Video remote sign language interpreting has been promoted as a scalable solution to address interpreter shortages in health care, but new randomized trial data suggest that this technology alone may not be sufficient to ensure effective communication with Deaf patients – an issue with immediate relevance for hearing and ear, nose, and throat clinics and emergency departments.
In the randomized clinical trial conducted in Colombia, use of video remote interpreting (VRI) improved some aspects of communication between Deaf patients and physicians, but did not consistently enhance overall comprehension, clarity, or reassurance during clinical encounters. The findings highlight gaps that may be particularly consequential in settings where accurate communication is essential for diagnosis and acute decision-making.
The trial included 210 Deaf adult patients whose primary language was Colombian Sign Language. Participants were randomly assigned to receive care either via VRI or else with the current communication tools used in the country (e.g., lip-reading, note-taking, mobile phones, images, or self-arranged interpretation). While the law in Colombia actually states that Deaf individuals must have access to interpreters in health care settings, the study authors note that “implementation of this law is severely limited.”
Communication quality was assessed using the validated Doctor-Patient Communication scale following each visit.
Patients who used VRI were more likely to report being encouraged to express themselves, receiving thorough physical examinations, being given complete information, and being involved in decision-making. However, there were no statistically significant differences in other key domains, including clarity of explanations, understanding the physician, and feeling listened to, reassured, or else having confidence in the physician.
The researchers emphasize that these observed communication failures are not solely technological. The trial identified broader preconditions that influenced outcomes, including health literacy among Deaf patients, trust in interpreters, training and oversight of interpreting services, and reliable access to devices and internet connectivity. Without these elements, video remote interpreting may introduce new vulnerabilities rather than eliminate barriers.
This has implications for clinic and hospital leadership. Simply installing video interpreting platforms may not meet legal, ethical, or clinical obligations to ensure equitable care. For otolaryngology practices and emergency departments, structured workflows, staff training on working effectively with interpreters, and protocols for escalating to in-person interpretation when needed may be critical.
The researchers noted that this was the first randomized trial globally to evaluate VRI efficacy among Deaf patients, and that these results from Colombia may similarly reflect challenges faced in other low- and middle-income settings as well as resource-constrained environments elsewhere.
The findings suggest that, as hearing and ear, nose, and throat clinics and emergency departments increasingly care for Deaf patients – and as digital health tools continue to expand – communication equity may not be fully addressed through technology alone. Systems-level planning, professional training, and patient-centered safeguards may be necessary to support safe and effective care for this patient cohort.
The authors declared having no competing interests.
Source: JAMA Network
