Communication about End-of-Life Care between Language-Discordant Patients and Clinicians: Insights from Medical Interpreters

Norris, Wendi M.; Wenrich, Marjorie D.; Nielsen, Elizabeth; Treece, Patsy D.; Jackson, J. Carey; Curtis, J. Randall

doi:10.1089/jpm.2005.8.1016

Cited by 91 publications

(119 citation statements)

References 23 publications

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“…In a community-based study, families reported that nurses were more likely to have discussed symptoms and their treatment than physicians and that discussions with nurses were more understandable than those with physicians. 24 These data confirm the importance of nurses in the communication and coordination of care for dying patients and their family members. Our findings support the need to expand nurses' skills and to offer opportunities to participate in end-of-life communication as a way to improve the quality of end-of-life care.…”

Section: Discussionmentioning

confidence: 57%

Nurses' Identification of Important yet Under-Utilized End-of-Life Care Skills for Patients with Life-Limiting or Terminal Illnesses

Reinke

Shannon

Engelberg

et al. 2010

Journal of Palliative Medicine

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Rationale: This study was designed to identify nurses' perspectives on nursing skills that are important yet under-utilized in end-of-life care. Methods: A 45-item survey was administered to nurses (n ¼ 717) in four U.S. states with a response rate of 79%. We identified skills that were endorsed by more than 60% of nurses as extremely important and also endorsed as not currently practiced by more than 25% of nurses. We used Chi square statistics to examine professional characteristics associated with ratings of end-of-life care skills including practice settings, years of experience, and end-of-life care education. Content analysis was used to examine nurses' responses to open-ended questions. Results: Nineteen items were endorsed as extremely important and also ranked as under-utilized. These end-oflife care skills included communication skills, symptom management competencies especially those concerning anxiety and depression, and issues related to patient-centered care systems. Four complementary themes emerged from qualitative analysis of nurses' comments, which supported the quantitative findings. Conclusions: This study provides a summary of skills nurses feel are important and under-utilized in their care of patients with life-limiting illnesses. The findings support the need to target both nursing education and healthcare system interventions to improve the use of practical end-of-life care skills by nurses with a focus on communication and symptom management skills.

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Section: Discussionmentioning

confidence: 57%

Nurses' Identification of Important yet Under-Utilized End-of-Life Care Skills for Patients with Life-Limiting or Terminal Illnesses

Reinke

Shannon

Engelberg

et al. 2010

Journal of Palliative Medicine

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“…Interpreters reported that complexity of information, information overload, and lack of clinician sensitivity toward the cultural and socioeconomic backgrounds of families with limited English were their primary challenges. Within the palliative care setting, Norris, Wenrich, Nielsen, Treece, Jackson and Curtis (2005) conducted a large qualitative study of 68 professional medical interpreters in the US about communication about end of life care. These interpreters emphasized the importance of both doctor and interpreter conveying compassion when delivering bad news.…”

Section: Introductionmentioning

confidence: 99%

A bridge between cultures: interpreters’ perspectives of consultations with migrant oncology patients

Butow

Lobb

Jefford

et al. 2010

Support Care Cancer

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Abstract:Background: Migration is increasing world-wide. In previous research into people with cancer from culturally and linguistically diverse (CALD) backgrounds, interpreter accuracy, professionalism, and continuity have emerged as key concerns for patients. Little is known about interpreters' perceptions of their role and the challenges they face. This study aimed to obtain their perspective. Methods: 30 interpreters (Greek n=7, Chinese n=11, and Arabic n=12) participated in four focus groups which were audio-taped, transcribed, and analysed for themes using N-Vivo software. Results: Skills as an interpreter were broadly perceived as conveying information accurately, being confidential and impartial.

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“…We used a previous qualitative study with interpreters as a basis for survey development and included questions about specific experiences and attitudes toward interpreting discussions about end-of-life issues that were raised by interpreters in focus groups. 13 Prior to administration, the survey was pilot-tested with a group of interpreters employed at a public hospital in California that serves a large population of LEP patients. The pilot-testers endorsed the survey as being clear and not burdensome to complete.…”

Section: Survey Developmentmentioning

confidence: 99%

“…12 Data from qualitative research with interpreters suggest that languagediscordant discussions about end-of-life issues require unique skills from physicians and interpreters, including sensitivity to cultural cues related to death and dying and the ability to negotiate perceived tensions in the interpreter's role between providing strict interpretation versus acting as a cultural broker or an advocate for the patient and family. 13,14 Interpreters also report difficulty handling their own emotions and not feeling like a part of the health care team when interpreting for discussions about death and dying or delivering bad news. 13 The growing awareness of such challenges and the increasing frequency of these situations call for a deeper understanding of the experiences of interpreters in these uniquely difficult conversations in order to improve the quality of interpretation and the quality of care.…”

mentioning

confidence: 99%

“…13,14 Interpreters also report difficulty handling their own emotions and not feeling like a part of the health care team when interpreting for discussions about death and dying or delivering bad news. 13 The growing awareness of such challenges and the increasing frequency of these situations call for a deeper understanding of the experiences of interpreters in these uniquely difficult conversations in order to improve the quality of interpretation and the quality of care. We therefore conducted a national survey of health care interpreters to assess their attitudes, experiences, and perceived needs when interpreting for discussions about end-of-life issues.…”

mentioning

confidence: 99%

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Interpretation for Discussions about End-of-Life Issues: Results from a National Survey of Health Care Interpreters

Schenker

Fernández

Kerr

et al. 2012

Journal of Palliative Medicine

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Background: Communication about end-of-life issues is difficult across language barriers. Little is known about the experience of health care interpreters in these discussions. Objectives: Objectives of this study were to: 1) assess the experiences of healthcare interpreters when interpreting discussions about end-of-life issues; 2) identify interpreter characteristics and experiences that may be associated with improved satisfaction and comfort with interpreting these discussions; and 3) describe interpreter training needs. Methods: The study utilized an electronically administered survey distributed nationally to health care interpreters in the United States. One hundred and forty-two health care interpreters participated. Measurements included general experiences, attitudes, and perceived training needs when interpreting discussions about endof-life issues. Results: Most respondents had received a certificate in interpretation (71%, 101/142), completed more than 40 hours of training (89%, 127/142), and had more than 5 years of interpreting experience (65%, 93/142). Overall, 85% (121/142) of respondents had interpreted discussions about end-of-life issues and most interpreted multiple discussions per week. Of those interpreters who had experience with these discussions, the majority (85%, 103/ 121) reported feeling comfortable, but only half (48%, 58/121) reported that these discussions usually went well. Interpreters who felt clear about their role were more likely than interpreters who did not feel clear about their role to think that discussions went well (51% [57/112] versus 11% [1/9], p = 0.02) and to feel comfortable interpreting (88% [98/112] versus 56% [5/9], p = 0.01). Eighty percent (97/121) of respondents with experience in end-of-life discussions were personally interested in more specific training for these discussions. Attitudes and perceived training needs did not differ by interpreter demographics or qualifications. Conclusions: The majority of interpreters have experience with end-of-life discussions but, independent of interpreter training and experience, only half report that these discussions usually go well. Interpreters want and may benefit from targeted educational interventions that could improve the quality of care for vulnerable patients and families in these difficult situations. Health systems and interpreter certification programs should incorporate specific training on how to interpret discussion about end-of-life issues.

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Communication about End-of-Life Care between Language-Discordant Patients and Clinicians: Insights from Medical Interpreters

Cited by 91 publications

References 23 publications

Nurses' Identification of Important yet Under-Utilized End-of-Life Care Skills for Patients with Life-Limiting or Terminal Illnesses

Nurses' Identification of Important yet Under-Utilized End-of-Life Care Skills for Patients with Life-Limiting or Terminal Illnesses

A bridge between cultures: interpreters’ perspectives of consultations with migrant oncology patients

Interpretation for Discussions about End-of-Life Issues: Results from a National Survey of Health Care Interpreters

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