Empowering Interpreters to Partner in Palliative Care Conversations: Effect of a Dialogue-Based Curriculum on Interpreter Attitudes and Confidence (GP701)

Abstract

•Design a 6-session curriculum for their practice site to improves dialogues with face-to-face interpreters who partner with them in conducting palliative care conversations with patients and their families with limited English proficiency.•Plan to overcome barriers in their practice site to conducting the dialogues, identify colleagues to be recruited to join the sessions (e.g. social workers, chaplains), and identify resources needed (e.g. financing lunches or afternoon snacks). Effective communication across cultural and linguistic barriers during breaking bad news, DNR, and EOL conversations requires professional medical interpreters skilled in PC communication and clinicians skilled in working with interpreters. Train interpreters in palliative care (PC) terminology; Train interpreters to be effective cultural brokers during PC conversations; Increase interpreters' sense of empowerment, professionalism, and team membership. A six-session curriculum: “Palliative Care Dialogues with Interpreters”, facilitated by an experienced PC social worker (SW) and physician, was delivered to medical interpreters from Brigham and Women's Hospital and Dana-Farber Cancer Institute. The curriculum included links to relevant materials, and structured 1-hour sessions including role-plays on: Initiating and managing a pre-encounter conference; Family meetings; Terms used in PC meetings; Family meetings to discuss code status and end of life-prolonging therapies; Cultural Mediating; Interpreting for SWs and chaplains (with SW and chaplains doing role plays); and Experiencing being a cultural mediator in End of Life Care. 41 participants completed a 23-question pre- and post-course survey on their attitudes towards and confidence in interpreting for palliative care conversations. There was a highly significant improvement in interpreter post-course attitude (N = 48; p=.0050) and confidence (N = 41. p=1.4080 x 10-11). Facilitated dialogues enabled interpreters to assert concerns, share knowledge, and practice new behaviors in a “safe” space, behaviors they reported they then used in clinical practice. Dialogues provided clinicians an opportunity to learn about the challenging linguistic, cultural and emotional experiences of medical interpreters. Facilitated and well-structured dialogues, including didactics, discussions and roleplaying caused highly significant improvements in interpreter attitudes about and confidence in interpreting PC conversations.