Reducing Clinical Errors in Cancer Education: Interpreter Training

Abstract

Over 22 million US residents are limited English proficient. Hospitals often call upon untrained persons to interpret. There is a dearth of information on errors in medical interpreting and their impact upon cancer education. We conducted an experimental study of standardized medical interpreting training on interpreting errors in the cancer encounter, by comparing trained and untrained interpreters, using identical content. Nine interpreted cancer encounters with identical scripts were recorded and transcribed. Using an “Error Analysis Tool,” a bilingual linguist and two bilingual medical providers scored the transcripts for interpreting errors made, including their potential clinical severity. Trained interpreters were 70% less likely to have clinical errors than untrained ones. The likelihood of medical error increased with the length of the concept and decreased with the precision of vocabulary. It is important to train medical interpreters and to ensure their availability in cancer education encounters to minimize the risk for errors.

Clinicians' Obligations to Use Qualified Medical Interpreters When Caring for Patients with Limited English Proficiency

“…A concern of clinical and ethical importance relates specifically to the risk of errors during a verbal consent process for a patient with LEP that does not involve a qualified medical interpreter [11]. In the United States, the Department of Health and Human Services (HHS) establishes competencies required of a "qualified interpreter" [12].…”

“…Health care professionals should use extreme caution when using ad hoc interpreters. The use of ad hoc interpreters-a broad category that includes a patient's friends or family members and unqualified bilingual staff-can significantly increase medical errors [11]. Health care professionals face potential civil liability when they fail to provide qualified interpreters, if such failure leads to a tort cause of action, such as lack of informed consent, breach of duty to warn, or improper medical care [15].…”

Physical examination of the female cancer patient with sexual concerns: What oncologists and patients should expect from consultation with a specialist

“…As a routine practice, the adolescent or adult patient is given the opportunity for private consultation with the clinician during each encounter. In addition, if the examiner and the patient do not speak the same language, a medical interpreter must be engaged to ensure patient consent, bidirectional communication, and therapeutic benefit of the encounter . In some settings, with appropriate planning, medical interpretation can be provided by phone.…”

“…In addition, if the examiner and the patient do not speak the same language, a medical interpreter must be engaged to ensure patient consent, bidirectional communication, and therapeutic benefit of the encounter. 94,95 In some settings, with appropriate planning, medical interpretation can be provided by phone. The benefits to having an interpreter present during the physical examination, including an ad hoc interpreter such as a partner or bilingual staff member, must outweigh the risks, including patient discomfort and the potential for miscommunication.…”

Medical Interpreters

“…4 Interpretation requires an absolute command of two languages, in-depth knowledge of cultural context, and the ability to manipulate registers ranging from formal to casual, including slang. 4,7 Ad hoc interpreters are significantly more likely to commit an interpretation error of clinical consequence, 8 yet employed hospital interpreters have also been found to commit errors of clinical significance. 4,7 Ad hoc interpreters are significantly more likely to commit an interpretation error of clinical consequence, 8 yet employed hospital interpreters have also been found to commit errors of clinical significance.…”