“I Know Hyena. Do you Know Hyena?” Challenges in Interpreter-Mediated Dementia Assessment, Focusing on the Role of the Interpreter

Abstract

Dementia assessment requires functional communication and interaction between healthcare professionals and the patient being assessed. These can be affected by the requirement for an interpreter to communicate with the patient. The purpose of this study was to elucidate the interactions between patient, healthcare professionals and interpreter, focusing on the role of the interpreter and the challenges that may arise in interpreter-mediated dementia assessment. The study had an ethnographic design in which the data consisted of audio and video recordings of 19 dementia assessments conducted in the presence of an interpreter. The data were analyzed using the constant comparative method. The results showed that the interpreter could affect the patient’s performance and results during the dementia assessment. The interpreter could alter the meaning and content of what was communicated, sometimes change information and instructions exchanged between the patient and healthcare professionals, could avoid interpreting everything being said, and occasionally made their own corrections to what was being communicated. This occurred mainly because of the interpreter’s lack of linguistic skills and the interpreter failing to adhere to the ethical guidelines governing their profession. These challenges could also occur when the interpreter was not familiar with the context of dementia assessment. Alterations made by the interpreter to what was being communicated could lead to incorrect evaluation of the patient’s cognitive abilities and health status. This, in turn, may lead to misjudgment of the patient’s remaining resources and symptoms and their required treatment and support.

The impact of training on communication quality during interpreter‐mediated cognitive assessments: Study protocol for a randomized controlled trial

“…To our knowledge, this is the first time that training designed to upskill interpreters in dementia and cognitive assessments will have undergone evaluation in a RCT. A number of studies have observed the influence that interpreters can have on the accuracy of cognitive assessments, and recommended training and resourcing to optimize interpreters’ performance, 13 , 15 , 22 yet the training has not undergone rigorous evaluation. To address this gap, we have partnered with key stakeholders in the interpreting and dementia care sectors to co‐design an online training resource for interpreters.…”

“…Generic interpreter training may not equip interpreters with the necessary skills to manage the complex demands of interpreting cognitive assessments, potentially leading to inaccurate assessments, miscommunication, and/or poor patient/client experience. 15 , 21 Most professional interpreters in Australia have received training and have passed an examination to gain certification from the National Accreditation Authority for Translators and Interpreters (NAATI). However, prior to 2007, training was not a prerequisite to examination, and some professional interpreters still lack training.…”

“…They should know translations for relevant medical terminology, and also be familiar with how commonly encountered conditions present 18 . Interpreters must accurately render not only the content but also the form of patients’/clients’ speech during cognitive assessments, because features of speech such as hesitations, incomplete or misused words, repetitions, variations in tone or pace, and distorted meaning may indicate cognitive impairment 15,19 . The interpreter should also be able to describe features of a patient/client's speech, and may be asked to by a clinician/assessor during a debriefing 16 .…”

“…5 While using professional interpreters is always preferable, studies have shown that professional interpreters can influence outcomes of cognitive and mental health assessments, although the reasons are not well understood. [12][13][14][15] Interpreters perform better when they are briefed prior to an assessment, and are aware of the purpose of the interaction, familiar with assessment instruments, and able to anticipate any challenges with interpreting key ocabulary. 16,17 Interpreting for cognitive assessments requires a high degree of linguistic accuracy.…”

“…18 Interpreters must accurately render not only the content but also the form of patients'/clients' speech during cognitive assessments, because features of speech such as hesitations, incomplete or misused words, repetitions, variations in tone or pace, and distorted meaning may indicate cognitive impairment. 15,19 The interpreter should also be able to describe features of a patient/client's speech, and may be asked to by a clinician/assessor during a debriefing. 16. Communication with cognitively impaired people can poses interactional challenges for interpreters.…”