Interpreting at the End of Life: A Systematic Review of the Impact of Interpreters on the Delivery of Palliative Care Services to Cancer Patients With Limited English Proficiency

Abstract

Context Language barriers can influence the health quality and outcomes of Limited English Poficiency (LEP) patients at end of life, including symptom assessment and utilization of hospice services. Objective To determine how professional medical interpreters influence the delivery of palliative care services to LEP patients. Methods We conducted a systematic review of the literature in all available languages of six databases from 1966 to 2014. Studies evaluated use of language services for LEP patients who received palliative care services. Data were abstracted from ten articles and collected on study design, size, comparison groups, outcomes and interpreter characteristics. Results Six qualitative and four quantitative studies assessed the use of interpreters in palliative care. All studies found that the quality of care provided to LEP patients receiving palliative services is influenced by the type of interpreter used. When professional interpreters were not used, LEP patients and families had inadequate understanding about diagnosis and prognosis during goals of care conversations, and patients had worse symptom management at the end of life, including pain and anxiety. Half of the studies concluded that professional interpreters were not utilized adequately and several suggested that pre-meetings between clinicians and interpreters were important to discuss topics and terminology to be used during goals of care discussions. Conclusion LEP patients had worse quality of end-of-life care and goals of care discussions when professional interpreters were not used. More intervention studies are needed to improve the quality of care provided to LEP patients and families receiving palliative services.

Improving the effectiveness of interpreted consultations: Australian interpreter, general practitioner and patient perspectives

“…This is the first Australian study to explore and integrate the experience and perspectives of GPs, interpreters and patients from CALD communities, using FGDs supplemented by semistructured interviews. Our findings reinforce recommendations to engage trained interpreters where doubt exists about patient language fluency, and to follow existing guidelines about working with interpreters, including briefing them prior to consultations (Silva et al., ). It appears, however, that some of the skills required of doctors (such as speaking in short, simple speech turns) are difficult and may need explicit training and supervised practice.…”

“…The considerable benefits of general practitioners (GPs) working with interpreters, especially trained health interpreters, in consultations with patients who have low English proficiency have previously been described (Karliner, Jacobs, Chen, & Mutha, 2007;Leanza, Boivin, & Rosenberg, 2010;Rosenberg, Richard, Lussier, & Shuldiner, 2011;Silva et al, 2016). In Australia, approximately 5% of general practice consultations are in a language other than English (Bayram et al, 2016), and telephone or on-site interpreters can be accessed free of charge to the patient in both general practice and hospital-based consultations (Christine, 2010).…”

Perspectives of oncology nurses and oncologists regarding barriers to working with patients from a minority background: Systemic issues and working with interpreters

“…However, medical interpreting is usually proximate consecutive (PCMI) or over-the-telephone consecutive (remote consecutive medical interpreting [RCMI]) (Gany et al, 2007). Only through new communication training approaches augmented by system-level changes that cultivate simultaneous translation, alongside the use of short phrases, can the clinician-patient relationship be restored to its proper place (Gany et al, 2013;Silva et al, 2015). When HPs describe the patient in the third person to the interpreter, rather than making first person statements directly to the patient, the clinicianpatient relationship has slipped to allow the clinician-interpreter and interpreter-patient relationships to be privileged [24,26], hence the care paradigm is fundamentally altered.…”

“…Many of these problems predominate with the consecutive model of language translation. Only through new communication training approaches augmented by system-level changes that cultivate simultaneous translation, alongside the use of short phrases, can the clinician-patient relationship be restored to its proper place (Gany et al, 2013;Silva et al, 2015).…”

Cancer Counseling of Low‐Income Limited English Proficient Latina Women Using Medical Interpreters: Implications for Shared Decision‐Making

“…Effective interpretation requires language proficiency and mastery of medical terminology in both languages, as well as memory skills, ability to negotiate a three-way conversation, and basic knowledge of cultural customs that can influence health communication (Quan and Lynch 2010). The oncology setting, with its complex information and potential for information overload, can be particularly challenging for interpreters (Butow et al 2012;Perez et al 2016;Silva et al 2016). In prenatal genetic counseling, research has shown that misinterpretation limited comprehension and inhibited development of a trusting relationship (Browner et al 2003).…”