Are Good Intentions Good Enough?: Informed Consent Without Trained Interpreters
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To examine the informed consent process when trained language interpreters are unavailable.
Ensuring sufficient patient understanding for informed consent is especially challenging for patients with Limited English Proficiency (LEP). While US law requires provision of competent translation for LEP patients, such services are commonly unavailable.
Design and Participants
Qualitative data was collected in 8 prenatal genetics clinics in Texas, including interviews and observations with 16 clinicians, and 30 Latina patients. Using content analysis techniques, we examined whether the basic criteria for informed consent (voluntariness, discussion of alternatives, adequate information, and competence) were evident for each of these patients, contrasting LEP patients with patients not needing an interpreter. We present case examples of difficulties related to each of these criteria, and compare informed consent scores for consultations requiring interpretation and those which did not.
We describe multiple communication problems related to the use of untrained interpreters, or reliance on clinicians’ own limited Spanish. These LEP patients appear to be consistently disadvantaged in each of the criteria we examined, and informed consent scores were notably lower for consultations which occurred across a language barrier.
In the absence of adequate Spanish interpretation, it was uncertain whether these LEP patients were provided the quality and content of information needed to assure that they are genuinely informed. We offer some low-cost practice suggestions that might mitigate these problems, and improve the quality of language interpretation, which is essential to assuring informed choice in health care for LEP patients.
KEY WORDSinformed consent language barriers genetic counseling Latinas
- 8.US Census Bureau. QT-02. Profile of Selected Social Characteristics: 2000. US Census Bureau, US Department of Commerce 2001 [cited 2001 Nov. 21]. Available from: http://factfinder.census.gov/servlet/QTTable?ds_name=D&geo_id=D&qr_name=ACS_C2SS_EST_G00_QT02&_lang=en.
- 9.Office for Civil Rights. Policy Guidance - Title VI Prohibition Against National Origin Discrimination as it Affects Persons with Limited English Proficiency. Office for Civil Rights, U S Department of Health and Human Services 2002 [cited 2002 June 19]. Available from: http://www.hhs.gov/ocr/lep/guide.html.
- 10.Fortier JP, Strobel C, Aguilera E. Language barriers to health care: federal and state initiatives, 1990–1995. J Health Care Poor Underserved. 1998;9(suppl):S81–100.Google Scholar
- 11.Hawryluk M. AMA: Doctors shouldn’t pay for translators. Interpreters’ fees often exceed Medicaid payments for office visits. American Medical Association 2002. Available from: http://www.ama-assn.org/sci-pubs/amnews/pick_02/gvsb0114.htm.
- 13.Perkins J, Vera Y. Legal protections to ensure linguistically appropriate health care. J Health Care Poor Underserved. 1998;9(suppl):S62–80.Google Scholar
- 14.US Department of Health and Human Services. Guidance to Federal Financial Assistance Recipients Regarding Title VI Prohibition Against National Origin Discrimination Affecting Limited English Proficient Persons. 8-4-2003. HHS Office for Civil Rights.Google Scholar
- 15.NCIHC. National Standards of Practice for Interpreters in Health Care. National Council on Interpreting in Health Care 2005. Available from: http://www.ncihc.org/sop.php.
- 18.Carter-Pokras O, O’Neill MJ, Cheanvechai V, Menis M, Fan T, Solera A. Providing linguistically appropriate services to persons with limited English proficiency: a needs and resources investigation. Am J Manag Care. 2004;10 Spec No:SP29–36.Google Scholar
- 20.Riddick S. Improving access for limited English-speaking consumers: a review of strategies in health care settings. J Health Care Poor Underserved. 1998;9(suppl):S40–61.Google Scholar
- 27.Beauchamp TL, Childress JF. Principles of Biomedical Ethics, 4th ed. New York: Oxford University Press; 1994.Google Scholar
- 35.Kuller JA, Laifer SA. Contemporary approaches to prenatal diagnosis. Am Fam Physician. 1995;52(8):2277–6.Google Scholar
- 37.Hunt LM, de Voogd KB. Autonomy, danger, and choice: the moral imperative of an “at risk” pregnancy for a group of low income Latinas in Texas. In: Harthorn BH, Oaks L, eds. Risk, Culture, & Health Inequality: Shifting Perceptions of Danger and Blame. Greenwood Press: 2003:74–103.Google Scholar
- 40.Miles M, Huberman AM. Qualitative Data Analysis: An Expanded Source Book. 2nd ed. Sage Publications; 1994.Google Scholar
- 41.Bernard HR. Research Methods in Anthropology. 2nd ed. Thousand Oaks, CA: Sage Publishers; 1994.Google Scholar
- 45.Levine RJ. Ethics and Regulation of Clinic Research. New Haven: Yale University Press; 1986.Google Scholar
- 46.NSGC. Code of Ethics. National Society of Genetic Counselors 2006 [cited 2006 July 7]. Available from: http://www.nsgc.org/about/codeEthics.cfm.
- 53.Office for Civil Rights. OCR Fact Sheet—Language Assistance to Persons with Limited English Proficiency (LEP). Office for Civil Rights, US Department of Health and Human Services 2000 [cited 2001 Nov. 6]. Available from: http://www.hhs.gov/ocr/lep/fact.html.