Inuit interpreters engaged in end-of-life care in Nunavik, Northern Quebec

Abstract

Background: Inuit interpreters are key players in end-of-life (EOL) care for Nunavik patients and families. This emotionally intensive work requires expertise in French, English and Inuit dialects to negotiate linguistic and cultural challenges. Cultural differences among medical institutions and Inuit communities can lead to value conflicts and moral dilemmas as interpreters navigate how best to transmit messages of care at EOL. Objectives: Our goal was to understand the experience of Inuit interpreters in the context of EOL care in Nunavik in order to identify training needs. Design: In the context of a larger ethnographic project on EOL care in Nunavik, we met with 24 current and former interpreters from local health centres and Montreal tertiary care contexts. Data included informal and formal interviews focusing on linguistic resources, experiences concerning EOL care, and suggestions for the development of interpretation training. Results: Inuit working as interpreters in Nunavik are hired to provide multiple services of which interpretation plays only a part. Many have no formal training and have few resources (e.g. visual aids, dictionaries) to draw upon during medical consultations. Given the small size of communities, many interpreters personally know their clients and often feel overwhelmed by moral dilemmas when translating EOL information for patients and families. The concept of moral distress is a helpful lens to make sense of their experience, including personal and professional repercussions. Conclusions: Inuit interpreters in Nunavik are working with little training yet in context with multiple linguistic and cultural challenges. Linguistic and cultural resources and focused training on moral dilemmas unique to circumpolar contexts could contribute to improved work conditions and ultimately to patient care.​​​​

Time to Diagnosis and Treatment with Palliative Radiotherapy among Inuit Patients with Cancer from the Arctic Territory of Nunavut, Canada

“…For example, 75% of our study patients spoke no English. Inuit interpreters therefore play a key role within the oncology team, but face numerous challenges in carrying out end-of-life discussions, including experiencing high moral distress [15]. Moreover, as seen in our study, radiation oncologists often submit the treatment plan on the day of consultation.…”

Feasibility and ethical issues: experiences and concerns of healthcare workers regarding a new RSV prophylaxis programme in Nunavik, Quebec

“…Nurses worked in general in the villages for one or two years, or less [21: 651]. This high turnover can restrain the development of long-term coordinated networks and smooth communication [19], challenge the sustainability of projects and initiatives [16], and ultimately can have a significant impact on the continuity of care [17,21]. Communication issues were probably due also to the short delay between the announcement of the new programme and the need to implement it before the upcoming RSV season.…”

“…Furthermore, communication issues with Inuit parents underlined by some HCWs raised ethical concerns regarding the guarantee of a free and informed consent from parents. Communication problems with health services influence the attitudes of Inuit regarding medical care [21], and have an impact on the health on Canadian Inuit infants [27]. As explained by Hordyk and her colleagues [21], "Misunderstandings in communication affect patient access to care, quality of care, patient capacity to provide informed consent, patient understanding of treatment directives or preventive measures, and patient adherence to treatment.…”

“…Also, we did not obtain the perspective of INESSS or Quebec Ministry of Health. In addition, the evaluation of the PVZ programme did not consider the Inuit experiences and perspectives, as described in other studies in Nunavik about cervical cancer and prevention strategies [17], youth mental health services [16], a nutritional project dedicated to Inuit pregnant women [19], or the role of interpreters in the end of life management [21].…”

Twenty “must-read” research articles for primary care providers in Nunavik: scoping study and development of an information tool

“…Cerigo [41] Inuit women's attitudes and experiences towards cervical cancer and prevention strategies in Nunavik, Quebec Fraser [42] Experience and representations of health and social services in a community of Nunavik Hordyk [1] End-of-life care in Nunavik, Quebec: Inuit experiences, current realities, and ways forward Hordyk [43] Inuit interpreters engaged in end-of-life care in Nunavik, Northern Quebec was included in the Qanuilirpitaa? 2017 survey.…”