A qualitative analysis of the impact of English proficiency on clinician-patient communication related to immediate breast reconstruction following mastectomy.

BACKGROUND

Quantitative studies have shown that patients with limited English proficiency are less likely to undergo immediate breast reconstruction than English-proficient patients, yet patient experiences remain poorly characterized. To better understand this disparity, we explored the effects of language proficiency on communication during immediate breast reconstruction decision-making.

METHODS

We performed a qualitative analysis using semistructured interviews of 24 women (12 English proficient, 12 limited English proficient) who underwent mastectomy and were candidates for immediate breast reconstruction at an urban safety-net hospital (2022-2024). Interviews were conducted in each patient's primary language, transcribed, and analyzed in NVivo. Deductive and inductive coding identified predetermined and emergent themes. Inter-rater reliability (Cohen's κ) was used to assess coding consistency.

RESULTS

Of the 24 patients, 16 underwent immediate breast reconstruction (37% limited English proficiency), and 8 did not (75% limited English proficiency). Four themes emerged: perceived clinician-patient communication factors, perceived interpreter effectiveness, comfort asking questions, and social determinants of health. Patients with limited English proficiency reported feeling less general clarity and comprehension: "I was left with confusion," perceived less clinician listening, and felt visits were rushed: "everything was going so fast." In-person interpretation was preferred. Interpreter quality impacted trust, with 1 patient saying, "language is a barrier…if you're not being understood, it gives you fear." Social support was influential in the decision-making process, whereas unmet social needs hindered decision-making.

CONCLUSION

We identified that modifiable, patient-reported communication barriers, along with social factors, influence immediate breast reconstruction decision-making. Targeted interventions to improve communication and interpreter services, foster trust, and advance equity are warranted to improve disparities in care.