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Clinical Pearl: End of Life Care

Date Authored: February 20, 2006

Communicating about end-of-life care is often difficult for clinicians and patients, but additional complexities exist when they do not speak the same languages. A recent study published in the Journal of Palliative Medicine 1 provides insights for physicians about how to improve end-of-life discussions with non-English speaking patients and families. This qualitative study with professional medical interpreters provides some specific tools that may improve quality of communication about end-of-life discussions in these provider-patient encounters.

Recommendations for physicians include:

  • Meet briefly with interpreters prior to and after bad news or difficult discussions to help prepare the interpreter and allot the interpreter to provide the physician with information about the patient, family or culture.
  • Discuss with the interpreter whether the physician expects strict interpretation or prefers cultural brokering.
  • Consider meeting with the interpreter after the discussion to allow for any necessary debriefing.
  • Use nonverbal forms of education such as drawing or showing pictures
  • Understand that not all tools (such as pain scales) are universal and physicians need to use terms that are culturally relevant.
  • Avoid using jokes or humor because they may be misunderstood or considered offensive

Recommendations for interpreters:

Be clear when they are strictly interpreting and when they are interjecting their own suggestions or providing cultural brokering.

1.  “Communication about End-of-Life Care between Language-Discordant Patients and Clinicians: Insights from Medical Interpreters” (WM Norris, et al). Journal of Palliative Medicine, Vol 8, Number 5, 2005, 1016-1024.