The content of talk about health conditions and medications during appointments involving interpreters

Equity in access to facial transplantation

We examine ethical considerations in access to facial transplantation (FT), with implications for promoting health equity. As a form of vascularised composite allotransplantation, FT is still considered innovative with a relatively low volume of procedures performed to date by a small number of active FT programmes worldwide. However, as numbers continue to increase and institutions look to establish new FT programmes, we anticipate that attention will shift from feasibility towards ensuring the benefits of FT are equitably available to those in need. This manuscript assesses barriers to care and their ethical implications across a number of considerations, with the intent of mapping various factors relating to health equity and fair access to FT. Evidence is drawn from an evolving clinical experience as well as published scholarship addressing several dimensions of access to FT. We also explore novel concerns that have yet to be mentioned in the literature.

The professional interpreter's effect on empathic communication in medical consultations: A qualitative analysis of interaction

OBJECTIVE

To investigate how empathic communication is expressed in interpreter-mediated consultations (IMCs) and the interpreter's effect on it.

METHODS

We coded 20 authentic video-recorded IMCs by using the Empathic Communication Coding System (ECCS). We compared patient-initiated empathic opportunities (EOs) and doctors' responses as expressed by patients and doctors and as rendered by interpreters.

RESULTS

We identified 44 EOs. In 2 of the 44 EOs there was a close match in the way the EOs were expressed by the patient in the first place and in the way they were rendered by the interpreter. Twenty-four of the 44 EOs that were passed on by the interpreter to the doctor and presented the doctor with an opportunity to respond, came with a shift in meaning and/or intensity. Twenty of the 44 EOs were not passed on by the interpreter to the doctor.

CONCLUSION

In IMCs, EOs are subject to the interpreter's renditions and the doctor's actions during interaction.

PRACTICE IMPLICATIONS

Doctors and interpreters require skills to detect patient cues, assess them correctly, render them completely and in an appropriate manner (interpreters) and display communicative behaviours that take into account the intricacies of interpreter-mediated clinical communication and facilitate each other's communicative goals.

Emotion work in interpreter-mediated consultations: A systematic literature review

OBJECTIVE

To identify the ways in which physicians, patients and interpreters express emotions, react to emotional expressions and/or coordinate the emotional interaction in interpreter-mediated consultations (IMCs).

METHODS

We systematically searched four databases and screened 10 307 articles. The following inclusion criteria were applied: 1) participants are patients with limited proficiency in the host language, physicians and professional interpreters, 2) analysis of patient-physician-interpreter interaction, 3) focus on emotions, 4) in vivo spoken language interpretation, and 5) authentic primary data.

RESULTS

The results of 7 included studies suggest that physicians, patients and interpreters work together and verbally and paraverbally contribute to the co-construction of emotional communication (EC) in IMCs. However, a decrease in EC might still compromise the patient's quality of care in IMCs.

CONCLUSION

There is a dearth of scientific evidence of EC as an interactional process between participants in IMCs. More research on under investigated modes of communication and emotions is needed to advance our understanding. For now, EC seems to be subject to the successful interaction between participants in IMCs.

PRACTICE IMPLICATIONS

Evidence-based curricula of interprofessional education between physicians and interpreters on EC in IMCs could be beneficial to the effective co-construction of EC in IMCS.

Face-to-face communication between patients and family physicians in Canada: A scoping review

OBJECTIVE

Patient-provider communication is critical in primary care. Canada's unique health system, population distribution, and cultural context suggest there is value in addressing the topic in the Canadian context. We conducted a scoping review to synthesize recent Canadian literature to inform practice in primary care settings and identify research agendas for patient-provider communication in Canada.

METHODS

Using Arksey and O'Malley's framework we searched four literature databases: Medline, Web of Science, CINAHL and EMBASE. We extracted 21,932 articles published between 2010 and 2017. A total of 108 articles met the inclusion criteria. The articles were analyzed qualitatively using thematic analysis to identify major themes.

RESULTS

Four major themes were identified: information sharing, relationships, health system challenges, and development and use of communication tools.

CONCLUSION

Our review identified a need for Canadian research regarding: communication in primary care with Aboriginal, immigrant, and rural populations; the impact of medical tourism on primary care; and how to improve communication to facilitate continuity of care.

PRACTICE IMPLICATIONS

Challenges providers face in primary care in Canada include: communicating with linguistically and culturally diverse populations; addressing issues that emerge with the rise of medical tourism; a need for decision aids to improve communication with patients.

Improving the effectiveness of interpreted consultations: Australian interpreter, general practitioner and patient perspectives

Healthcare consultations with patients lacking English proficiency are challenging for all parties, even in Australian primary care where the engagement of interpreters is encouraged and fully subsidised. Our objective was to understand these challenges from the perspectives of interpreters, patients and general practitioners in order to improve the effectiveness of interpreted consultations. Our investigator team approached the interpreted consultation as an interprofessional collaboration. A convenience sample of seven general practitioners, eight health interpreters and six representatives from culturally and linguistically diverse communities (representing the patient perspective) participated in three separate focus group discussions, lasting 60-90 min each, exploring participant experiences with healthcare consultations in which interpreters were present. Two semistructured interviews were undertaken subsequently with three additional community representatives purposively recruited to increase participant diversity. Data were collected in 2016 and analysed inductively using a method of constant comparison to identify, and reach consensus on, key emerging themes. All participant groups emphasised the importance of working with trained interpreters, rather than relying on family interpreters or a doctor's own second language skills. Although participants reported experiences of effective interpreted consultations, other reports suggested that some doctors are unaware of, or have difficulty following, accepted guidelines about speech, gaze and turn-taking. Challenges identified in relation to interpreted consultations fell into the five themes of contextual constraints, consultation complexity, communication difficulties, the interpreter role and collaboration. Some general practitioner participants appeared to be unsure and anxious about the etiquette of interpreted consultations, and there was some confusion between and within participant groups about interpreter roles and professional codes. A briefing session prior to the consultation, clarifying the roles of all parties, including any family or bicultural workers present, may help to establish respectful, flexible and effective interprofessional collaborations and to encourage participants to directly address any problems during the consultation.

Digital communication between clinician and patient and the impact on marginalised groups: a realist review in general practice

BACKGROUND

Increasingly, the NHS is embracing the use of digital communication technology for communication between clinicians and patients. Policymakers deem digital clinical communication as presenting a solution to the capacity issues currently faced by general practice. There is some concern that these technologies may exacerbate existing inequalities in accessing health care. It is not known what impact they may have on groups who are already marginalised in their ability to access general practice.

AIM

To assess the potential impact of the availability of digital clinician-patient communication on marginalised groups' access to general practice in the UK.

DESIGN AND SETTING

Realist review in general practice.

METHOD

A four-step realist review process was used: to define the scope of the review; to search for and scrutinise evidence; to extract and synthesise evidence; and to develop a narrative, including hypotheses.

RESULTS

Digital communication has the potential to overcome the following barriers for marginalised groups: practical access issues, previous negative experiences with healthcare service/staff, and stigmatising reactions from staff and other patients. It may reduce patient-related barriers by offering anonymity and offers advantages to patients who require an interpreter. It does not impact on inability to communicate with healthcare professionals or on a lack of candidacy. It is likely to work best in the context of a pre-existing clinician-patient relationship.

CONCLUSION

Digital communication technology offers increased opportunities for marginalised groups to access health care. However, it cannot remove all barriers to care for these groups. It is likely that they will remain disadvantaged relative to other population groups after their introduction.

Difficulties in using interpreters in clinical encounters as experienced by immigrants living in Sweden

AIMS AND OBJECTIVES

To study a group of immigrants' experiences regarding interactions with primary health care through an interpreter.

BACKGROUND

Approximately, 230 million people are resettled outside of their own home country. Thus, more than 3% of the world's population are migrants. It is a major challenge for health care providers to satisfy immigrants' needs for individualised health care services.

DESIGN

Qualitative study.

METHODS

Focus group interviews were conducted with four groups of immigrants (n = 24) from Bosnia and Herzegovina, Croatia, Kosovo and Somalia. The group interviews were audio recorded, transcribed and analysed, and the text was categorised using the content analysis method.

RESULTS

Participants' expectations of the interpreter-mediated consultations were high, but not always fulfilled. Interpreters being late, lacking professionalism or lacking knowledge in medical terminology and the use of health care professionals or relatives as interpreters were some of the problems raised.

CONCLUSION

A well-organised, disciplined interpreter service with professional and competent interpreters is needed to overcome problems regarding clinical consultations involving interpreters. A satisfactory language bridge has a significant impact on the quality of communications.

CLINICAL IMPLICATION

Interpreter services should be well organised, and interpreters should be linguistically, culturally and socially competent, as these factors may have a significant impact on consultation outcomes. Using relatives or staff as interpreters can sometimes be a solution but often results in an unsatisfactory clinical consultation.

Emotions in primary care: Are there cultural differences in the expression of cues and concerns?

OBJECTIVE

This study compared native-Dutch and Turkish-Dutch patients' expressions of emotional cues/concerns and GPs' responses to these cues/concerns. Relations between patient's cues/concerns and GPs' perceptions of the patient's health complaint were examined too.

METHODS

82 audiotaped encounters with native-Dutch and 38 with Turkish-Dutch GP patients were coded using the VR-CoDES and VR-CoDES-P. Patients filled out a survey before each consultation to assess their cultural identification, Dutch language proficiency and health-related variables. GPs filled out a survey after each consultation to assess their perceptions of the patient's health complaint.

RESULTS

Turkish-Dutch patients expressed more cues than native-Dutch patients, which was explained by higher worries about their health and worse perceived general health. GPs responded more often with space-providing responses to Turkish-Dutch patients compared to native-Dutch patients. Turkish-Dutch patients' cue expression strongly influenced GPs' perceptions about the presence of psychosocial problems.

CONCLUSION

Migrant patient-related factors influence the amount of emotional cue expression in primary care. GPs perceive these cues as indicating the presence of psychosocial problems and provide space for patients to elaborate on their emotional distress.

PRACTICE IMPLICATIONS

GPs should be trained in using more affective communication techniques to enhance elicitation of the underlying reasons for migrant patients' enhanced emotional cue expression.

Interpreter-mediated dentistry

The global movements of healthcare professionals and patient populations have increased the complexities of medical interactions at the point of service. This study examines interpreter mediated talk in cross-cultural general dentistry in Hong Kong where assisting para-professionals, in this case bilingual or multilingual Dental Surgery Assistants (DSAs), perform the dual capabilities of clinical assistant and interpreter. An initial language use survey was conducted with Polyclinic DSAs (n = 41) using a logbook approach to provide self-report data on language use in clinics. Frequencies of mean scores using a 10-point visual analogue scale (VAS) indicated that the majority of DSAs spoke mainly Cantonese in clinics and interpreted for postgraduates and professors. Conversation Analysis (CA) examined recipient design across a corpus (n = 23) of video-recorded review consultations between non-Cantonese speaking expatriate dentists and their Cantonese L1 patients. Three patterns of mediated interpreting indicated were: dentist designated expansions; dentist initiated interpretations; and assistant initiated interpretations to both the dentist and patient. The third, rather than being perceived as negative, was found to be framed either in response to patient difficulties or within the specific task routines of general dentistry. The findings illustrate trends in dentistry towards personalized care and patient empowerment as a reaction to product delivery approaches to patient management. Implications are indicated for both treatment adherence and the education of dental professionals.

Turkish migrant GP patients' expression of emotional cues and concerns in encounters with and without informal interpreters

OBJECTIVE

The aim of this study was to compare patients' expressions of emotional cues and concerns, and GPs' responses during consultations with and without informal interpreters. Furthermore, informal interpreters' expression of emotional cues and concerns and their responses were examined too.

METHODS

Twenty-two audiotaped medical encounters with Turkish migrant patients, eleven with and eleven without an informal interpreter, were coded using the Verona Coding Definitions of Emotional Sequences (VR-CoDES) and the Verona Codes for Provider Responses (VR-CoDES-P).

RESULTS

In encounters with informal interpreters, patients expressed less emotional concerns than in encounters without informal interpreters. Only half of all patients' cues is being translated by the informal interpreter to the GP. Furthermore, 20% of all cues in encounters with informal interpreters is being expressed by the interpreter, independent of patients' expression of emotions.

CONCLUSION

The presence of an informal interpreter decreases the amount of patients' expression of emotional concerns and cues. Furthermore, a substantial amount of cues is being expressed by the informal interpreter, corroborating the often-made observation that they are active participants in triadic medical encounters.

PRACTICE IMPLICATIONS

GPs should be trained in communication strategies that enable elicitation of migrant patients' emotions, in particular in encounters with informal interpreters.

The Patient’s Lifeworld: Building meaningful clinical encounters between patients, physicians and interpreters

In this paper, our objectives are first to explore the different ways physicians and interpreters interact with patients’ Lifeworld, and second, to describe and compare communication patterns in consultations with professional and those with family interpreters. We used a qualitative design and conducted analyses of transcriptions of 16 family practice consultations in Montréal in the presence of interpreters. Patterns of communication are delineated grounded in Habermas’ Communicative Action Theory and Mishler’s operational concepts of Voice of Medicine and Voice of Lifeworld. Four communication patterns emerged: (1) strategically using Lifeworld data to achieve biomedical goals, (2) having an interest in the Lifeworld for itself, (3) integrating the Lifeworld with biomedicine and (4) referring to another professional. Our results suggest physicians engage with patients’ Lifeworld and may benefit from both types of interpreters’ understanding of the patient’s specific situations. A professional interpreter is likely to transmit the patient’s Lifeworld utterances to the physician. A family member, on the other hand, may provide extra biomedical and Lifeworld information, but also prevent the patient’s Lifeworld accounts from reaching the physician. Physicians’ training should include advice on how to work with all type of interpreters and interpreters’ training should include mediation competencies in order to enhance their ability to promote the processes of co-construction of meaning.

Health and prevention among East African women in the U.S

African-born individuals in the U.S. face significant health challenges, including low utilization of preventive screening services. Using a community-based participatory research framework, we describe preliminary efforts at establishing a collaborative relationship with the East African communities of San Diego, identifying salient community health needs, and developing a framework for disseminating information and addressing identified health gaps. To this end, 40 East African-born women participated in focus groups with the purpose of eliciting community perspectives on U.S. health care services, beliefs about preventive screening, and to garner recommendations for future outreach. Qualitative analyses identified participants' desire to engage in primary prevention techniques that incorporated best practices from their home countries and the U.S., and the need for health education programs to provide information on increasingly prevalent chronic diseases. The findings are discussed in connection with continued community-engaged efforts and the implications for health and resettlement policies to reduce inequities disfavoring resettled refugees.

Errors of medical interpretation and their potential clinical consequences: a comparison of professional versus ad hoc versus no interpreters

STUDY OBJECTIVE

To compare interpreter errors and their potential consequences in encounters with professional versus ad hoc versus no interpreters.

METHODS

This was a cross-sectional error analysis of audiotaped emergency department (ED) visits during 30 months in the 2 largest pediatric EDs in Massachusetts. Participants were Spanish-speaking limited-English-proficient patients, caregivers, and their interpreters. Outcome measures included interpreter error numbers, types, and potential consequences.

RESULTS

The 57 encounters included 20 with professional interpreters, 27 with ad hoc interpreters, and 10 with no interpreters; 1,884 interpreter errors were noted, and 18% had potential clinical consequences. The proportion of errors of potential consequence was significantly lower for professional (12%) versus ad hoc (22%) versus no interpreters (20%). Among professional interpreters, previous hours of interpreter training, but not years of experience, were significantly associated with error numbers, types, and potential consequences. The median errors by professional interpreters with greater than or equal to 100 hours of training was significantly lower, at 12, versus 33 for those with fewer than 100 hours of training. Those with greater than or equal to 100 hours of training committed significantly lower proportions of errors of potential consequence overall (2% versus 12%) and in every error category.

CONCLUSION

Professional interpreters result in a significantly lower likelihood of errors of potential consequence than ad hoc and no interpreters. Among professional interpreters, hours of previous training, but not years of experience, are associated with error numbers, types, and consequences. These findings suggest that requiring at least 100 hours of training for interpreters might have a major impact on reducing interpreter errors and their consequences in health care while improving quality and patient safety.