P3.163: Language Access in Pediatric Perioperative Settings: Insights from Interpreters on Consent Discussions with Emerging English-Proficient Patients and Families

Background: Patients with emerging English-proficiency face well-documented disparities in surgical and anesthetic care due to language barriers. Qualified healthcare interpreters are essential in bridging communication gaps and ensuring informed consent in the perioperative period. Despite their critical roles, no studies have examined interpreters’ experiences specifically in pediatric perioperative care, where communication involves complex dynamics between healthcare providers, children, and caregivers. We explored interpreters’ perspectives on pediatric consent discussions to identify key barriers and facilitators to effective interpretation in this setting.

Methods: A semi-structured interview guide was developed with input from interpreters and a qualitative research expert. We conducted interviews with healthcare interpreters who provided perioperative interpretation within the prior year until thematic saturation was achieved. Transcripts were coded in Dedoose software with iterative, inductively-derived codes followed by consensus-based coding. Team-based thematic analysis identified key themes.

Results: Seventeen healthcare interpreters from Stanford Health Care and Stanford Medicine Children’s Health participated, with a median of 15 years of experience. Most were women (65%). Interpreters identified as Hispanic/Latino (47%), White/European (43%), and Asian/Asian American (10%). Spanish was the most common language interpreted (88%), followed by French, Mandarin, Cantonese, and Portuguese. Most interpreters worked full-time (88%) and held formal certifications, including CHI (59%) and CoreCHI (29%). Interpreters described their role as extending beyond language interpretation to include communication facilitation, cultural mediation, and patient advocacy.

Barriers to effective consent discussions included provider reluctance to engage interpreters as partners in communication, inappropriate requests for interpreters' signatures without verified interpretation, and challenges posed by bilingual family members. Interpreters reported that bilingual relatives often interrupted or offered alternative phrasing, which sometimes led to confusion or misunderstanding during consent discussions. Interpreters also mentioned challenges with access to Indigenous and rare language interpreters, reducing equitable communication for those patients. Facilitators included pre-encounter briefings with care teams to clarify goals and roles, as well as the use of teach-back methods to confirm patient and caregiver understanding (Table 1).

Interpreters highlighted unique challenges in the pediatric perioperative setting, including the need to balance adolescent autonomy with parental involvement and to shift between interpretation modes to manage bilingual family dynamics (Figure 1). In high-stress situations, such as consent for urgent surgery, interpreters emphasized the importance of empathy-driven care teams that fully integrate interpretation services.

Conclusion: Experienced interpreters highlighted multiple factors associated with effective informed consent discussions. Key takeaways include ensuring pre-surgery/anesthesia informed consent discussions occur in the patient’s and family's primary language, prioritizing in-person interpretation when available, training providers to effectively collaborate with interpreters, and expanding interpretation access to include Indigenous/rare languages. Recommendations include incorporating pre-encounter briefing sessions and introducing interpreters to caregivers as part of the healthcare team. Additionally, providers should facilitate age-appropriate discussions that account for adolescent autonomy while ensuring caregivers remain engaged in decision-making.