeks
Primary	Percentage of InfoViz Tools Completely Filled Out	Feasibility with respect to tool use will be measured as the proportion of InfoViz tools with pain severity marked, at least one pain location marked, and at least one pain quality marked on the InfoViz tool.	up to 1 day
Primary	Percentage of Items Correctly Performed on the Investigator Designed Fidelity Checklist	Feasibility will be in part measured by InfoViz tool fidelity. The percentage of items correctly performed by participants on the investigator-designed fidelity checklist will be reported.	up to 1 day
Primary	Percentage of Congruency in Mutual Understanding: Patient to Interpreter	One question item from the 6-item Mutual Understanding Scale (MUS) asks participants about their main symptom (i.e., "What was the most important health complaint for which the physician was visited?") and providers to report participants' main symptom (e.g., "What was the most important health complaint for which the patient consulted with you?"). The percentage of congruency between the patient and interpreter response, from 0-100 where 100 is total congruency.	up to 1 day
Primary	Percentage of Congruency in Mutual Understanding: Interpreter to Provider	One question item from the 6-item Mutual Understanding Scale (MUS) asks participants about their main symptom (i.e., "What was the most important health complaint for which the physician was visited?") and providers to report participants' main symptom (e.g., "What was the most important health complaint for which the patient consulted with you?"). The percentage of congruency between the interpreter and provider, from 0-100 where 100 is total congruency.	up to 1 day
Primary	Percentage of Congruency in Mutual Understanding: Patient to Provider	One question item from the 6-item Mutual Understanding Scale (MUS) asks participants about their main symptom (i.e., "What was the most important health complaint for which the physician was visited?") and providers to report participants' main symptom (e.g., "What was the most important health complaint for which the patient consulted with you?"). The percentage of congruency between patient and provider, from 0-100 where 100 is total congruency.	up to 1 day
Secondary	Participant Satisfaction With Communication Answer	Satisfaction with communication will be measured using one item, "Overall, how satisfied are you with your doctor's communication with you about pain?" with response categories of very satisfied, satisfied, neither satisfied nor dissatisfied, dissatisfied, or very dissatisfied. Mean score between 1-5, where 5 indicate higher satisfaction and 1 indicate very dissatisfaction, was calculated across participant groups (i.e., patient, interpreter, provider).	up to 1 day
Secondary	Participant Pain Relief Measured Using a 5 Point Verbal Rating Scale	Participants will be asked to rate the amount of pain relief experienced since the clinic visit using a 5-point Verbal Rating Scale: none, slight, moderate, lots, complete. A mean score between 1-5, where higher scores equal complete pain relief.	one time post 4-6 weeks after the clinic vist
Secondary	Participant Response to Pain Interference Question	One question item derived from the 12-Item Short-Form Health Survey, "During the past 4 weeks, how much did pain interfere with your normal work including both work outside the home and housework?" with response options: "not at all," "a little bit," "moderately," "quite a bit," or "extremely." The number of participants who responded to each condition will be reported. Mean score 1-5, where higher score indicates extreme pain interference, was calculated.	usual care participants assessed at baseline and InfoViz participants assessed at 4 weeks
Secondary	Quality of Communication Answer	Quality of communication will be measured using one item, "Overall, how would you rate this doctor's communication about pain with you? " with response items of excellent, very good, good, fair, or poor. Mean scores of 1 to 5, where higher number indicates excellent quality of communication, was calculated.	up to 1 day