title: Communication about end-of-life care between language-discordant patients and clinicians: insights from medical interpreters.
abstract: BACKGROUND
  Communication about health care and especially end-of-life care is difficult for clinicians and patients when they do not speak the same language. Our purpose was to improve understanding of how to approach discussions between language-discordant patients and clinicians about terminal or life-threatening illness.
  
  
  METHODS
  We conducted a qualitative study with 4 focus groups with 43 professional medical interpreters. We asked open-ended questions concerning physician and interpreter communication about end-of-life care. Focus groups were audiotaped, transcribed, and analyzed using principles of grounded theory. Results were presented to an additional 3 focus groups with 25 medical interpreters to ensure that analyses represented interpreters' perspectives.
  
  
  RESULTS
  We developed 3 frameworks for understanding high-quality language-discordant communication about end-of-life care. The first framework addresses physician and interpreter professionalism, including humanistic qualities and emotional support capabilities important for high quality care. The second framework is physician-centered and highlights communication skills, as well as coordination with other providers and cultural sensitivity. The third framework is interpreter-centered, focusing on role conflicts, including struggles concerning expectations to provide strict interpretation versus being a cultural broker. Interpreters' recommendations for improving quality of this care include pre-meetings with interpreters before encounters involving delivery of bad news and explicit discussions with interpreters about whether the clinician expects strict interpretation or cultural brokering.
  
  
  CONCLUSIONS
  These results provide insights for physicians about how to improve end-of-life discussions with language-discordant patients and their families. Interpreter recommendations provide physicians and health care organizations with specific tools that may improve quality of communication about end-of-life discussions.
authors.affiliation: Division of Pulmonary and Critical Care, Department of Medicine, School of Medicine University of Washington, Seattle, Washington 98104, USA.
authors.forename: Wendi M
authors.initials: WM
authors.lastname: Norris
authors.forename: Marjorie D
authors.initials: MD
authors.lastname: Wenrich
authors.forename: Elizabeth L
authors.initials: EL
authors.lastname: Nielsen
authors.forename: Patsy D
authors.initials: PD
authors.lastname: Treece
authors.forename: J Carey
authors.initials: JC
authors.lastname: Jackson
authors.forename: J Randall
authors.initials: JR
authors.lastname: Curtis
mesh_terms: D000328:Adult; D003144:Communication Barriers; D005260:Female; D017144:Focus Groups; D006801:Humans; D007802:Language; D008297:Male; D008875:Middle Aged; D017060:Patient Satisfaction; D010817:Physician-Patient Relations; D011787:Quality of Health Care; D013727:Terminal Care / Q000523:psychology / Q000592:standards*; D014481:United States