Interpreting in Palliative Care

WHAT IS PALLIATIVE CARE?
Palliative care describes the care that is provided to people who have life-threatening illnesses.  Patients cannot be cured of all illnesses. For example, cancer which has spread in the body is usually not curable, although treatment can help people live longer. Motor neuron disease, also called ALS, and other diseases of the nervous system are also incurable.  Patients who have a life-threatening illness are usually older people, but may be any age, including children.

Doctors and healthcare workers provide treatment to prolong the person’s life, to provide rehabilitation and to provide comfort. When the aim of care is to provide comfort and maintain quality of life, this is called palliative care.

Healthcare workers also provide advice and support to the patient’s family and friends, during the illness and provide bereavement support after the patient’s death.

All healthcare workers should do this. Sometimes patients have more complex problems and these patients may be referred to specialists in palliative care. Specialists in palliative care look after patients in their own homes, in hospitals and in specialist units called hospices. This is a link to a vimeo from the Irish Association for Palliative Care which explains this. (http://www.iapc.ie)

IMPORTANT ASPECTS TO PALLIATIVE CARE
Autonomy
A patient has a right to make their own health care decisions. This is called autonomy. The patient has the right to have information to be involved in decisions about their health. Not all patients wish to be involved in decisions, but should be given the opportunity to be involved.

Disclosure of information
‘Breaking bad news’
Because palliative care is about life-threatening illness, this is often ‘bad news’. There may be a new diagnosis of an incurable illness, or test results may show that an illness is getting worse, or that a person’s prognosis, or future is much shorter than the person hopes for. Telling patients this type of information is sometimes called ‘breaking bad news’. This is a particular skill that doctors and nurses need to use.

Negotiation of disclosure of information
When breaking bad news, the information is usually given in stages. This allows the patient to take the information slowly. There is a negotiation of disclosure of information. This means that the conversation may be slow.

As the illness progresses, there may be repeated discussions about the illness and the future, repeated ‘breaking bad news’.

Because this is ‘bad news’ patients may be upset, or angry or shocked. This is normal, and the healthcare worker allows the person express his or her emotions.

Differing cultural responses
Different cultures deal with bad news and treatment decisions in different ways. In Ireland, the usual way is to give the patient the opportunity to ask questions about their illness and to be involved in treatment decisions. Families do not make decisions for patients, unless the patient wishes the family to be involved.

Improving comfort and quality of life
Improving comfort and quality of life for the patient means that the patient’s problems, their symptoms such as pain and sickness and their worries and concerns are identified by asking the patient questions. These questions are sometimes very detailed and precise answers are needed by the healthcare worker to identify the problem and provide the best treatment.

RESOURCES FOR INTERPRETING IN PALLIATIVE CARE CONTEXTS
There are limited resources and guidelines regarding interpreting in the palliative care context. This guide, published in the Journal of Palliative Medicine, provides some top tips to consider when providing interpreting services to patients with limited English proficiency.

Latif Z, Kontrimas J, Goldhirsch J, Abrahm J, Warraich HJ. Top Ten Tips Palliative Care Clinicians Should Know About Working with Medical Interpreters. J Palliat Med. 2022 Sep;25(9):1426-1430. doi: 10.1089/jpm.2022.0091. Epub 2022 Mar 18. PMID: 35319273.

  • Ensure the presence of a professionally trained medical interpreter during encounters and avoid assigning family members or bilingual staff to the role of the interpreter
  • Conducting a pre-encounter huddle can provide interpreters with appropriate context for the encounter and facilitate the discussion
  • Partnering with the interpreter to help them manage a family meeting is critical to ensuring effective communication
  • Discussing with interpreters the best approach to handle ‘‘untranslatable’’ words can reduce miscommunication
  • Patients’ family dynamics may reflect their cultures and may include unique patient and family roles during end-of-life discussions
  • Using the ‘‘teach back’’ method with patients with LEP can ensure improved patient understanding
  • Providing the patient and interpreter with contact information for palliative care clinicians can facilitate continuity and accessibility of palliative care to patients with LEP
  • Involving interpreters in post-encounter team debriefings can improve patient care and team dynamics
  • Interpreters may experience emotional distress when delivering bad news and are vulnerable to experiencing vicarious trauma