What Weighs into a Clinician's Decision to Request an Interpreter? A Discrete Choice Experiment.

BACKGROUND: When a patient and clinician do not speak the same language, the absence of language-concordant care necessitates professional interpretation to ensure safety. However, many clinicians proceed without a professional interpreter, often relying on informal interpreters such as family members or other methods, which may increase the risk of medical errors and incomplete communication. Understanding factors that influence interpreter use is necessary to improve language access. This study sought to quantify the trade-offs clinicians consider when deciding whether to request a professional medical interpreter for patients with non-English language preferences. METHODS: The authors conducted an electronic discrete choice experiment at a large urban academic medical center. Participants evaluated choice sets describing theoretical clinical encounters characterized by seven attributes. Data were analyzed using Hierarchical Bayesian modeling to estimate relative importances of attributes. RESULTS: Ninety-three clinicians (attending physicians, residents/fellows, nurse practitioners, and physician assistants) from various specialties (49.5% from Medicine) participated. The most important attribute driving clinicians' decision to request a professional medical interpreter was whether the patient's "English proficiency is good enough for the encounter" (27.1%), followed by clinical complexity of the encounter (19.4%) and having a bilingual family member present (18.8%). CONCLUSION: Decisions to request professional interpreters are primarily driven by clinicians' subjective perception of their patient's English proficiency, followed by the clinical complexity of the encounter and the availability of untrained or informal interpretation. Interventions should promote interpreters whenever patients report a non-English language preference and simplify interpreter access.