Translating Pediatric Hospital Interpreters' Feedback From Difficult Conversations into Improved Communication

Lost in translation: a national cross-sectional study on medical interpreter use by pediatric residents

BACKGROUND

Lack of communication in a family's preferred language is inequitable and results in inferior care. Pediatric residents provide care to many families with non-English or French language preferences (NEFLP). There is no data available about how Canadian pediatric residents use interpreters, making it difficult to develop targeted interventions to improve patient experience.

OBJECTIVES

Our purpose was to assess translation services in pediatric training centers and evaluate resident perception of their clinical skills when working with NEFLP patients and families. This survey represents the first collection of data from Canadian pediatric residents about interpreter services.

METHODS

Eligible participants included all pediatric residents enrolled in an accredited Canadian pediatric training program. An anonymous survey was developed in REDCap© and distributed via email to all pediatric residents across Canada. Descriptive statistics were performed in STATA v15.1.

RESULTS

122 residents responded. Interpreter services were widely available but underused in a variety of clinical situations. Most (85%) residents felt they provided better care to patients who shared their primary language (English or French), compared with families who preferred other languages-even when an interpreter was present. This finding was consistent across four self-assessed clinical skills.

CONCLUSIONS

Residents are more confident in their clinical and communication skills when working with families who share their primary language. Our findings suggest that residents lack the training and confidence to provide equal care to families with varying language preferences. Pediatric training programs should develop curriculum content that targets safe and effective interpreter use while reviewing non-spoken aspects of cultural awareness and safety.

Distressing Discussions in Pediatric Interpreted Medical Encounters: A Qualitative Study of Medical Interpreter Perspectives on Clinician Communication Practices

INTRODUCTION

This study explores pediatric medical interpreters' perspectives on clinician communication practices in medical encounters characterized by distressing content and difficult discussions.

METHOD

In this interpretative phenomenological analysis, 13 Spanish-English interpreters at a midwestern pediatric hospital were purposively recruited and, in 2021-2022, completed a demographic survey and semistructured interview on communication in distressing interpreted medical encounters.

RESULTS

Participants described clinician practices for effective cross-cultural interpreted communication. Practices align with recommendations on prebriefing, debriefing, jargon, stakeholder positioning, and teamwork. Novel findings relate to encounters with multiple parties, multilingual patients with monolingual parents, and coordination among clinicians.

DISCUSSION

Findings corroborate recommendations for interpreted communication best practices, extend them to distressing pediatric encounters, and offer recommendations for clinicians using interpreting services in distressing encounters. Participants' insights are distilled into a series of clinician best practices for high-quality interpreted communication during difficult discussions and for strengthening language access services in pediatric medical settings.

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

OBJECTIVES

Skilled medical interpreters are essential to providing high-quality, culturally sensitive palliative care and addressing health-care disparities for patients with limited English proficiency (LEP). While the benefits of utilizing medical interpreters are well documented, interpreter roles and experiences in palliative care are unique and poorly defined. This narrative review examines the extant literature on medical interpreters in palliative care to define their unique roles and describe their experiences and recommendations.

METHODS

A narrative literature review was completed through systematically searching the following databases: Medline, Embase, Web of Science, and CINHAL. Title and abstract screening was completed, followed by full-text review.

RESULTS

Ten articles met inclusion criteria and were included in the review. Medical interpreters play several roles in palliative care for patients with LEP including interpreting language and meaning, acting as a cultural broker, and advocating for patients and families. Medical interpreters report being comfortable interpreting palliative care discussions; however, they face challenges in navigating their complex roles and the emotional impact of palliative care encounters. Their recommendations to improved palliative care encounters involving medical interpreters are careful language choice, holding pre- and post-meetings, education for interpreters and health-care professionals, and further integrating the medical interpreter into the interprofessional team.

SIGNIFICANCE OF RESULTS

Medical interpreters play several complex roles when participating in palliative care encounters for patients with LEP. Understanding these roles and the experiences allows medical interpreters to be better integrated into the interprofessional team and enhances the ability to provide quality, culturally sensitive palliative care for patients with LEP. Further research is required to understand how implementing the recommendations of medical interpreters impacts patient outcomes.