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Expressing Empathy in Critical Conversations with Families: Do Interpreters Lose Something in Translation?

February 21, 2023

No matter what information we have to share with families, how we communicate that information and how that information is received by a family is key to developing trust and having meaningful conversations. How good are we at communicating empathy when we have critical information to share with families in care conferences? If a family does not speak English as their primary language, does the use of an interpreter make our expressing empathy more difficult and negatively impact the relationship and ability to engage in shared decision-making? 

Olszewski et al from Seattle Children’s Hospital (10.1542/peds.2022-059447) share with us an analysis of a mixed-methods study of 29 audio-recorded care conferences of pediatric patients with serious illness that occurred between 2018 and 2021, of which 11 required the use of an interpreter. The study did not find that clinicians were less empathetic in care conferences that involved the interpreter. Instead, the authors found that empathetic expression was similar in conferences with and without the use of interpreters, suggesting that these interpreters helped convey. 

There is much more to be gained from reading this study than just the benefits of an interpreter to help convey clinician empathy. There is a great deal to be learned about how frequently empathy is “buried” (meaning followed immediately by medical talk and information). This study found that this occurred 62% of the time, regardless of whether there was an interpreter. When empathy was not buried, families responded with agreement, gratitude, or further emotional comments 83% of the time. In contrast, when empathy was buried or missed, families responded with supportive alliance comments only about 15 % of the time.

The study also may introduce you to the use of “NURSE(S)” as a way to respond to patients with an empathetic response. NURSE(S) is a mnemonic for the following steps in demonstrating empathy to a family:

  • Naming or mirroring the emotion being shared by a family member
  • Understanding the emotion
  • Respecting the family and patient by reiterating that their reaction is important
  • Supporting the patient by reiterating your commitment to helping them through this challenging time
  • Exploring the emotion further as needed to make sure you understand where they are with
  • Silence used as needed

The article contains some good and not so good examples of opportunities where empathy was unburied, buried, or missed that are well worth learning from.

We all need to strive to be more empathetic in how we communicate with families during these conversations. This study will raise your own awareness of what you do or perhaps don’t do to convey empathy and is well worth reading. Link to it and learn more.

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