PM2018: Improving Interpreting in Palliative Care

Purpose/Objectives: In the US, over 25 million people have limited English proficiency (LEP); these patients face challenges when navigating healthcare, including difficulty with medical understanding, worse end of life (EOL) symptom management, and lack of access to hospice. Use of professional interpreters has improved patient outcomes and satisfaction, yet little literature exists on the collaboration between palliative care (PC) providers and interpreters, despite their important intersection in caring for LEP patients receiving PC.
The overall goals of this project are: 1) to increase interpreters’ knowledge of PC and explore their views on how clinicians could improve patient interactions. 2) Additionally, increase PC provider compliance with interventions when working with interpreters to improve competency in goals of care (GOC) and EOL encounters with PC patients with LEP.

Design/Methods: Surveys were distributed to PC providers before and after a presentation on gaps affecting LEP patients and the importance of appropriately using interpreters. The same process was used to present to interpreters on PC and common communication tools through VitalTalk. Providers were asked to report which interventions they regularly implement before and after the presentation, and interpreters were asked to report which interventions they observe PC providers using.

Results: We surveyed 13 interpreters. 28 PC providers completed the pre-survey, and 13 completed the post-survey. Providers reported increases in 5 of the 10 key interventions, and a small decrease in others. Providers also reported their concerns with PC encounters involving interpreters.
This QI project had a specific aim to increase PC provider compliance with interventions to use interpreters appropriately from 60% to 90% averaged over all interventions and maintain for 1 year, with a global goal of improving PC provider competency in GOC and EOL interpreter encounters. The following key drivers were identified: 1) interpreter reported comfort with EOL and GOC discussions; 2) provider-reported compliance with interventions and 3) interpreter-reported measurement of provider compliance. This was addressed through the following interventions: 1) provide PC and VitalTalk primer to interpreters; and 2) provide a presentation to providers and interpreters on appropriate use of interpreters in PC.

Conclusion/Discussion: Our project revealed that PC providers can optimize interpreter use for difficult conversations. We demonstrated increased PC provider understanding after an introductory presentation on care gaps and appropriate interpreter use. However, our didactic education appears to have driven down provider confidence in interpreter encounters as self-awareness of knowledge gaps emerged. We plan to survey interpreters again to assess their observations of provider compliance after a 2 month period following education. We hope that providing bidirectional education to PC providers and interpreters will not only increase competency in difficult conversations that focus on GOC and EOL, but also improve collaboration between both groups and optimize the quality of care provided to LEP patients.