INTERPRETing to increase access to PSYcho-oncology care (INTERPRET-PSY) for cancer patients with limited English proficiency: study protocol for a pilot randomized controlled trial

Abstract

Background: People with cancer who have limited English proficiency (LEP) are at high risk for poor mental health outcomes in survivorship as they face cultural, linguistic, and mobility-related barriers to accessing psychosocial care. Telemental health interventions can be of great utility because they can decrease participation burden and are cost-effective. Patients with LEP who receive telemental health services primarily access them through remote interpretation due to a shortage of bilingual therapists. Remote interpreting can be: (1) simultaneous (rarely used in medical settings) or consecutive (usual care in medical settings). Prior research has found that Remote Simultaneous Medical Interpreting (RSMI) resulted in fewer errors, better medical outcomes, and higher patient satisfaction than consecutive methods in oncology and primary care settings. Yet, RSMI has not been studied in the context of a counseling/psychotherapy encounter. INTERPRET-PSY is a mixed method, 3-arm pilot randomized controlled trial (RCT) designed to determine if RSMI is feasible and acceptable in comparison to usual care (RCMI) and "gold standard" care (bilingual provider) in delivering counseling/psychotherapy to Mandarin-speaking LEP cancer patients. Methods: A total of 45 participants will be randomly assigned to one of 3 arms (n = 15 RCMI, n = 15 RSMI, and n = 15 bilingual provider) to receive 6 counseling/psychotherapy sessions. Feasibility and acceptability of the interpreting modalities (RCMI, RSMI) will be evaluated through self-report assessments. Secondary outcomes will include therapeutic alliance, MCP-Ch content comprehension, and clinically significant interpreting errors across the interpreting (RCMI, RSMI) arms. Semi-structured interviews with a purposively sampled subset of patients, their interventionists, and interpreters (if applicable) across all 3 arms will assess potential barriers and facilitators to successful interpreter-mediated communication and outcomes. Discussion: INTERPRET-PSY is the first study to examine the feasibility and acceptability of delivering a culturally adapted, evidence-based, and telehealth-delivered counseling/psychotherapy intervention to cancer patients with LEP via RCMI and RSMI. Results of the pilot RCT will be submitted for publication in a peer-reviewed journal and serve as preliminary data for a larger, multisite RCT grant application for a fully powered RCT of interpreting modalities in the provision of linguistically accessible and culturally appropriate psycho-oncology care.