Empowering interpreters to partner in palliative care (PC) conversations: Effect of a dialogue-based curriculum.

Abstract

21 Background: 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. But interpreters are rarely included in meetings preceding these conversations, or made aware of the patient’s prognosis or the emotionally-charged subjects likely to arise. They may know the patient and family, cultural norms, and identify the decision makers, but often do not feel empowered to offer this crucial information to clinicians. To be effective cultural brokers, interpreters must be trained in PC terminology and feel empowered to contribute. Methods: 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 confidence in interpreting these conversations. Results: There was a highly significant improvement in interpreter post-course 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. Conclusions: Facilitated and well-structured dialogues, including didactics, discussions and roleplaying caused highly significant improvements in interpreter confidence in interpreting PC conversations.