Language Barriers and Breast Reconstruction Decision-Making-A Literature Review and Exploratory Analysis

Effective patient-provider communication is crucial in breast reconstruction to balance extensive surgical options and patient preferences. Language barriers may impede informed decision-making, affecting reconstruction rates and patient satisfaction. This exploratory review investigates the association between language barriers and breast reconstruction decision-making.

Following PRISMA 2020, PubMed, SCOPUS, CINAHL, and Medline-Ovid databases were searched from June 2013 to June 2023. Studies were selected based on criteria focusing on language differences impacting post-mastectomy breast reconstruction. Search terms were restricted to studies directly quantifying language status and breast reconstruction to maintain the specificity needed to isolate language as a variable in reconstruction decision-making. Risk of bias was assessed using the Cochrane ROBINS-I tool. An exploratory meta-analysis was conducted using Cochrane-Mantel-Haenszel methods to determine odds ratios and heterogeneity (RevMan Web).

Seven studies met inclusion criteria. Moderate to serious risk of bias was observed in the majority of the included studies, and the operationalization of "language barrier" varied across studies (e.g., limited English proficiency, interpreter need, non-English primary language). Non-English speakers showed a non-significant trend toward lower rates of breast reconstruction compared to English speakers (pooled OR 0.34; 95% CI 0.10 - 1.13; P = 0.08). Substantial heterogeneity was present across all analyses (I² = 96 - 97%), limiting interpretation of the pooled estimates. In a sensitivity analysis excluding one potential outlier, non-English speakers had lower odds of reconstruction (pooled OR 0.25, 95% CI, 0.07 - 0.90, P = 0.03); however, heterogeneity remained high and small-study effects cannot be excluded.

Language discordance was consistently associated with reduced breast reconstruction rates across included studies, though substantial heterogeneity and residual confounding by socioeconomic status, insurance, and cultural factors limit definitive inference. Narrative synthesis suggested that language barriers were associated with poorer patient-provider communication, reduced information availability, and lower quality of care. These findings should be interpreted as exploratory given the limited and heterogenous evidence base. Future research on standardized assessment of language barriers, evaluation of interpreter services, and culturally sensitive interventions may help mitigate disparities in breast reconstruction.