Working with interpreters: The challenges of introducing Option Grid patient decision aids

Abstract

ObjectiveWe aimed to observe how an Option Grid TM decision aid for clinical encounters might be used where an interpreter is present, and to assess the impact of its use on shared decision making. MethodsData were available from three clinical consultations between patient, clinician (a physiotherapist), and interpreter about knee osteoarthritis. Clinicians were trained in the use of an Option Grid decision aid and the tool was used. Consultations were audio-recorded, transcribed, and translated by independent translators into English. ResultsAnalysis revealed the difficulties with introducing a written decision aid into an interpreted consultation. The extra discussion needed between the clinician and interpreter around the principles and purpose of shared decision making and instructions regarding the Option Grid decision aid proved challenging and difficult to manage. Discussion of treatment options while using an Option Grid decision aid was predominantly done between clinician and interpreter. The patient appeared to have little involvement in discussion of treatment options. ConclusionPatients were not active participants within the discussion. Further work needs to be done on how shared decision making can be achieved within interpreted consultations. Practice ImplicationsOption Grid decision aids are not being used as intended in interpreted consultations.

Patients’ views on the use of an Option Grid for knee osteoarthritis in physiotherapy clinical encounters: An interview study

“…All 72 patient participants were interviewed. Clinicians were also interviewed and data from this are reported elsewhere, as are the main findings of the trial, in addition to a discourse analysis of how the Option Grids were used when an interpreter was present in the consultation …”

Patient involvement and institutional logics: A discussion paper

“…The research covers a wide range of topics, such as definitions of the concept of patient involvement, the importance of patient involvement, factors influencing patient participation in healthcare decisions, methods employed in the patient participation process, patient participation tools and techniques as well as the consequences, both beneficial and potentially detrimental, of patient participation in healthcare decision‐making (Shaghayegh, Hamzehgardeshi, Hessam, & Hamzehgardeshi, ). We have examined studies that pay great attention to exploring different parties’ understanding of patient involvement (Arnetz & Zhdanova, ; Luttik et al., ; O'Brien et al., ; Rise et al., ; VIBIS, , ) and in developing methods and testing tools to facilitate patient involvement, such as decision aids (Wood, Phillips, Edwards, & Glyn, ), patient information (Grime & Dudley, ), guidelines (Miller & Rollnick, ), electronic health records (Milne et al., ) and smartphone applications (Lalloo, Jibb, Rivera, Agarwal, & Stinson, ). Also literature on evaluating patient involvement is growing (Gibson, Welsman, & Britten, ), just like philosophical (Määttä, Lützén, & Öresland, ) and critical perspectives (Handberg, Beedholm, Bregnballe, Nellemann, & Seibæk, ; O'Shea, Chambers, & Boaz, ) on the topic.…”

“What would you recommend doctor?”—Discourse analysis of a moment of dissonance when sharing decisions in clinical consultations

“…Two consultations were audio‐recorded for each of the 25 patients (50 consultations in total)—their initial diagnostic consultation at the Breast Cancer Centre and the follow‐up visit one week later. Family members or companions were sometimes present and their interactions have also been included in the analysis as the contribution of companion interactions within the consultation are of importance . The breast care team had been part of a SDM implementation programme, contributing to the development of SDM interventions and tools.…”

“…Studies of how clinicians talk to patients during consultations in which treatment decisions are being made have been undertaken in a number of settings. These include studies of SDM in primary care during discussions of antibiotic expectations, management of cholesterol, and in secondary care settings when interpreters are present . In addition, a study by Robertson et al has exemplified the complex conversational processes at work between doctors and their patients when sharing decisions in consultations.…”