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
This research was supported by the NIH National Center for Human Genome Research (1RO1 HG001384-01). The research was also supported by a grant from the San Antonio Area Foundation. We wish to thank the staff and patients whose kind cooperation made this research possible. Emily Bergstrom, Heide Castañeda, Heidi Connealy, and Aaron Whiteford provided invaluable help with a variety of data analysis and literature review tasks. We also wish to thank Carole H. Browner and Mabel Preloran for their integral involvement and thoughtful insights throughout all phases of the project.
Conflict of interest
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