‘Don’t blame the middle man’: an exploratory qualitative study to explore the experiences of translators breaking bad news

Abstract

Background: Healthcare professionals find breaking bad news difficult and upsetting. Increasing cultural diversity has led to a greater number of patients whose first language differs to that of the healthcare provider, with more patients requiring a translator to facilitate communication. Hospitals often ask non-clinical translators to facilitate breaking bad news. We sought to explore the experiences of translators within a specialist oncology centre. Methods: Following ethical and governance approvals, semi-structured interviews were undertaken with five translators recruited from the specialist oncology centre. Interviews were audiotaped and transcribed verbatim. The data were analysed thematically, with major themes and subthemes identified. Setting: Outpatient setting of a regional cancer centre. Participants: Translators serving a regional cancer centre. Main outcome measures: Qualitative data identified through thematic analysis. Results: Major themes included the significant emotional impact of translating distressing information, the challenges of accurately conveying information in a culturally congruent format and the need for formal briefing, debriefing and support. Subthemes included feeling guilty for divulging distressing news, being the focus of patients' distress or anger, and feeling in conflict with the patient or family and issues surrounding confidentiality. Translators also felt a strong sense of advocacy for the patients and found encounters with death and dying emotionally challenging. Conclusions: The increasing use of translators in the care of patients with advanced cancer is increasingly resulting in lay people being subject to similar emotional pressures faced by clinical staff, yet without the necessary formal training or support mechanisms that are recommended for clinicians. This exploratory study highlights the training and support needs of non-clinical staff as identifying a unique set of communication challenges faced by translators.

The emotional effects on professional interpreters of interpreting palliative care conversations for adult patients: A rapid review

“…Nineteen articles were identified for full text retrieval, of which 11 were included for analysis (Figure 1). Whilst most were qualitative studies, 30,32,34,37,38,40 two articles were cross-sectional online surveys distributed to healthcare interpreters. 33,35 One article described a quality improvement project evaluating an intervention to improve interpreter confidence in palliative care conversations.…”

“…(Interpreter, Australia) 37 'Guilt' was associated with the responsibility of delivering bad news or being on the receiving end of distress. 35,40 Less frequent emotions experienced included anger at patients' circumstances, 37 shock at argumentative clients 38 and horror when clinicians are disengaged from distressing conversations. 35 .…”

“….she [the patient] was angry, that's why she took out on me but still made me feel bad and upset, you know? (Interpreter, UK) 40 'Loneliness' 32,35,39 was described, including feelings of isolation, 38 abandonment 34 or alienation, 31 often when feeling disparate from clinicians or services.…”

“…Country of study USA [30][31][32][33][34] 5 Australia [35][36][37] 3 Canada 38, 39 2 UK 40 1 Languages Spanish Only 30 1 Spanish and Chinese 32 1 Inuit (Inuktitut, French) 38 1 Aboriginal (Cree/Ojibway) 39 1 More than 2 languages 33,34,37,40 4 Unspecified 31,35 2 Study design…”

Breaking bad news in a cross-language context: A qualitative study to develop a set of culturally and linguistically appropriate phrases and techniques with Zulu speaking cancer patients

“…While BBN may be demanding and often uncomfortable for practitioner and patient [14,15], it is generally accepted that bad news should be disclosed to the extent that the patient wishes [14,16]. BBN techniques have repercussions for all involved [17][18][19].…”