Healthcare Provider Perspectives Regarding Use of Medical Interpreters During End-of-Life Conversations With Limited English Proficient Patients

Abstract

Background: Healthcare providers increasingly care for patients with Limited English Proficiency (LEP). There is limited research evaluating healthcare provider utilization practices, attitudes, perceived benefits and barriers regarding the use of medical interpreters in end of life (EOL) and goals of care (GOC) conversations. Objectives: To elicit healthcare providers’ opinions of the role, factors that impact decisions to use medical interpreters and perceived utility of using medical interpreters when conducting EOL and GOC conversations with LEP patients and their families. Design: Cross-sectional survey of internal medicine trainees and attending physicians from a U.S. medical center. Results: A total of 117 surveys were collected with a response rate of 51%. In-person medical interpreters received higher ratings with regard to their helpfulness compared to telephone medical interpreters during EOL and GOC conversations. Being an attending physician and having received training in the use of a medical interpreter predicted higher composite scores reflecting greater awareness of the roles of medical interpreters and endorsement of best communication practices. In-person interpreters were viewed by a subset of participants as “standard of care” during EOL and GOC conversations. Conclusion: Having more years in practice and receiving training in the use of medical interpreters correlated with more favorable attitudes toward the role of medical interpreters and positive communication practices. Incorporating early training in the use of medical interpreters could help enhance communication practices and outcomes during EOL and GOC conversations with LEP patients.

A multi-language qualitative study of limited English proficiency patient experiences in the United States

“…It reflects a common experience associated with having limited communication ability in English when interacting with healthcare providers and systems, regardless of diagnosis. The participants' reflections reinforce the findings of multiple studies about the sources of inequitable health outcomes for persons with language barriers seeking healthcare services in the US as well as other countries [ 3 , 5 , 7 , 8 , 14 , 19 , 21 , 23 , 31 , 33 ]. Importantly, it also captures how these individuals are aware of the risks associated with having a language barrier and the added layer of stress it contributes to the experience of acute illness and chronic illness management.…”

Forgotten in the crowd: A qualitative study of medical interpreters' role in medical teams

“…A pre‐encounter huddle with interpreters may provide the interpreters with an opportunity to learn basic information about the patient prior to the encounter and carry the encounter with more skill and confidence. Pre‐encounter huddles have also been suggested by previous studies, which highlight the value of providing interpreters with a one‐sentence summary about patients 36 . Interpreters also focused on the importance of utilizing the teach‐back method with LEP patients as it can provide a safety check to ensure patients’ understanding regarding their conditions and care instructions.…”

“…Pre-encounter huddles have also been suggested by previous studies, which highlight the value of providing interpreters with a one-sentence summary about patients. 36 Interpreters also focused on the importance of utilizing the teach-back method with LEP patients as it can provide a safety check to ensure patients' understanding regarding their conditions and care instructions.…”

The roles and experiences of medical interpreters in palliative care: A narrative review

“…The 10 studies included in this review are all studies published in peer-reviewed journals. They utilized 1 or more of the following data collection techniques: semi-structured interviews (n = 5) (Hordyk et al 2017;Kirby et al 2017;Latif et al 2022a;Rhodes et al 2021;Silva et al 2020), surveys (n = 4) (James and Crawford 2021; Schenker et al 2012;Silva et al 2022;Weaver et al 2022) and observation (n = 1) (Hordyk et al 2017). Most of the studies included examined the perspectives of the medical interpreters themselves (Hordyk et al 2017;James and Crawford 2021;Kirby et al 2017;Latif et al 2022a;Norris et al 2005;Rhodes et al 2021;Schenker et al 2012;Silva et al 2020;Weaver et al 2022), while 1 study analyzed the perspectives of both training and attending level physicians (Silva et al 2022).…”

“…They utilized 1 or more of the following data collection techniques: semi-structured interviews (n = 5) (Hordyk et al 2017;Kirby et al 2017;Latif et al 2022a;Rhodes et al 2021;Silva et al 2020), surveys (n = 4) (James and Crawford 2021; Schenker et al 2012;Silva et al 2022;Weaver et al 2022) and observation (n = 1) (Hordyk et al 2017). Most of the studies included examined the perspectives of the medical interpreters themselves (Hordyk et al 2017;James and Crawford 2021;Kirby et al 2017;Latif et al 2022a;Norris et al 2005;Rhodes et al 2021;Schenker et al 2012;Silva et al 2020;Weaver et al 2022), while 1 study analyzed the perspectives of both training and attending level physicians (Silva et al 2022). In the 9 studies that focused on medical interpreters' perspectives, the interpreters worked with patients who spoke a wide range of languages, with the most common being Spanish (Hordyk et al 2017;James and Crawford 2021;Kirby et al 2017;Latif et al 2022a;Norris et al 2005;Rhodes et al 2021;Schenker et al 2012;Silva et al 2020;Weaver et al 2022).…”