RECENT RESEARCH
Researchers: Professor Reema Harrison and Dr Ashfaq Chauhan
Institution: Macquarie University, NSW
Funded by: Cancer Institute NSW
Some of the most crucial health conversations are about the wishes of people with advanced cancer for their future care.
Yet for people from culturally and linguistically diverse (CALD) backgrounds, these crucial and ongoing ‘Advanced Care Planning’ (ACP) conversations are often conducted via interpreters who have limited support and/or information about the patient’s circumstances. In addition, many concepts and words relating to emotive topics such as cancer, treatment and dying cannot be directly translated. Interpreters, however, are charged with communicating these topics from one cultural world into another.
Significantly lower rates of ACP uptake among CALD communities compared to the general population are attributed to low clinician confidence in communicating about ACP when language is a barrier. Without a person-centric plan for their care, CALD patients experience inequity in care quality, characterised by higher rates of burdensome care towards the end of their lives. To address this issue, clinicians, academics, interpreters and healthcare consumers from Macquarie University have embarked on a program of work to improve ACP uptake in people from CALD backgrounds affected by cancer.
Our analysis of 31 resources that seek to promote ACP with multicultural communities in Australia demonstrated that, whilst they espouse meaningful engagement and encourage clinicians to involve interpreters where language support is needed, there is a lack of guidance about how to work with interpreters as partners in the care team. In focus groups that we then conducted with 16 healthcare staff and six interpreters, both clinicians and interpreters reported that interpreters are considered as language conduits, receive less respect than clinicians, and are not considered part of the care team, constraining their collaboration in ACP.
Both clinicians and interpreters also identified difficulties in navigating ACP communications due to a lack of shared understanding about the words and concepts to use. Clinicians often request that interpreters do verbatim translations only, which presents challenges in many cultures and languages, while a lack of agreement about approaches to managing family expectations creates further barriers.
Pre- and de-briefing were identified as useful for interprofessional collaboration, but were not integrated into consultations. Interpreters frequently reported going into ACP communications unaware of the nature of the conversation to be had, without the necessary resources, and feeling unprepared, while lack of opportunities to debrief after consultations led to increased likelihood of interpreter burnout and reluctance to engage in ACP. These barriers were particularly pronounced for interpreters working remotely.
We conclude that improving interprofessional collaboration between clinicians and interpreters is necessary to enhance uptake of ACP among CALD communities, and we have embarked on the co-design of a program that aims to effect this improvement.
You can find more details of this project here.
