title: Alterations during medical interpretation of ICU family conferences that interfere with or enhance communication.
abstract: BACKGROUND
  Many conferences in the ICU occur with the families of patients with limited English proficiency, requiring a medical interpreter. Despite the importance of medical interpretation, little is known about the alterations that occur and their effect on communication.
  
  
  OBJECTIVE
  This study characterizes the types, prevalence, and potential effects of alterations in interpretation during ICU family conferences involving end-of-life discussions.
  
  
  METHODS
  We identified ICU family conferences in two hospitals in which a medical interpreter was used. Ten conferences were audiotaped; 9 physicians led these conferences, and 70 family members participated. Research interpreters different from those attending the conference translated the non-English language portions of the audiotaped conferences. We identified interpretation alterations, grouped them into four types, and categorized their potential effects on communication.
  
  
  RESULTS
  For each interpreted exchange between clinicians and family, there was a 55% chance that an alteration would occur. These alterations included additions, omissions, substitutions, and editorializations. Over three quarters of alterations were judged to have potentially clinically significant consequences on the goals of the conference. Of the potentially significant alterations, 93% were likely to have a negative effect on communication; the remainder, a positive effect. The alterations with potentially negative effects included interference with the transfer of information, reduced emotional support, and reduced rapport. Those with potential positive effects included improvements in conveying information and emotional support.
  
  
  CONCLUSIONS
  Alterations in medical interpretation seem to occur frequently and often have the potential for negative consequences on the common goals of the family conference. Further studies examining and addressing these alterations may help clinicians and interpreters to improve communication with family members during ICU family conferences.
authors.affiliation: Department of Emergency Medicine, Kern Medical Center, Bakersfield, CA, USA.
authors.forename: Kiemanh
authors.initials: K
authors.lastname: Pham
authors.forename: J Daryl
authors.initials: JD
authors.lastname: Thornton
authors.forename: Ruth A
authors.initials: RA
authors.lastname: Engelberg
authors.forename: J Carey
authors.initials: JC
authors.lastname: Jackson
authors.forename: J Randall
authors.initials: JR
authors.lastname: Curtis
mesh_terms: D003142:Communication; D003144:Communication Barriers; D006801:Humans; D007362:Intensive Care Units; D007802:Language; D010817:Physician-Patient Relations; D011368:Professional-Family Relations; D013727:Terminal Care; D014177:Translations