End-of-Life Decision-Making for ICU Patients With Limited English Proficiency: A Qualitative Study of Healthcare Team Insights

Abstract

Objectives: Research indicates that the increasing population of over 25 million people in the United States who have limited English proficiency experience differences in decision-making and subsequent care at end of life in the ICU when compared with the general population. The objective of this study was to assess the perceptions of healthcare team members about the factors that influence discussions and decision-making about end of life for patients and family members with limited English proficiency in the ICU. Design: Qualitative study using semistructured interviews with ICU physicians, nurses, and interpreters. Setting: Three ICUs at Mayo Clinic Rochester. Subjects: Sixteen ICU physicians, 12 ICU nurses, and 12 interpreters. Intervention: None. Measurements and Main Results: We conducted 40 semistructured interviews. We identified six key differences in end-of-life decision-making for patients with limited English proficiency compared with patients without limited English proficiency: 1) clinician communication is modified and less frequent; 2) clinician ability to assess patient and family understanding is impaired; 3) relationship building is impaired; 4) patient and family understanding of decision-making concepts (e.g., palliative care) is impaired; 5) treatment limitations are often perceived to be unacceptable due to faith-based and cultural beliefs; and 6) patient and family decision-making styles are different. Facilitators of high-quality decision-making in patients with limited English proficiency included: 1) premeeting between clinician and interpreter; 2) interpretation that communicates empathy and caring; 3) bidirectional communication of cultural perspectives; 4) interpretation that improves messaging including appropriate word choice; and 5) clinician cultural humility. Conclusions: End-of-life decision-making is significantly different for ICU patients with limited English proficiency. Participants identified several barriers and facilitators to high-quality end-of-life decision-making for ICU patients and families with limited English proficiency. Awareness of these factors can facilitate interventions to improve high-quality, compassionate, and culturally sensitive decision-making for patients and families with limited English proficiency.

Interpreters’ perceptions of culture bumps in genetic counseling

“…Numerous prior studies have noted interpreters’ unique contribution to empathic cross‐cultural communication, including the previously noted article by Gutierrez et al (2019), as well as a study by Barwise et al (2019) which underlines the direct relationship between interpreters’ incorporation of empathy and cultural perspectives and the quality of end‐of‐life discussions and decision‐making for ICU patients with LEP. The findings of these previous studies support the recommendations produced by the current study that culture bumps may be mitigated or eliminated by collaborating with interpreters who are well‐versed in the intricacies of cross‐cultural communications and interactions.…”

WITHDRAWN: Developing an Electronic Search Strategy Algorithm for Detecting Professional Interpreter Use among Patients with Limited English Proficiency: A Derivation and Validation Study

“…[15][16][17] Interpreter services positively impact communication and outcomes, increasing patient and family satisfaction with care, increasing understanding of diagnosis and treatment plans, reducing complications and length of hospital stay, and bolstering the use of preventive healthcare services. [11][12][13][18][19][20] Across the lifespan from pediatric care to end of life care, interpreters have been shown to bene t patients. [14,21] Despite evidence of the bene t of interpreters, interpreters are underused as clinicians try to "get-by" with their own limited language skills or those of family members.…”

How Should Clinicians Respond to Language Barriers That Exacerbate Health Inequity?

“…12 Even when professional interpreting is utilized appropriately for informed consent discussions, care conferences, and daily updates, patients and families with LEP still receive a fraction of the communication that English-speaking families receive from their health care team, 27,29 which affects the therapeutic relationship between health care team members and the patient and family, complicating shared decision making. 22,29,30 If distributive injustice can be redressed by increasing access to professional interpreting services, correcting relational injustice requires restructuring health care systems to develop bilingual competence and to recruit and hire more bilingual clinicians. Patient-physician non-English language concordance has been shown to improve a range of patient outcomes, including glycemic control, pain management, and cancer screening adherence.…”