Background & Aims
Health inequality can be influenced by many factors including geography (i.e. access to healthcare services), language and communication barriers, patient preferences, health literacy, waiting times, perceived discrimination and physician bias. The 2021 UK census showed that 7.1% of the population were proficient in English but did not use it as their main language. 1.5% of the population were unable to speak English well and a further 0.3% of the population were unable to speak English at all. (1) 34% of adults in the UK (Adult Chronic Pain Health Survey, 2017) suffer from some degree of chronic pain. (2) This burden potentially has similar prevalence in the non-English speaking contingent of patients suitable for neuromodulation therapies; however this has not been reported before. This is the first quantification of outcomes in patients with a language barrier highlighting key issues around SCS efficacy in this population.
Methods
After local approval, 494 chronic pain patients (May 2021 – June 2022) were referred to a neuromodulation service in a large tertiary inner-city hospital in the UK and reviewed. From this pool, 44 patients were identified (9%) whose native language was not English.
31 patients (70%) in this group were suitable for SCS. Data was analysed from 25 patients who underwent SCS and did not use English as their first language.
Results
Of the 25 SCS patients that were initially implanted, 2 patients did not comply with questionnaires and additional 2 patients did not comply with health quality related data collection. 3 patients underwent revision and 2 patients were explanted, giving an explant rate of 8%, which is in higher than our centre’s average explant rate of 4% across all types of neuromodulation devices.
The mean overall NRS decreased from 7.76 at baseline (n=23) to 4.18 at 12 months (p < 0.0001) (n=19) with mean EQ-5D-5L index scores increasing from 0.23 at baseline (n=21) to 0.75 at 12 months (p = 0.0021) (n=17).
Conclusions
The statistically significant improvement in NRS and EQ-5D-5L scores at 12 months validates the need for therapy in this vulnerable group and highlights the growing demand for healthcare to be delivered to patients who cannot communicate in the language of their resident country.
The explant rate (8%) and poor compliance with questionnaires (8%) in the ethnic minority population could potentially be attributed to lack of education or language barriers impeding effective dialogue with patients.
Despite cultural factors, language barriers and beliefs, as possible confounders, we report successful outcomes at 12 months highlighting the need for ethnic inclusivity in the context of SCS therapy.
References
1. Office for National Statistics (ONS), released 29 November 2022, ONS website, statistical bulletin, Language, England and Wales: Census 2021
2.Chronic pain in adults 2017 Health Survey for England, https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/940858/Chronic_Pain_Report.pdf