BACKGROUND: Communication about health care and especially end-of-life care is difficult for clinicians and patients when they do not speak the same language. Our purpose was to improve understanding of how to approach discussions between language-discordant patients and clinicians about terminal or life-threatening illness. METHODS: We conducted a qualitative study with 4 focus groups with 43 professional medical interpreters. We asked open-ended questions concerning physician and interpreter communication about end-of-life care. Focus groups were audiotaped, transcribed, and analyzed using principles of grounded theory. Results were presented to an additional 3 focus groups with 25 medical interpreters to ensure that analyses represented interpreters' perspectives. RESULTS: We developed 3 frameworks for understanding high-quality language-discordant communication about end-of-life care. The first framework addresses physician and interpreter professionalism, including humanistic qualities and emotional support capabilities important for high quality care. The second framework is physician-centered and highlights communication skills, as well as coordination with other providers and cultural sensitivity. The third framework is interpreter-centered, focusing on role conflicts, including struggles concerning expectations to provide strict interpretation versus being a cultural broker. Interpreters' recommendations for improving quality of this care include pre-meetings with interpreters before encounters involving delivery of bad news and explicit discussions with interpreters about whether the clinician expects strict interpretation or cultural brokering. CONCLUSIONS: These results provide insights for physicians about how to improve end-of-life discussions with language-discordant patients and their families. Interpreter recommendations provide physicians and health care organizations with specific tools that may improve quality of communication about end-of-life discussions.
BACKGROUND: Communication about health care and especially end-of-life care is difficult for clinicians and patients when they do not speak the same language. Our purpose was to improve understanding of how to approach discussions between language-discordant patients and clinicians about terminal or life-threatening illness. METHODS: We conducted a qualitative study with 4 focus groups with 43 professional medical interpreters. We asked open-ended questions concerning physician and interpreter communication about end-of-life care. Focus groups were audiotaped, transcribed, and analyzed using principles of grounded theory. Results were presented to an additional 3 focus groups with 25 medical interpreters to ensure that analyses represented interpreters' perspectives. RESULTS: We developed 3 frameworks for understanding high-quality language-discordant communication about end-of-life care. The first framework addresses physician and interpreter professionalism, including humanistic qualities and emotional support capabilities important for high quality care. The second framework is physician-centered and highlights communication skills, as well as coordination with other providers and cultural sensitivity. The third framework is interpreter-centered, focusing on role conflicts, including struggles concerning expectations to provide strict interpretation versus being a cultural broker. Interpreters' recommendations for improving quality of this care include pre-meetings with interpreters before encounters involving delivery of bad news and explicit discussions with interpreters about whether the clinician expects strict interpretation or cultural brokering. CONCLUSIONS: These results provide insights for physicians about how to improve end-of-life discussions with language-discordant patients and their families. Interpreter recommendations provide physicians and health care organizations with specific tools that may improve quality of communication about end-of-life discussions.
Authors: Anna M Nápoles; Jasmine Santoyo-Olsson; Leah S Karliner; Helen O'Brien; Steven E Gregorich; Eliseo J Pérez-Stable Journal: J Health Care Poor Underserved Date: 2010-02
Authors: Lisa C Lindley; Mary L Held; Kristen M Henley; Kathryn A Miller; Katherine E Pedziwol; Laurie E Rumley Journal: J Racial Ethn Health Disparities Date: 2016-04-08