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.
The current COVID-19 pandemic has impacted the way outpatient palliative care providers deliver care for patients and their families. Operational changes such as the reduction of in-person care to minimize the risk of exposure is a way healthcare has adjusted to the pandemic. Our New York City-based outpatient palliative care practice is embedded in oncology. Adopting telemedicine was an essential tool to continue providing comprehensive palliative care to vulnerable oncology patients during the COVID-19 pandemic. We describe a case illustrating the benefits and barriers of telemedicine in the care of an oncology patient in the outpatient palliative care setting.
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