Language Concordance in Critical Care: A Systematic Review

OBJECTIVES: Language barriers are associated with differences in care delivery processes and outcomes in critical care settings, with differences despite language assistance services. Less is known about outcomes associated with language concordant care. Language concordance is a linguistic match between a patient's preferred language and the language used by their care team. We undertook a systematic review to examine the measurement and impact of language concordant care delivery during critical illness, inclusive of the critical care recovery period after hospitalization. DATA SOURCES AND STUDY SELECTION: A systematic review was conducted in PubMed, CINAHL, PsycINFO, Embase, and Cochrane of English-language publications from database inception to March 3, 2026. Studies that investigated adults in critical care and post-ICU recovery clinic settings that included measurement of language concordance were included. Study quality was evaluated by the Joanna Briggs Institute Critical Appraisal Checklist. DATA SYNTHESIS: Of 1,682 unique records identified, 11 were eligible for inclusion (128,181 total patients; mean [sd] age, 68.4 [17.9 yr]; 72,872 [56.9%] male and 55,082 [43.1%] female). Six studies assessed clinical decision-making. Reported outcomes included code status changes, family conferences, communication complexity, delirium, length of stay, mechanical ventilation, and mortality. Due to significant heterogeneity in study analyses and reported outcomes, data were not pooled for quantitative analysis. CONCLUSIONS: Current evidence suggests that language-concordant care may influence clinically meaningful processes of critical care, warranting interventional studies to guide care delivery recommendations.