title: Interpreting at the End of Life: A Systematic Review of the Impact of Interpreters on the Delivery of Palliative Care Services to Cancer Patients With Limited English Proficiency.
abstract: BACKGROUND
  Language barriers can influence the health quality and outcomes of limited English proficiency (LEP) patients at end of life, including symptom assessment and utilization of hospice services.
  
  
  OBJECTIVE
  To determine how professional medical interpreters influence the delivery of palliative care services to LEP patients.
  
  
  METHODS
  We conducted a systematic review of the literature in all available languages of six databases from 1960 to 2014. Studies evaluated use of language services for LEP patients who received palliative care services. Data were abstracted from 10 articles and collected on study design, size, comparison groups, outcomes, and interpreter characteristics.
  
  
  RESULTS
  Six qualitative and four quantitative studies assessed the use of interpreters in palliative care. All studies found that the quality of care provided to LEP patients receiving palliative services is influenced by the type of interpreter used. When professional interpreters were not used, LEP patients and families had inadequate understanding about diagnosis and prognosis during goals of care conversations, and patients had worse symptom management at the end of life, including pain and anxiety. Half of the studies concluded that professional interpreters were not used adequately, and several studies suggested that premeetings between clinicians and interpreters were important to discuss topics and terminology to be used during goals of care discussions.
  
  
  CONCLUSIONS
  LEP patients had worse quality of end-of-life care and goals of care discussions when professional interpreters were not used. More intervention studies are needed to improve the quality of care provided to LEP patients and families receiving palliative services.
authors.affiliation: Department of Geriatrics and Palliative Medicine, Weill Cornell Medical Center, New York, New York, USA. Electronic address: mis9202@med.cornell.edu.
authors.forename: Milagros D
authors.initials: MD
authors.lastname: Silva
authors.affiliation: Immigrant Health and Cancer Disparities Service, Department of Psychiatry & Behavioral Sciences, Memorial Sloan-Kettering Cancer Center, New York, New York, USA.
authors.forename: Margaux
authors.initials: M
authors.lastname: Genoff
authors.affiliation: University of Washington School of Medicine, Seattle, Washington, USA.
authors.forename: Alexandra
authors.initials: A
authors.lastname: Zaballa
authors.affiliation: Medical Library, Memorial Sloan-Kettering Cancer Center, New York, New York, USA.
authors.forename: Sarah
authors.initials: S
authors.lastname: Jewell
authors.affiliation: Department of Palliative Medicine, Memorial Sloan-Kettering Cancer Center, New York, New York, USA.
authors.forename: Stacy
authors.initials: S
authors.lastname: Stabler
authors.affiliation: Department of Healthcare Policy and Research, Weill Cornell Medical Center, New York, New York, USA; Immigrant Health and Cancer Disparities Service, Department of Psychiatry & Behavioral Sciences, Memorial Sloan-Kettering Cancer Center, New York, New York, USA.
authors.forename: Francesca M
authors.initials: FM
authors.lastname: Gany
authors.affiliation: Department of Healthcare Policy and Research, Weill Cornell Medical Center, New York, New York, USA; Immigrant Health and Cancer Disparities Service, Department of Psychiatry & Behavioral Sciences, Memorial Sloan-Kettering Cancer Center, New York, New York, USA; Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, New York, USA.
authors.forename: Lisa C
authors.initials: LC
authors.lastname: Diamond
mesh_terms: D003144:Communication Barriers; D006282:Health Personnel / Q000523:psychology; D006801:Humans; D009369:Neoplasms / Q000523:psychology / Q000628:therapy*; D010166:Palliative Care / Q000379:methods* / Q000523:psychology; D010348:Patient Care Team; D013727:Terminal Care / Q000379:methods* / Q000523:psychology; D014175:Translating
keywords: Cancer; end of life; hospice; interpreter use; limited English proficiency; non-English-speaking patients; palliative care