title: 'Don't blame the middle man': an exploratory qualitative study to explore the experiences of translators breaking bad news.
abstract: BACKGROUND
  Healthcare professionals find breaking bad news difficult and upsetting. Increasing cultural diversity has led to a greater number of patients whose first language differs to that of the healthcare provider, with more patients requiring a translator to facilitate communication. Hospitals often ask non-clinical translators to facilitate breaking bad news. We sought to explore the experiences of translators within a specialist oncology centre.
  
  
  METHODS
  Following ethical and governance approvals, semi-structured interviews were undertaken with five translators recruited from the specialist oncology centre. Interviews were audiotaped and transcribed verbatim. The data were analysed thematically, with major themes and subthemes identified.
  
  
  METHODS
  Outpatient setting of a regional cancer centre.
  
  
  METHODS
  Translators serving a regional cancer centre.
  
  
  METHODS
  Qualitative data identified through thematic analysis.
  
  
  RESULTS
  Major themes included the significant emotional impact of translating distressing information, the challenges of accurately conveying information in a culturally congruent format and the need for formal briefing, debriefing and support. Subthemes included feeling guilty for divulging distressing news, being the focus of patients' distress or anger, and feeling in conflict with the patient or family and issues surrounding confidentiality. Translators also felt a strong sense of advocacy for the patients and found encounters with death and dying emotionally challenging.
  
  
  CONCLUSIONS
  The increasing use of translators in the care of patients with advanced cancer is increasingly resulting in lay people being subject to similar emotional pressures faced by clinical staff, yet without the necessary formal training or support mechanisms that are recommended for clinicians. This exploratory study highlights the training and support needs of non-clinical staff as identifying a unique set of communication challenges faced by translators.
authors.affiliation: Department of Palliative Medicine, B6N Royal Gwent Hospital, Cardiff Rd, Newport NP20 2UB, UK.
authors.forename: Joanna
authors.initials: J
authors.lastname: Prentice
authors.affiliation: Department of Palliative Medicine, B6N Royal Gwent Hospital, Cardiff Rd, Newport NP20 2UB, UK.
authors.forename: Annmarie
authors.initials: A
authors.lastname: Nelson
authors.affiliation: Department of Palliative Medicine, B6N Royal Gwent Hospital, Cardiff Rd, Newport NP20 2UB, UK.
authors.forename: Jessica
authors.initials: J
authors.lastname: Baillie
authors.affiliation: Department of Palliative Medicine, B6N Royal Gwent Hospital, Cardiff Rd, Newport NP20 2UB, UK.
authors.forename: Hannah
authors.initials: H
authors.lastname: Osborn
authors.affiliation: Department of Palliative Medicine, B6N Royal Gwent Hospital, Cardiff Rd, Newport NP20 2UB, UK simon.noble@wales.nhs.uk.
authors.forename: Simon
authors.initials: S
authors.lastname: Noble
keywords: breaking bad news; communication; interpreter; translator