Telehealth Care for People With Serious Illnesses and Preferred Languages Other Than English.

Importance: Telehealth use in outpatient care has increased. Patients who speak preferred languages other than English (PLOE) experience disparities in telehealth use and in care provided via telehealth for serious illnesses (eg, cancer and other illnesses with high mortality risk and negative effects on daily functioning or quality of life). However, little is known about the experiences of people with PLOE receiving serious illness care via telehealth. Objective: To identify facilitators and barriers to providing serious illness care via telehealth to people with PLOE. Design, Setting, and Participants: This qualitative study analyzed semistructured interviews with Cantonese- or Spanish-speaking patients or their caregivers receiving outpatient serious illness care via telehealth at 2 University of California, San Francisco palliative care clinics (one focused on cancer and one on noncancer serious illnesses). The study included participants aged 18 years or older who spoke Spanish or Cantonese (the 2 most prevalent non-English languages in San Francisco). Participants were recruited via telephone outreach conducted by language-concordant study staff. If patients could not communicate by telephone (eg, they had anarthria or advanced dementia), their caregivers were interviewed instead. Semistructured interviews were conducted between June and August 2023. Exposure: At least 1 outpatient telehealth visit in the last year. Main Outcomes and Measures: One-on-one semistructured interviews developed using the Capability, Opportunity, Motivation, and Behavior framework were conducted by telephone to capture patient and caregiver perceptions on facilitators and barriers to serious illness care via telehealth. Interviews were recorded, transcribed, translated, and analyzed using thematic analysis. Results: This study included 20 participants (mean [SD] age, 64.7 [15.4] years; 14 females [70%]). Three key themes were identified from the transcripts of 9 Cantonese-speaking participants (45%; 3 patients and 6 caregivers) and 11 Spanish-speaking participants (55%; 7 patients and 4 caregivers). First, health system processes determined visit type and impacted telehealth accessibility. Second, between-visit communication using digital health tools (eg, the electronic patient portal) was challenging due to limited availability in non-English languages and digital literacy requirements. Finally, patient-clinician language concordance and longitudinal relationships with certified interpreters facilitated high-quality serious illness communication during telehealth visits, although family interpreters were sometimes required to overcome barriers associated with video interpretation, because patients sometimes had concerns about interpreter privacy and accuracy. Conclusions and Relevance: In this qualitative study of 20 semistructured interviews, Cantonese- and Spanish-speaking participants experienced barriers to serious illness care via telehealth before, during, and between visits. These findings underscore the need for interventions to promote equitable telehealth care for people with serious illnesses and PLOE, such as training more language-concordant clinicians, incorporating interpreters into interdisciplinary teams, and ensuring access to patient portals in languages other than English.