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Health Equity/Community Health

Poster Session 2

(509) Association of non-English primary language with patient decision quality regarding mode of delivery after cesarean

Tuesday, February 13, 2024

3:30 PM – 5:00 PM

Location: Prince George's Exhibit Hall CDE, Lower Atrium Level

Primary & Presenting Author(s)

Daisy Leon-Martinez, MD (she/her/hers)

Assistant Professor
University of California, San Francisco (UCSF)
San Francisco, CA, United States

Coauthor(s)

CB

Cinthia Blat, MPH

Data Systems Supervisor
University of California, San Francisco (UCSF)
San Francisco, CA, United States
Anjali J. Kaimal, MD (she/her/hers)

Professor and Vice Chair of Clinical Operations, Department of OBGYN
University of South Florida Morsani College of Medicine
Tampa, FL, United States
William A. Grobman, MD, MBA

Professor
The Ohio State University
Columbus, Ohio, United States
Miriam Kuppermann, PhD

Professor
University of California, San Francisco (UCSF)
San Francisco, CA, United States

Objective: To analyze the association of non-English primary language (NEPL) with patient decision quality regarding mode of delivery after cesarean.

Study Design: Secondary analysis of a multicenter randomized trial of pregnant people with one prior cesarean and no prior vaginal birth after cesarean conducted 2016-19. Participants were randomized before 25 weeks’ gestation to use a tablet-based decision support tool focused on trial of labor after cesarean (TOLAC) choice or to have usual care before electing a mode of delivery. Primary language was self-reported at enrollment. Validated scales measuring decision quality (decisional conflict, decision self-efficacy, decision satisfaction, knowledge, and shared decision-making) were administered by phone at 34-37 weeks’ gestation. To assess the association of NEPL (defined as use of non-English for primary language communication) with decision quality, we calculated mean scores for each scale by NEPL status and estimated adjusted mean differences (aMD) by using linear regression. Model covariates were selected by backwards stepwise regression

Results:

Compared to those who used English as their primary language (n = 1037), those with NEPL (n = 248) had significantly higher scores for decisional conflict (20.9 vs 16.7; aMD 4.1, 95% CI [1.9, 6.4], p< 0.001). Decision self-efficacy (88.6 vs 90.9; aMD -3.9, 95% CI [-5.9, -1.8], p< 0.001) and decision satisfaction (4.6 vs 4.7; aMD -0.1, 95% CI [-0.2, 0.0], p=0.013) were both worse (as indicated by lower scores) for NEPL participants. The aMD for knowledge scores (0.0, 95%CI [-0.3, 0.3), p=0.956) and shared decision-making scores (-1.1, 95%CI [-3.7, 1.6], p=0.426) were similar between the two groups

Conclusion: In the context of decision making regarding TOLAC, NEPL participants had lower decision quality scores compared to those who used English as their primary language. Given the association of NEPL with decreased participation in shared decision-making and poorer healthcare outcomes, further research is needed to understand the experience of NEPL individuals and improve counseling strategies to mitigate disparities