Yilu Ma, MS, MA, CMI, director, Interpreter Services
Once a month, from January to June, you could find a room full of medical interpreters and palliative care clinicians, including physicians, nurse practitioners, social workers and spiritual care providers, sharing a hot lunch and passionate conversations as they worked together to improve care for patients and families with language barriers and hearing impairments.
This unprecedented series was spearheaded by Janet L. Abrahm, MD, FACP, FAAHPM, division chief for the Adult Palliative Care Program of Dana-Farber/Brigham and Women’s Cancer Center, and Jessica Goldhirsch, MPH, MSW, LCSW, a clinical social worker in Care Coordination and the Adult Palliative Care Consult Service. Abrahm and Goldhirsch collaborated with Marta Solis, MBA, a Spanish medical interpreter and training coordinator, to promote mutual understanding and exchange of ideas about palliative care between medical interpreters and palliative care providers.
During the educational series, role-playing was often used to practice new behaviors leading to improved collaboration between the interpreters and clinicians. The following is just one example of a conversation before a family meeting.
Oncologist: “We want to tell the patient the cancer has spread. We’re going to make sure the patient understands this development and ask her to make some decisions.”
Interpreter: “I think we should talk to her daughter first. Otherwise, the daughter would be very upset.”
Oncologist: “My worry is that we have to make decisions about resuscitation. We want to know what the patient feels about her quality of life. I understand that I should not tell her what her prognosis is because it’s disrespectful in Chinese culture to do so. But don’t we need to hear from her?”
Interpreter: “It’s very important to have the patient’s voice heard, but I suggest we talk to her family member first.”
Oncologist: “Could you or someone from the care team help me figure out how to best approach the daughter?”
Medical interpreters primarily function as language conduits between providers and patients with language barriers or hearing impairments. But increasingly, health care providers understand that interpretation alone is not sufficient for culturally competent health care. Providers are making space for medical interpreters to engage in cultural mediation where an interpreter clarifies and advises on cultural considerations at pre-meetings and debriefings.
Interpreters often find themselves having to balance between providers with tightly-held principles of patient autonomy, individual choices and decisions, informed consent and truth-telling, and patients and families who find these principles at odds with their beliefs, decision-making processes and practices. Some families make health care decisions together and find it difficult when providers ask patients to make decisions or to appoint a health care proxy.
Family meetings are sometimes convened in a rush due to urgency, without key members of the family present. This causes frustration among the patient’s family. In such situations, interpreters are needed to bridge cultural differences, helping to achieve better outcomes.
Following the dialogue series, members of Interpreter Services and the Adult Palliative Care Program expressed their appreciation for each other and for the valuable practical guidance they gained to better deliver more culturally appropriate care, together.