Interpreter use in telehealth genetic counseling sessions

Patients in the United States with Limited English Proficiency (LEP) lack access to language-concordant genetic counselors. This places patients with LEP at a disadvantage during appointments due to previously identified factors such as time constraints, lack of formal training for genetic counselors, and interpreters' limited training in genetics terminology. When done well, interpretation services enhance healthcare and expand access to genetic counseling. Given the increased utilization of telehealth for the delivery of genetic counseling services including telephone and video communication, it is imperative to adapt practices to avoid exacerbating disparities among underserved communities. This qualitative study explores strategies used by experienced genetic counselors (GCs) in telehealth sessions with interpreters. Participants were board-certified GCs and had high-volume of patients with LEP seen via telehealth. Semi-structured interviews (n = 11) were conducted virtually and recorded. Interviews were coded for themes using descriptive coding. Development of the codebook was done with study team members reviewing 1-2 transcripts against the initial codebook for feedback. Codes and the codebook were refined through an iterative process. Thematic analysis revealed two major themes: how GCs gained their knowledge, and strategies GCs used during interpreted telehealth appointments. Experienced GCs gained their knowledge through on-the-job experience, learning from interpreters, and from bilingual colleagues. Results also indicated that when providing services over telehealth for patients with LEP, experienced GCs employ strategies to overcome difficulties in educating, assessing patient understanding, and meeting psychosocial needs. These strategies build on GC core competencies and best practices for working with interpreters to adapt for telehealth delivery. As such, this study offers practical guidance for GCs and trainees with suggestions before, during, and after an interpreted telehealth appointment. GCs can make strides for equity in the quality of telehealth sessions for patients regardless of language by leveraging these insights, learning about the cultures of the communities they frequently serve, and willingness to adapt sessions.