HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:
Guest Access | Sign In via User Name/Password

This Article Full Text (PDF) Submit a response Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to My Personal Article Archive Download to citation manager Google Scholar Articles by Pham, K. Articles by Curtis, J. R. PubMed PubMed Citation Articles by Pham, K. Articles by Curtis, J. R.

Alterations During Medical Interpretation of ICU Family Conferences that Interfere with or Enhance Communication

¹Department of Emergency Medicine, Kern Medical Center, Bakersfield, CA ²Center for Reducing Health Disparities, Division of Pulmonary and Critical Care, MetroHealth Medical Campus of Case Western Reserve University, Cleveland, OH ³Division of Pulmonary and Critical Care, Department of Medicine, School of Medicine, University of Washington, Seattle, WA ⁴Division of General Internal Medicine, Department of Medicine, School of Medicine, University of Washington, Seattle, WA

jrc{at}u.washington.edu

Abstract

Rationale: Many family conferences in the ICU occur with 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.

Objectives: 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 2 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 portions of the audiotaped conferences. We identified interpretation alterations, grouped them into four types, and categorized their potential effects on communication.

Results: For interpreted exchanges 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 potential negative effects included interference with 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 improve communication with family members during ICU family conferences.

Key Words: communication • end-of-life care • dying • death • palliative care • cross-cultural • limited English proficiency • family