1
|
Williams KE, Casola AR, Mechler K. Interpreting Difficult Conversations-Evaluating How to Support Medical Interpreters in the Delivery of Serious News. J Palliat Med 2024; 27:1210-1214. [PMID: 38973559 DOI: 10.1089/jpm.2023.0623] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/09/2024] Open
Abstract
Background: Despite their essential role in language concordant patient care, medical interpreters do not routinely receive training focused on difficult conversations and may not feel comfortable interpreting these encounters. Previous studies, while acknowledging the need for increased support, have provided limited strategies targeted at enhancing interpreter training and improving interpreter comfort levels in difficult conversations. Methods: Fifty-seven in-person medical interpreters providing services at our quaternary and community hospitals completed a 21-question mixed-methods survey regarding their comfort levels and experiences surrounding serious illness conversations. Results: Most medical interpreters reported being uncomfortable interpreting conversations surrounding difficult diagnosis, poor prognosis, and/or end-of-life. Nearly all respondents (98%) indicated that pre-meetings and/or debriefings with the medical team are helpful, yet only 25% reported frequent participation in these meetings. Conclusions: Our study highlighted the significant variability in medical interpreter training as well as ranging comfort levels in interpreting difficult conversations. Medical providers should not presume that interpreters are instantly prepared for these encounters. Current findings call for novel training opportunities specific to medical interpreters and difficult dialogues, as well as improved adherence of interprofessional pre-meeting/debriefings when serious news is discussed.
Collapse
Affiliation(s)
- Kaitlyn E Williams
- Division of Palliative Care, Department of Family and Community Medicine, Thomas Jefferson University Hospital (TJUH), Philadelphia, Pennsylvania, USA
| | - Allison R Casola
- Department of Family and Community Medicine, Thomas Jefferson University Hospital (TJUH), Philadelphia, Pennsylvania, USA
| | - Kathleen Mechler
- Division of Palliative Care, Department of Family and Community Medicine, Thomas Jefferson University Hospital (TJUH), Philadelphia, Pennsylvania, USA
| |
Collapse
|
2
|
Burke C, Doody O, Lloyd B. Healthcare practitioners' perspectives of providing palliative care to patients from culturally diverse backgrounds: a qualitative systematic review. BMC Palliat Care 2023; 22:182. [PMID: 37978500 PMCID: PMC10655398 DOI: 10.1186/s12904-023-01285-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Accepted: 10/13/2023] [Indexed: 11/19/2023] Open
Abstract
BACKGROUND Palliative care practitioners are increasingly caring for patients and families from diverse cultural backgrounds. There is growing awareness of the influence of culture on many aspects of care in the palliative phase of an illness. However, disparities have been noted in the provision of palliative care to patients from culturally diverse backgrounds and challenges have been reported in meeting their needs and those of their families. METHOD A qualitative systematic review of research papers identified through searching four databases. Papers were screened against inclusion criteria within the timeframe of January 2012 to March 2022. Data was extraction from all included studies and methodological quality assessed utilising the Critical Appraisal Skills Programme Tool. Thematic analysis followed Braun and Clarke's framework and the review is reported in line with PRISMA guidelines. FINDINGS The search yielded 1954 results of which 26 were included for appraisal and review. Four themes were identified: communication and connection, the role of the family in death and dying, the role of education in addressing uncertainty, and institutional and societal factors. The findings highlighted challenges of communication and a fear of acting in a culturally insensitive way, the pivotal role of the family, the need for an individualised approach to care, the universality of needs when approaching end of life and the need for education of practitioners. CONCLUSION These findings suggest that healthcare practitioners draw on their existing skills to adapt their practice to meet the needs of patients from culturally diverse backgrounds. However, results also indicate a need for further education and identification of educational approaches best suited to supporting healthcare professionals in practice.
Collapse
Affiliation(s)
- Colette Burke
- Milford Care Centre, Castletroy, Limerick, V94 H795, Ireland
| | - Owen Doody
- Department of Nursing and Midwifery, Faculty of Education and Health Sciences, University of Limerick, Limerick, V94 T9PX, Ireland
| | - Barbara Lloyd
- Department of Nursing and Midwifery, Faculty of Education and Health Sciences, University of Limerick, Limerick, V94 T9PX, Ireland.
| |
Collapse
|
3
|
Granhagen Jungner J, Tiselius E, Pergert P. Reasons for not using interpreters to secure patient-safe communication - A national cross-sectional study in paediatric oncology. PATIENT EDUCATION AND COUNSELING 2021; 104:1985-1992. [PMID: 33526338 DOI: 10.1016/j.pec.2021.01.017] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/11/2020] [Revised: 01/11/2021] [Accepted: 01/16/2021] [Indexed: 06/12/2023]
Abstract
OBJECTIVE To investigate the reasons for not using interpreters to secure patient-safe communication. METHODS Healthcare personnel at six paediatric oncology centres in Sweden responded to the Communication over Language Barriers questionnaire. Descriptive and comparative analyses were performed. RESULTS The participants (n = 267) often cared for patients with limited Swedish proficiency, although they were not trained in using interpreters. A lack of time was perceived as a barrier in emergency care situations, but also in planned care situations. Another barrier was the interpreter's ability to correctly interpret medical/care terminology. There were significant differences in evaluating the interpreters' abilities between those with/without education in using interpreters, and between Medical Doctors and Nursing Assistants. Participants were unsure whether the patient had received the correct information and thought that it was difficult to control the family/patient's understanding of the given information. The vast majority did not perceive financial constraints as a barrier for using interpreters. CONCLUSIONS Economic resources and legislation are not enough to increase the use of interpreters. Reasons for not using interpreters are found in limitations of time, training, and interpreters' skills and knowledge. PRACTICE IMPLICATIONS There is a need for a greater focus on training, interpreters' skills, and booking procedures in paediatric healthcare.
Collapse
Affiliation(s)
| | - Elisabet Tiselius
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden; Department of Swedish Language and Multilingualism, Stockholm University, Stockholm, Sweden.
| | - Pernilla Pergert
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden.
| |
Collapse
|
4
|
de Voogd X, Willems DL, Onwuteaka-Philipsen B, Torensma M, Suurmond JL. Health care staff's strategies to preserve dignity of migrant patients in the palliative phase and their families. A qualitative study. J Adv Nurs 2021; 77:2819-2830. [PMID: 33755223 DOI: 10.1111/jan.14829] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Revised: 02/13/2021] [Accepted: 03/05/2021] [Indexed: 11/28/2022]
Abstract
AIMS To determine registered nurses' and care assistants' difficulties and strategies for preserving dignity of migrant patients in the last phase of life and their families. BACKGROUND Preserving dignity of patients in a palliative phase entails paying attention to the uniqueness of patients. Migrant patients often have particular needs and wishes that care staff find difficult to address, or meet, and hence the patient's dignity might be at stake. METHODS We performed five focus group discussions with care staff and one with key figures with diverse ethnic backgrounds in the Netherlands (2018-2020). Thematic analysis was used. RESULTS Care staff creatively safeguarded the patient's dignity in daily care by attending to personal needs concerning intimate body care and providing non-verbal attention. Care staff had difficulties to preserve dignity, when the patient's family engaged themselves in the patient's choices or requests. According to care staff, the interference of family impeded the patient's quality of life or threatened the patient's dignity in the last days, or family member's choices (seemingly) prevailed over the patient's wishes. Care staff safeguarded dignity by catering to cultural or religious practices at the end of life and employing cultural knowledge during decision making. Key figures emphasized to make decisions with patient and family together and to listen more carefully to what patients mean. Bypassing family was experienced as harmful, and repetitively informing family, about, for example, the patient's disease or procedures in the nursing home, was experienced as ineffective. CONCLUSION To preserve the patient's dignity, attention is needed for relational aspects of dignity and needs of family, next to patients' individual needs. IMPACT Care staff should be supported to employ strategies to engage family of migrant patients, by, for example, acknowledging families' values, such as giving good care to the patient and the importance of religious practices for dignity.
Collapse
Affiliation(s)
- Xanthe de Voogd
- Amsterdam UMC, Department of Public & Occupational Health, Amsterdam Public Health Research Institute, University of Amsterdam, Amsterdam, Netherlands
| | - Dick L Willems
- Amsterdam UMC, Department of Ethics, Law and Humanities, Amsterdam UMC Expertise Center for Palliative Care and Amsterdam Public Health Research Institute, Amsterdam, Netherlands
| | - Bregje Onwuteaka-Philipsen
- Amsterdam UMC, Department of Public & Occupational Health, Amsterdam UMC Expertise Center for Palliative Care and Amsterdam Public Health Research Institute, Amsterdam, Netherlands
| | - Marieke Torensma
- Amsterdam UMC, Department of Public & Occupational Health, Amsterdam Public Health Research Institute, University of Amsterdam, Amsterdam, Netherlands
| | - Jeanine L Suurmond
- Amsterdam UMC, Department of Public & Occupational Health, Amsterdam Public Health Research Institute, University of Amsterdam, Amsterdam, Netherlands
| |
Collapse
|
5
|
Duque PA, Betancur Manrique Y, Franco Galvis A, Hoyos Castañeda M, Valencia Hernández EE. Afrontamiento de docentes de enfermería ante la muerte del paciente en unidades de cuidado crítico. INVESTIGACIÓN EN ENFERMERÍA: IMAGEN Y DESARROLLO 2021. [DOI: 10.11144/javeriana.ie22.adem] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Abstract
Introducción. La muerte es un fenómeno que preocupa a la humanidad, por tanto, es objeto de cuidado por enfermería como parte de las competencias inherentes a la disciplina. Objetivo. Describir el nivel de afrontamiento de las enfermeras frente a la muerte de pacientes en unidades de cuidado crítico. Método. Estudio piloto observacional, de tipo descriptivo transversal, con método de muestreo probabilístico, teniendo en cuenta el número de enfermeras que se desempañaban como docentes de enfermería en el área de cuidado crítico de cuatro universidades de Pereira y Manizales (n = 30). Se aplicó encuesta autoadministrada, elaborada por las investigadoras, con datos sociodemográficos, curriculares y del perfil docente. Para evaluar el nivel de afrontamiento, se utilizó la escala de Bugen de afrontamiento de la muerte, validada al castellano. Resultados. El 100% de docentes de enfermería tuvo una experiencia cercana a la muerte con algún ser querido, y el 73.3% no había tenido ninguna preparación como enfermera acerca de la muerte, lo que se puso de manifiesto según la escala de Bugen, donde el 36.8% (n = 11) de la población puntuó por debajo del percentil 33, el 33.4% (n = 10) de la población por encima del percentil 66, y el 29.9% (n = 9) puntuó en la zona intermedia. Conclusión. Las enfermeras necesitan mejorar su nivel de afrontamiento ante la muerte, mediante una formación sólida en cuidados integrales al final de la vida y el buen morir, para lograr competencias específicas que puedan ser enseñadas en los actos docentes de manera consciente.
Collapse
|
6
|
Schouten BC, Cox A, Duran G, Kerremans K, Banning LK, Lahdidioui A, van den Muijsenbergh M, Schinkel S, Sungur H, Suurmond J, Zendedel R, Krystallidou D. Mitigating language and cultural barriers in healthcare communication: Toward a holistic approach. PATIENT EDUCATION AND COUNSELING 2020; 103:S0738-3991(20)30242-1. [PMID: 32423835 DOI: 10.1016/j.pec.2020.05.001] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/30/2019] [Revised: 04/28/2020] [Accepted: 05/01/2020] [Indexed: 06/11/2023]
Abstract
Due to ongoing globalization and migration waves, healthcare providers are increasingly caring for patients from diverse cultural and/or ethnic minority backgrounds. Adequate health communication with migrants and ethnic minorities is often more difficult to establish compared to people belonging to the majority groups of a given society, because of a combination of language and cultural barriers. To address this topic, in December 2018 a symposium was organized-under the auspices of the Amsterdam Center for Health Communication-during which speakers from both academia and professional practice discussed the current state-of-the-art and brought forward innovative solutions to improve intercultural communication in healthcare. Main questions that were discussed during this symposium included: "How can language barriers in intercultural health communication be mitigated?" and "Which innovations can contribute to improving intercultural health communication?" In this paper, we discuss some answers to these questions and propose that in order to enhance intercultural communication and healthcare for migrant and ethnic minority patients, a more holistic approach to studying when, how, and for what purposes (a combination of) communication strategies should be utilized in mitigating both language and cultural barriers to decrease health disparities and improve health care for migrant and ethnic minority patients.
Collapse
Affiliation(s)
- Barbara C Schouten
- Amsterdam School of Communication Research/ASCoR, University of Amsterdam, the Netherlands.
| | - Antoon Cox
- Interpreting Studies, Antwerp Campus, KU, Leuven, Belgium.
| | - Gözde Duran
- Expertise Centre Dementia for Professionals, University College Windesheim, the Netherlands.
| | - Koen Kerremans
- Department of Linguistics & Literary Studies, Free University Brussels, Belgium.
| | | | - Ali Lahdidioui
- Dutch Association Moroccan Physicians [AMAN], the Netherlands.
| | - Maria van den Muijsenbergh
- Radboud University Medical Centre, Department of Primary and Community Care Health Disparities Group, Nijmegen, the Netherlands; Pharos, Centre of Expertise on Health Disparities, Utrecht, the Netherlands.
| | - Sanne Schinkel
- Amsterdam School of Communication Research/ASCoR, University of Amsterdam, the Netherlands.
| | - Hande Sungur
- Amsterdam School of Communication Research/ASCoR, University of Amsterdam, the Netherlands.
| | - Jeanine Suurmond
- Department of Social Medicine, Amsterdam University Medical Centre, the Netherlands.
| | - Rena Zendedel
- Department of Languages, Literature and Communication, Utrecht University, the Netherlands.
| | | |
Collapse
|
7
|
Relational autonomy: what does it mean and how is it used in end-of-life care? A systematic review of argument-based ethics literature. BMC Med Ethics 2019; 20:76. [PMID: 31655573 PMCID: PMC6815421 DOI: 10.1186/s12910-019-0417-3] [Citation(s) in RCA: 76] [Impact Index Per Article: 15.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2019] [Accepted: 10/10/2019] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Respect for autonomy is a key concept in contemporary bioethics and end-of-life ethics in particular. Despite this status, an individualistic interpretation of autonomy is being challenged from the perspective of different theoretical traditions. Many authors claim that the principle of respect for autonomy needs to be reconceptualised starting from a relational viewpoint. Along these lines, the notion of relational autonomy is attracting increasing attention in medical ethics. Yet, others argue that relational autonomy needs further clarification in order to be adequately operationalised for medical practice. To this end, we examined the meaning, foundations, and uses of relational autonomy in the specific literature of end-of-life care ethics. METHODS Using PRESS and PRISMA procedures, we conducted a systematic review of argument-based ethics publications in 8 major databases of biomedical, philosophy, and theology literature that focused on relational autonomy in end-of-life care. Full articles were screened. All included articles were critically appraised, and a synthesis was produced. RESULTS Fifty publications met our inclusion criteria. Twenty-eight articles were published in the last 5 years; publications were originating from 18 different countries. Results are organized according to: (a) an individualistic interpretation of autonomy; (b) critiques of this individualistic interpretation of autonomy; (c) relational autonomy as theoretically conceptualised; (d) relational autonomy as applied to clinical practice and moral judgment in end-of-life situations. CONCLUSIONS Three main conclusions were reached. First, literature on relational autonomy tends to be more a 'reaction against' an individualistic interpretation of autonomy rather than be a positive concept itself. Dichotomic thinking can be overcome by a deeper development of the philosophical foundations of autonomy. Second, relational autonomy is a rich and complex concept, formulated in complementary ways from different philosophical sources. New dialogue among traditionally divergent standpoints will clarify the meaning. Third, our analysis stresses the need for dialogical developments in decision making in end-of-life situations. Integration of these three elements will likely lead to a clearer conceptualisation of relational autonomy in end-of-life care ethics. This should in turn lead to better decision-making in real-life situations.
Collapse
|
8
|
Cicolello K, Anandarajah G. Multiple Stakeholders' Perspectives Regarding Barriers to Hospice Enrollment in Diverse Patient Populations: A Qualitative Study. J Pain Symptom Manage 2019; 57:869-879. [PMID: 30790720 DOI: 10.1016/j.jpainsymman.2019.02.012] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2018] [Revised: 02/13/2019] [Accepted: 02/13/2019] [Indexed: 11/23/2022]
Abstract
CONTEXT Although studies show disparities in hospice care utilization, many questions remain regarding the causes of these disparities. Most studies focus on a single ethnic/racial group, and most use physician informants. None compare and contrast views of multiple stakeholders or use a systems approach within a single geographic region. OBJECTIVES To gain an in-depth understanding of causes of hospice enrollment disparities in diverse patient populations within one state in the U.S. METHODS We conducted in-depth, individual interviews with multiple stakeholders in hospice care for diverse communities in Rhode Island. We identified participants through purposeful and snowball sampling strategies, aiming for a maximum variation sample. Interviews were audio-recorded, transcribed verbatim, and analyzed using a multistep grounded theory approach. RESULTS Participants, self-identifying from a wide variety of ethnic backgrounds, included physicians, nurses, social workers, chaplains, nursing assistants, administrators, and caregivers. Five themes emerged regarding patient- and provider-level barriers to hospice enrollment: 1) universal challenges of goals of care (GOC) conversations; 2) cultural norms and beliefs; 3) language barriers; 4) provider-specific challenges; and 5) trust. In minority populations, the central theme of GOC conversation challenges was intensified by the other four themes. Suggested solutions included 1) increased palliative care training; 2) "cultural interpreters" from local communities; 3) specially trained "GOC language interpreters"; 4) improved workforce diversity; and 5) community-level advocacy. CONCLUSION The disparity in hospice enrollment among diverse patient populations is a complex and nuanced problem, involving numerous interrelated barriers. Addressing this disparity will require innovative solutions at multiple levels.
Collapse
Affiliation(s)
- Katherine Cicolello
- The Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Gowri Anandarajah
- The Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA; Hope Hospice and Palliative Care Rhode Island, Providence, Rhode Island, USA.
| |
Collapse
|