Skip to main content

Advertisement

Log in

Understanding patient needs without understanding the patient: the need for complementary use of professional interpreters in end-of-life care

  • Short Communication
  • Published:
Medicine, Health Care and Philosophy Aims and scope Submit manuscript

Abstract

High-quality doctor-patient communication in end-of-life care results in better quality of life for patients. In linguistically and culturally diverse societies, language discordant consultations become daily practice, leading to difficulties in eliciting patient preferences toward end-of-life care. Although family members invariably act as informal interpreters, this may cause some ethical dilemmas. We present a case of a palliative patient whose son acted as an interpreter. This case generated a triple- layered ethical dilemma: (i) how to safeguard patient autonomy against paternalistic interventions by family members, (ii) how to respect the relational context in which patient autonomy can be realized, and (iii) how to respect the ethno-cultural values of the patient and his family. These issues are being discussed and reflected upon within the framework shared decision making involving informal- and professional interpreters. The complementary use of professional interpreters next to family members acting as informal interpreters is recommended.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

References

  • Angelelli, C.V. 2004. Medical interpreting and cross-cultural communication. Cambridge: Cambridge University Press.

    Book  Google Scholar 

  • Bauer, A.M., and Margarita Alegria. 2010. Impact of patient language proficiency and interpreter service use on the quality of psychiatric care: A systematic review. Psychiatric Services 61 (8): 765–773.

    Article  Google Scholar 

  • Benkel, Inger, H. Wijk, and U. Molander. 2009. Family and friends provide most social support for the bereaved. Palliative Medicine 23 (2): 141–149.

    Article  Google Scholar 

  • Bischoff, Alexander, Thomas V. Perneger, Patrick A. Bovier, Louis Loutan, and Hans Stalder. 2003. Improving communication between physicians and patients who speak a foreign language. The British Journal of General Practice 53: 541–546.

    Google Scholar 

  • Black, Jill D., and Larry D. Purnell. 2002. Cultural competence for the physical therapy professional. Journal of Physical Therapy Education 16 (1): 3–10.

    Google Scholar 

  • Butow, Phyllis N., Elizabeth Lobb, Michael Jefford, David Goldstein, Maurice Eisenbruch, Afaf Girgis, Madeleine King, Ming Sze, Lynley Aldridge, and Penelope Schofield. 2012. A bridge between cultures: Interpreters’ perspectives of consultations with migrant oncology patients. Supportive Care in Cancer 20 (2): 235–244.

    Article  Google Scholar 

  • Butow, N. Phyllis, Ming Sze, Maurice Eisenbruch, Melaine L. Bell, Lynley J. Aldridge, Sarah Abdo, Michelle Tanious, Skye Dong, Rick Iedema, Janette Vardy, Rina Hui, Francis Boyle, Winston Liauw, and David Goldstein. 2013. Should culture affect practice? A comparison of prognostic discussions in consultations with immigrant versus native-born cancer patients. Patient Education and Counseling 92: 246–252.

    Article  Google Scholar 

  • Clayton, M. Josephine, Butow N. Phyllis, and Martin H.N. Tattersall. 2005. The needs of terminally ill cancer patients versus those of caregivers for information regarding prognosis and end-of-life issues. Cancer 103 (9): 1957–1964.

    Article  Google Scholar 

  • Crawley, M. Lavera. 2005. Racial, cultural, and ethnic factors influencing end-of-life care. Journal of Palliative Medicine 8 (Suppl 1): 58–69.

    Google Scholar 

  • Crawley, M. Lavera, Patricia A. Marshall, Bernard Lo, and Barbara A. Koening. 2002. Strategies for culturally effective end-of-life care. Annals of Internal Medicine 136: 673–679.

    Article  Google Scholar 

  • Delany, M. Clare. 2005. Respecting patient autonomy and obtaining their informed consent: Ethical theory–missing in action. Physiotherapy 91 (4): 197–203.

    Article  Google Scholar 

  • Dening, H. Karen, Louise Jones, and Elizabeth L. Sampson. 2013. Preferences for end-of-life care: A nominal group study of people with dementia and their family givers. Palliative Medicine 27 (5): 409–417.

    Article  Google Scholar 

  • Detering, M. Karen, Andrew D. Hancock, Michael C. Reade, and William Silvester. 2010. The impact of advance care planning on end of life care in elderly patients: Randomised controlled trial. The British Medical Journal 340: c1345.

    Article  Google Scholar 

  • Dworkin, Gerald. 1972. Paternalism. The Monist 56 (1): 64–85.

    Article  Google Scholar 

  • Flores, Glenn. 2005. The impact of medical interpreter services on the quality of healthcare: A systematic review. Medical Care Research and Review 62 (3): 255–299.

    Article  Google Scholar 

  • Giannousi, Zoe, Evangelos C. Karademas, and Georiga Dimitraki. 2016. Illness representations and psychological adjustment of Greek couples dealing with a recently-diagnosed cancer: Dyadic, interaction and perception-dissimilarity effect. Journal of Behavioral Medicine 39 (1): 85–93.

    Article  Google Scholar 

  • Goldstein, D., B. Thewes, and Phyllis N. Butow. 2002. Communicating in a multicultural society II: Greek community attitudes towards cancer in Australia. Internal Medicine Journal 32: 289–296.

    Article  Google Scholar 

  • Hagerty, G. Rebecca, Phyllis N. Butow, Peter A. Ellis, Elizabeth A. Lobb, Susan Pendlebury, Natasha Leighl, David Goldstein, Sing Kai Lo, and Martin H.N. Tattersall. 2004. Cancer patient preferences for communication of prognosis in the metastatic setting. Journal of Clinical Oncology 22 (9): 1721–1730.

    Article  Google Scholar 

  • Hagerty, G. Rebecca, Phyllis N. Butow, Peter Ellis, Dimitry, S., and M.H.N. Tattersall. 2005. Communicating prognosis in cancer care: A systematic review of the literature. Annals of Oncology 16 (7): 1005–1053.

    Article  Google Scholar 

  • Haroon-Iqbal, H., D. Field, H. Parker, and Z. Iqbal. 1995. Palliative care services for ethnic groups in Leicester. International Journal of Palliative Nursing 1: 114–116.

    Google Scholar 

  • Heyland, K. Daren, Diane E. Allan, Graeme Rocker, Peter Dodek, Deb Pinchora, Amiram Gafni, and Canadian Researchers at the End-of-Life Network (CARENET). 2009. Discussing prognosis with patients and their families near the end-of-life: Impact on satisfaction with end-of-life care. Open Medicine 3 (2): e101–e110.

    Google Scholar 

  • Holroyd, Jules. 2009. Relational autonomy and paternalistic interventions. Res Publica 15: 321–336.

    Article  Google Scholar 

  • Horvat, Lidia, Dell Horey, Panayiota Romios, and John Kis-Rigo. 2014. Cultural competence education for health professionals. Cochrane Database Systematic Review, 5: p. CD009405.

    Google Scholar 

  • Huang, X., Phyllis Butow, B. Meiser, and David Goldstein. 1999. Attitudes and information needs of Chinese migrant cancer patients and their relatives. Australian and New Zealand Journal of Medicine 29: 207–213.

    Article  Google Scholar 

  • Hwang, S. Shirley, Victor T. Chang, Yvette Alejandro, Pamela Osenenko, Davis Casaundra, Janet Cogswell, Shanthi Srinivas, and Basil Kasimis. 2003. Caregiver unmet needs, burden, and satisfaction in symptomatic advanced cancer patients at a Veterans Affairs (VA) medical center. Palliative Support Care 1 (4): 319–329.

    Article  Google Scholar 

  • McNamara, Beverley, Karen Martin, Charles Waddell, and Kevin Yuen. 1997. Palliative care in a multicultural society: Perceptions of health care professionals. Palliative Medicine 11 (5): 359–367.

    Article  Google Scholar 

  • Mitchison, Debbie, Phyllis Butow, Ming Sze, Lynley Aldridge, Rina Hui, Janette Vardy, Melaine Eisenbruch, Rick Iedema, and David Goldstein. 2012. Prognostic communication preferences of migrant patients and their relatives. Psycho-oncology 21 (5): 496–504.

    Article  Google Scholar 

  • Mystakidou, Kyriaki, Christina Liossi, Lambros Vlachos, and Joannis Papadimitriou. 1996. Disclosure of diagnostic information to cancer patients in Greece. Palliative Medicine 10 (3): 195–200.

    Article  Google Scholar 

  • Norris, Wendi M., Marjorie D. Wenrich, Elizabeth L. Nielsen, Patsy D. Treece, Carey J. Jackson, and Randall J. Curtis. 2005. Communication about end-of-life care between language-discordant patients and clinicians: Insights from medical interpreters. Journal of Palliative Medicine 8 (5): 1016–1024.

    Article  Google Scholar 

  • O’Neill, J. 1994. Ethnic minorities—neglected by palliative care providers? Journal of Cancer Care 3: 215–220.

    Google Scholar 

  • Park, Elyse, Joseph Betancourt, Elizabeth Miller, Michael Nathan, Ellie MacDonald, Owusu Ananeh-Firempong 2nd, and Valerie Stone. 2006. Internal medicine residents’ perceptions of cross-cultural training. Barriers, needs, and educational recommendations. Journal of General Internal Medicine 21: 476–480.

    Article  Google Scholar 

  • Parker, M. Sharon, Josephine M. Clayton, Karen Hancock, Sharon Walder, Phyllis N. Butow, Sue Carrick, David Currow, Davina Ghersi, Paul Glare, Rebecca Hagerty, and Martin H. Tattersall. 2007. A systematic review of prognostic/end-of-life communication with adults in the advanced stages of a life-limiting illness: Patient/caregiver preferences for the content, style, and timing of information. Journal of Pain and Symptom Management 34 (1): 81–93.

    Article  Google Scholar 

  • Rahmani, Azad, Akram Ghahramanian, and Atefeh Alahbakhshian. 2010. Respecting to patients’ autonomy in viewpoint of nurses and patients in medical-surgical wards. Iranian Journal of Nursing and Midwifery Research 15 (1): 14–19.

    Google Scholar 

  • Repetto, Lazzaro, Pierluca Piselli, Mimma Raffaele, and Carola Locatelli. 2009. Communicating cancer diagnosis and prognosis: When the target is the elderly patient—a GIOGer study. European Journal of Cancer 45: 374–383.

    Article  Google Scholar 

  • Sandman, Lars, and Christian Munthe. 2010. Shared decision making, paternalism and patient choice. Health Care Analysis 18 (1): 60–84.

    Article  Google Scholar 

  • Sheldon, Frances. 1995. Will the doors open? Multicultural issues in palliative care. Palliative Medicine 9 (2): 89–90.

    Article  Google Scholar 

  • Silva, D. Milagros, Margaux Genoff, Alexandra Zaballa, Sarah Jewell, Stacy Stabler, Francesca M. Gany, and Lisa C. Diamond. 2016. 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. Journal of Pain and Symptom Management 51 (3): 569–580.

    Article  Google Scholar 

  • Smith, K. Alexander, Rebecca L. Sudore, and Eliseo J. Perez-Stable. 2009. Palliative care for Latino patients and their families: Whenever we prayed, she wept. The Journal of the American Medical Association 301: 1047–1057.

    Article  Google Scholar 

  • Surbone, Antonella. 2008. Cultural aspects of communication in cancer care. Supportive Care in Cancer 16: 235–240.

    Article  Google Scholar 

  • Vaught, Wayne. 2003. A moral framework for multicultural education in healthcare. Theoretical Medicine and Bioethics 24 (4): 301–328.

    Article  Google Scholar 

  • Vidaeff, Alex C., Anthony J. Kerrigan, and Manju Monga. 2015. Cross-cultural barriers to health care. Southern Medical Journal 108 (1): 1–4.

    Article  Google Scholar 

  • Walczak, Adam, Phyllis N. Butow, Patricia M. Davidson, Frances A. Bellemore, Martin H.N. Tattersall, Josephine M. Clayton, Jane Young, Benjamin Mazer, Susan Ladwig, and Ronald M. Epstein. 2013. Patient perspectives regarding communication about prognosis and end-of-life issues: How can it be optimized? Patient Education and Counseling 90 (3): 307–314.

    Article  Google Scholar 

  • Wang, Xiaohui, Youyi Huang, Lalit Radha Krishna, and Rukshni Puvanendran. 2016. Role of the nasogastric tube and lingzhi (Ganoderma lucidum) in palliative care. Journal of Pain and Symptom Management 51 (4): 794–799.

    Article  Google Scholar 

  • Wright, A. Alexi, Baohui Zhang, Alaka Ray, Jennifer W. Mack, Elizabeth Trice, Tracy Balboni, Susan L. Mitchell, Vicki A. Jackson, Susan D. Block, Paul K. Maciejewski, and Holly G. Prigerson. 2008. Associations between end-of-life discussions, patient mental health, medical care near death, and caregiver bereavement adjustment. The Journal of the American Medical Association 300: 1665–1673.

    Article  Google Scholar 

  • Zhang, Baohui, Alexi A. Wright, Haiden A. Huskamp, Matthew E. Nilsson, Matthew L. Maciejewski, Craig C. Earle, Susan D. Block, Paul K. Maciejewski, and Holly G. Prigerson. 2009. Health care costs in the last week of life: Associations with end-of-life conversations. Archives of Internal Medicine 169 (5): 480–488.

    Article  Google Scholar 

Download references

Funding

No funding was received for this work.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Demi Krystallidou.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Krystallidou, D., Devisch, I., Van de Velde, D. et al. Understanding patient needs without understanding the patient: the need for complementary use of professional interpreters in end-of-life care. Med Health Care and Philos 20, 477–481 (2017). https://doi.org/10.1007/s11019-017-9769-y

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11019-017-9769-y

Keywords

Navigation