Fast Fact And Concept #154: Use of Interpreters in Palliative Care

Author: Sue Howard, M.D.

During times of emotional stress and conversations that touch the inner soul, it is most comforting and safe for patients and families to describe feelings and thoughts in their primary language. This Fast Fact reviews key issues when using interpreters in the palliative care setting.

Using Health Care Interpreters vs. Family

• Medical interpreters who have completed specific training and follow national standards/ethics of practice (National Council on Interpreting in Healthcare) should be utilized in caring for patients with limited English proficiency.
  
  
• Although using family members may seem convenient, it is fraught with problems. There is no assurance they will have the necessary language skills to convey medical information, and the patient may not feel comfortable expressing their feelings through family members. Family members may misinterpret medical phrases, censor sensitive/ taboo topics, or summarize discussions rather than translating them completely. Family members may have strong emotions that affect their objectivity and impartiality.
  
  In addition, being the bearer of bad news or discussing contentious information may have negative implications for a family member following the encounter.
  
  
• Ensure the patient and family that confidentiality will be maintained.

Interview Strategies

• Brief the interpreter before meeting with the patient/family. Explain the purpose of the encounter, your role, and the physical set-up of the room. It is important to warn the interpreter ahead of time if you will be discussing end-of-life issues and/or using the word “dying”. Emphasize that your statements should not be changed and that if your statement cannot be translated directly, the interpreter should alert you to rephrase.
• You and the interpreter should plan to be at eye level with the patient and you should directly face the patient while speaking, just as you would in a non-interpreter situation. Avoid the tendency for the patient and provider to give the appearance of speaking to the interpreter, rather than to each other. When at the bedside, you and the interpreter should be on the same side of the bed next to each other to prevent unnecessary turning of the patient’s head from side to side.
• Keep your sentences and questions concise.
• Avoid saying to the interpreter, Ask him... or Tell her…. Speak directly to the patient using the first person: “I am here today to talk to you about…”.
• Professional interpreters are required to interpret all information that is provided as outlined in their code of ethics. Do not tell the interpreter, “Do not translate this…”
• Resist the tendency to raise one’s voice when trying to communicate with someone who speaks a different language.
• Pause at the end of each statement to allow the interpreter time to interpret.
• Pay attention to non-verbal clues that the patient/family is confused or that your comments were misinterpreted (e.g. puzzled look, furrowed brow). Stop and clarify that the interpreter and patient/family have understood the information.
• Following the interview give the interpreter an opportunity to ask you questions or make comments about the encounter. If the discussion was emotionally charged, check-in with the interpreter, How are you doing? or Was that very distressing for you?

The need to use an interpreter implies that significant cultural differences exist between you and the patient/family. Professional interpreters can help you to provide effective and efficient communication that is culturally sensitive.

Check with your institution to see what resources are available to work with limited English proficient patients. Companies that provide trained telephone language interpreters for health care workers include Language Line (http://www.languageline.com), Pacific Interpreters (www.pacificinterpreters.com), CyraCom International (www.cyracom.net), Telelanguage (http://www.telelanguage.com) and MultiLingual Solutions (http://www.mlsolutions.com).

References

1. Crawley LM, Marshall PA, Lo B, Koenig BA. Strategies for Culturally Effective End-of-Life Care. Ann Intern Med 2002; 136:673-679.
2. Haffner L. Translation is not enough. Interpreting in a Medical Setting. West J Med 1992; 157:255-259.
3. Haffner L. Guide to Interpreter Positioning in Health Care Settings. The National Council on Interpreting in Health Care Working Paper Series 2003: 1-7. Available at http://www.ncihc.org/NCIHC_PDF/PositioningPaperFinalNovember2003.pdf.
4. Herndon E, Joyce L. Getting the Most from Language Interpreters. Family Practice Management 2004; 11:37-40. http://www.aafp.org/fpm/20040600/37gett.html
5. Minas M, Stankovska M, Ziguras S. Working with Interpreters: Guidelines for Mental Health Professionals. The Victorian Transcultural Psychiatry Unit 2001: 1-20. http://www.vtpu.org.au/docs/interpreter_guidelines.pdf
6. Pigazzini M, Tindaro F. The Interpreter in the Therapeutic Relationship: therapist or client. Psychomedia, 1-3, 1999. http://www.psychomedia.it/pm/grpind/transcult/interpreter.htm
7. Professional Standards Committee of Registry of Interpreters for the Deaf. Interpreting in Mental Health Settings. Standard Practice Paper 1997-1999. http://www.rid.org/126.pdf.

Additional Resources

Diversity (http://www.diversityrx.org) and the Cross Cultural Health Care Program (http://www.xculture.org).

Information about caring for patients with limited English proficiency: http://www.lep.gov.

Copyright/Referencing Information: Users are free to d ownload and distribute Fast Facts for educational purposes only. Citation for referencing: Howard S; Fast Facts and Concepts #154 Use of Interpreters in Palliative Medicine, April 2006. End-of-Life/Palliative Education Resource Center www.eperc.mcw.edu.

Fast Facts were edited by David Weissman MD, Palliative Care Center, Medical College of Wisconsin until January 2007.  For comments/questions write to the current editor, Drew Rosielle MD: drosiell@mcw.edu. The complete set of Fast Facts is available at EPERC: www.eperc.mcw.edu

Disclaimer: Fast Facts provide educational information, this information is not medical advice. Health care providers should exercise their own independent clinical judgment. Some Fast Fact information cites the use of a product in dosage, for an indication, or in a manner other than that recommended in the product labeling. Accordingly, the official prescribing information should be consulted before any such product is used.

Purpose: Self-Study Guide, Teaching

Audience(s)

ACGME Competencies: Interpersonal and Communication Skills and Professionalism

Keyword(s): communication