Are Good Intentions Good Enough?: Informed Consent Without Trained Interpreters

Abstract

OBJECTIVE:To examine the informed consent process when trained language interpreters are unavailable.BACKGROUND: Ensuring sufficient patient understanding for informed consent is especially challenging for patients with Limited English Proficiency (LEP). While US law requires provision of competent translation for LEP patients, such services are commonly unavailable. DESIGN AND PARTICIPANTS:Qualitative data was collected in 8 prenatal genetics clinics in Texas, including interviews and observations with 16 clinicians, and 30 Latina patients. Using content analysis techniques, we examined whether the basic criteria for informed consent (voluntariness, discussion of alternatives, adequate information, and competence) were evident for each of these patients, contrasting LEP patients with patients not needing an interpreter. We present case examples of difficulties related to each of these criteria, and compare informed consent scores for consultations requiring interpretation and those which did not. RESULTS:We describe multiple communication problems related to the use of untrained interpreters, or reliance on clinicians' own limited Spanish. These LEP patients appear to be consistently disadvantaged in each of the criteria we examined, and informed consent scores were notably lower for consultations which occurred across a language barrier. CONCLUSIONS:In the absence of adequate Spanish interpretation, it was uncertain whether these LEP patients were provided the quality and content of information needed to assure that they are genuinely informed. We offer some low-cost practice suggestions that might mitigate these problems, and improve the quality of language interpretation, which is essential to assuring informed choice in health care for LEP patients.

Professional Medical Interpreters Influence the Quality of Acute Ischemic Stroke Care for Patients Who Speak Languages Other than English

“…The direct relationship between receipt of PMI services and obtaining defect‐free AIS care may have several explanations. AIS patients who received PMI services may have had an increased understanding of their diagnoses and could have asked clarifying questions to make informed decisions about topics pertaining to issues such as their stroke treatment options and rehabilitation needs 12, 13. Clinicians who engaged PMI services may have leveraged the interpreters’ role as “cultural brokers” to better understand patients’ needs and perspectives and to have more meaningful conversations on topics such as stroke risk reduction and smoking cessation 14, 15, 16.…”

Increased Access to Professional Interpreters in the Hospital Improves Informed Consent for Patients with Limited English Proficiency

“…17,18 While federal guidelines mandate the use of qualified interpreters for patients with LEP, 19 this is an unfunded mandate, and multiple studies have demonstrated low rates of professional interpreter utilization during hospital encounters, including during informed consent discussions. [20][21][22][23][24][25][26] Time constraints and lack of immediate availability have been implicated by clinicians as major barriers to use of professional interpreters in the hospital. 27 A recent study demonstrated that surgeons' decisions to use professional interpreters for informed consent discussions depended in large part on the rapid availability of interpreter services.…”

Offering prenatal diagnostic tests: European guidelines for clinical practice

“…37 In writing these guidelines, we have made an attempt to address not only current clinical issues but also those that may arise in the near future. 38 For example, the use of microarray testing in place of conventional karyotyping for fetal chromosomal analysis is increasing the potential for unexpected findings.…”