Families with limited English proficiency receive less information and support in interpreted intensive care unit family conferences*

Abstract

Objective-Family communication is important for delivering high quality end-of-life care in the ICU, yet little research has been conducted to describe and evaluate clinician-family communication with non-English speaking family members. We assessed clinician-family communication during ICU family conferences involving interpreters and compared it to conferences without interpreters.Design-Cross-sectional descriptive study.Setting-Family conferences in the ICU's of four hospitals during which discussions about withdrawing life support or delivery of bad news were likely to occur.Participants-70 family members from 10 interpreted conferences and 214 family members from 51 non-interpreted conferences. Nine different physicians led interpreted conferences and 36 different physicians led non-interpreted conferences.Measurements-All 61 conferences were audiotaped. We measured the duration of time that families, interpreters, and clinicians spoke during the conference and we tallied the number of supportive statements issued by clinicians in each conference.Results-The mean conference time was 26.3 ± 13 minutes for interpreted and 32±15 minutes for non-interpreted conferences (p=0.25). The duration of clinician speech was 10.9 ± 5.8 minutes for interpreted conferences and 19.6 ± 10.2 minutes for non-interpreted conferences (p=0.001). The amount of clinician speech as a proportion of total speech time was 42.7% in interpreted conferences and 60.5% in non-interpreted conferences (p=0.004). Interpreter speech accounted for 7.9 ± 4.4 minutes and 32% of speech in interpreter conferences. Interpreted conferences contained fewer clinician statements providing support for families, including valuing families' input (p=0.01), easing emotional burdens (p<0.01), and active listening (p<0.01).Conclusions-This study suggests that families with non-English speaking members may be at increased risk of receiving less information about their loved one's critical illness as well as less NIH Public Access Author ManuscriptCrit Care Med. Author manuscript; available in PMC 2010 January 1.

Identifying Vulnerable Patients at Heightened Risk for Medical Error

“…29 Evaluation of communications between patients' families and health care providers during interpreted conferences revealed that alterations occurred 55% of the time and that more than 75% of the alterations had potentially important clinical consequences. 30 Nurses can resist serving as untrained, ad hoc interpreters or, if in a facility that expects dual-role interpreters, can advocate for validation of continued competency among interpreters.…”

The Pediatric Inpatient Family Care Conference: A Proposed Structure Toward Shared Decision-Making

“…17,20,31,32 Other situations in the pediatric inpatient setting that may benefi t from an FCC include: a prolonged hospital stay, involvement of several consulting physicians, preparation for discharge, or a particularly confusing diagnosis. We propose a model for the FCC on the pediatric inpatient service that is fl exible enough to allow for conferences with a variety of goals (Fig 1).…”

“…Even with interpretation services, 1 study found less information is transmitted in interpreted conferences compared with English-only conferences. 32 Research on family-centered rounds indicates that families prefer to have bilingual physicians caring for them, and if they are not available, they prefer in-person versus telephone translators. 33 The availability of professional interpreters may be limited, 34 and pediatricians often resort to ad hoc interpreters, despite the legal, ethical, and quality concerns of this option.…”

The Duty of the Physician to Care for the Family in Pediatric Palliative Care: Context, Communication, and Caring

“…25,39,41 Families who do not speak English are especially at risk for inadequate anticipatory guidance, owing to poor communication between the family and team. [42][43][44] When families are being asked to make decisions that will impact the quality and length of their child' s life, it is part of the physician' s ethical duty to provide timely information and a pathway toward shared decision-making for the family. Physicians must support and respect families' needs to make decisions that will be best for their individual child, but they should not leave the family completely alone to make these difficult decisions.…”