There are over 350 languages spoken in the US today. Of these, Spanish is the most common language in the category of languages other than English (LOE). Given this amazing diversity, the availability of interpreters in the medical system has been invaluable in providing high-quality care. Specifically, involving interpreters in family-centered rounds (FCR) has helped establish partnership with families and given them more opportunity to participate in medical decision-making.
In this issue of Hospital Pediatrics, Parente et al. showed the effects of medical team behavior on interpreter alterations by performing a secondary analysis on 10 FCR encounters of Spanish- speaking families, where 529 interpreted segments were coded (10.1542/hpeds.2024-007944). The interpreter alterations were coded as omissions, additions, or substitutions and were further categorized by whether the alterations had a positive or negative effect.
When looking at interpreted segments, at least one alteration was present in 72% of segments. Omissions were the most common type followed by substitutions and additions. A negative alteration occurred in 29% of total segments, such as loss of biomedical information, anticipatory guidance, and inaccurate interpretation of information. Alternatively, in 9% of segments, there was a positive alteration such as clarifying medical jargon, avoiding direct translation of idioms, and advocating for pauses in interpretation.
The medical team’s behavior was also coded into two main behaviors, which were how long someone spoke before pausing for interpretation and if they had used medical jargon. Interestingly, as the length of sentences spoken increased from one to three, the frequency of omissions also increased from 35% to 81%. This often meant that if supportive statements were given before presenting long biomedical sentences, the supportive statement might not get interpreted in favor of interpreting the biomedical sentence. As medical jargon increased, there was a loss of information but also a potential gain of information since interpreters might stop to simplify jargon into lay terms.
In the commentary on this article written by Lieberman et al, the authors suggest that successful communication with LOE families cannot be ensured simply by providing interpreter services (10.1542/hpeds.2024-008041); rather, the interpreter must be integrated into the medical team. Especially in matters of culturally sensitive communication, interpreters are invaluable resources as mediators to help educate the team. Given medical interpreters’ vital role in promoting patient safety and satisfaction, there is a significant need for formal medical training to teach effective collaboration with interpreters.
Reflecting on this study, a practical step that hospitalists can take to more effectively facilitate communication with interpreters is to huddle before patient encounters and empower the interpreters to bring up concerns about our communication. Another suggestion would be to debrief with interpreters immediately after FCR to get timely feedback about communication deficits or provider behaviors that could be modified in subsequent encounters. For more ideas on how to support interpreter services in our increasingly diverse patient population, check out the full article!