Abstract Title Education, Language, and Cultural Concordance Influence Patient-Physician Communication in Orthopaedics

Background

Disparities in healthcare outcomes are pronounced among racial and ethnic minorities in the United States, particularly in orthopaedics where only 4.7% of faculty are from underrepresented minority (URiM) groups. Previous research highlights that cultural competency and humility in healthcare can reduce these disparities and improve patient satisfaction. However, there is limited data on the impact of patient-physician cultural and language concordance in orthopaedic care.

Methods

A convenience sample of patients and orthopaedic surgeons from an urban tertiary medical center was surveyed between August 2021 and May 2023. A self-administered questionnaire, available in English and Spanish, assessed demographic information, language proficiency, treatment satisfaction, and the importance of cultural and language understanding by clinicians. The cohort included 394 patients, with data analyzed using descriptive statistics, ANOVA, Pearson’s correlation, chi-square tests, and logistic regression.

Results

A total of 394 patients completed the questionnaire, with 35% male and 65% female, and an average age of 54 years. Hispanic patients reported lower English proficiency compared to Caucasian and African-American subjects (p<0.001), and educational attainment significantly influenced patients' ability to communicate with their orthopaedic surgeon (p<0.001). Hispanic and African-American patients placed higher importance on cultural understanding by their orthopaedic surgeons compared to Caucasian patients (p<0.001). Among Hispanic patients, those treated by culturally and linguistically concordant surgeons reported better communication and higher satisfaction levels. Logistic regression showed that Hispanic patients who saw culture and language concordant surgeons valued Spanish-speaking surgeons more (66% vs 45%, p=0.04).

Conclusion

This study highlights the critical role of educational attainment and patient-physician cultural and language concordance in effective communication within orthopaedic care. The novel finding that Hispanic patients show significantly improved communication and satisfaction when treated by culturally and linguistically concordant surgeons underscores the need for increasing the number of culturally and linguistically proficient orthopaedic surgeons. Addressing these factors can enhance patient outcomes and satisfaction, particularly among Hispanic and African-American populations. Efforts should focus on improving health literacy and cultural humility training for orthopaedic surgeons to bridge the communication gap and reduce disparities in orthopaedic care.