Interpretation inaccuracies in pain communication between Hmong patients and clinicians in the USA: A conversation analysis informed study.

Effective pain communication between patients and providers is imperative in order for providers to understand how to properly manage pain. Limited English proficiency patients, who have to rely on interpreting services, experience poorer pain management than the general population. This study aims to explore the interactional features of pain communication that account for interpretation inaccuracies in consultations involving Hmong patients. We adopted a conversation analysis informed approach to analyze audio recordings of 27 triadic consultations involving 27 Hmong patients, four interpreters, and 20 clinicians in primary care clinics in Wisconsin, USA. We found two features of Hmong patients' pain communication that accounts for interpretation inaccuracies. First, Hmong patients frequently expressed their pain through storytelling, which cause problems when interpreters summarize and omit parts of the stories. Second, Hmong patients frequently used vocal features (such as elongation, voice intensity, and repetition of key lexicons) to convey pain severity, the level of importance of the pain concern, and associated emotions. However, the meaning of these features was not often interpreted accurately, which may have contributed to clinicians missing opportunities to display empathy and address patients' concerns. Problems arise when interpreters omit parts of patients' pain stories and fail to convey the meaning of vocal features. Training is needed to inform interpreters about how pain stories are contextually constructed, and how vocal features can be used to express various aspects of pain.