Background: Communication about health care and especially end-of-life care is difficult for
clinicians and patients when they do not speak the same language. Our purpose was to improve
understanding of how to approach discussions between language-discordant patients
and clinicians about terminal or life-threatening illness.
Methods: We conducted a qualitative study with 4 focus groups with 43 professional medical
interpreters. We asked open-ended questions concerning physician and interpreter communication
about end-of-life care. Focus groups were audiotaped, transcribed, and analyzed
using principles of grounded theory. Results were presented to an additional 3 focus groups
with 25 medical interpreters to ensure that analyses represented interpreters' perspectives.
Results: We developed 3 frameworks for understanding high-quality language-discordant
communication about end-of-life care. The first framework addresses physician and interpreter
professionalism, including humanistic qualities and emotional support capabilities important
for high quality care. The second framework is physician-centered and highlights
communication skills, as well as coordination with other providers and cultural sensitivity.
The third framework is interpreter-centered, focusing on role conflicts, including struggles
concerning expectations to provide strict interpretation versus being a cultural broker. Interpreters'
recommendations for improving quality of this care include premeetings with interpreters
before encounters involving delivery of bad news and explicit discussions with interpreters
about whether the clinician expects strict interpretation or cultural brokering.
Conclusions: These results provide insights for physicians about how to improve end-of-life
discussions with language-discordant patients and their families. Interpreter recommendations
provide physicians and health care organizations with specific tools that may improve
quality of communication about end-of-life discussions.
