Limited English Proficiency and Its Association With Quality of Care and Bereavement at the End of Life

Abstract

Background

Prior research has examined the impact of limited English proficiency (LEP) in the hospital setting at the end of life in select regions of the United States.

Objective

Examine whether LEP is associated with bereaved family ratings of quality of care in a national survey.

Design

Secondary data analysis of the National Health and Aging Trends Study (NHATS).

Setting/Participants

National sample of bereaved respondents.

Measurement

Last month of life survey about quality of care with decedents. Decedents classified as LEP based on need for translator, proxy use due to limited ability to speak English, and/or interview rating of understanding English. Multivariate regression model examined the overall association and interaction of LEP and Hispanic heritage after adjustment for socio-demographic, diagnoses, bereaved respondent relationship with decedent, and functional decline.

Results

Of 17.1 million deaths, 5.4% occurred in Hispanic decedents, compared to 3.0% among non-Hispanics (P ≤ .001). The strongest disparity was a 12.9-point lower adjusted quality-of-care rating for Hispanic decedents with LEP (65.6, 95% CI 55.3-76.1) compared with non-Hispanic decedents without LEP (78.5, 95% CI 77.5-79.6). These ratings were also lower than those of non-Hispanic decedents with LEP (84.1, 95% CI 74.0-94.4) as well as Hispanic decedents without LEP. Significance was determined by non-overlapping CIs. Respondents of Hispanic decedents with LEP reported trends of higher unmet needs for dyspnea palliation and receipt of goal concordant care.

Conclusion

LEP is prevalent in Hispanic decedents, with those with LEP reporting lower ratings of the quality of care compared to non-Hispanics without LEP.