Medical Interpreters' Experiences with Patients Who Are Near End-of-Life and Their Family Members.

Context: Medical interpreters play a critical role in communicating with patients and families with non-English language preference (NELP), previously referred to as limited English proficiency , near the end-of-life (EOL) but often receive minimal education about providing this type of care.

Objectives: To understand interpreter experiences with providing services for patients near the end of life and needs for professional support and training in EOL care.

Methods: A 60 question survey, was distributed to 1,660 medical interpreters at two hospitals and one interpreter service company. The survey included questions about participant characteristics, examined interpreter experiences, self-efficacy responding to EOL symptoms and EOL concerns, comfort levels, educational needs, racial discrimination, and barriers to effective interpretation for patients who are near EOL.

Results: Medical interpreters (n = 162) generally report high self-efficacy in interpreting conversations about EOL care but have lower scores regarding the communication and decision-making subscale compared to symptom management subscale (Diff=0.90 (95% CI 0.48 - 1.32), p<.0001). Many (70.4%) of the interpreters indicated that they never or seldom meet with the patient's medical providers prior to a goals of care meeting and only 52.2% report they are usually or always treated as part of the medical team. Interpreters often received little warning about conversation topics prior to interpreting. Qualitative comments revealed experiences of high emotional distress during and after these conversations. Approximately three quarters of the interpreters indicated they would be interested in receiving education regarding EOL topics. Increased experience as an interpreter was associated with a lower fear of death (r=-0.204, p=0.0092 and witnessed discrimination (r=0.179, p=0.0236).

Conclusion: Although self-efficacy for interpreting EOL conversations is generally high, interpreters desire education about EOL care. Interventions are also needed to address the high emotional toll of interpreting EOL conversations. Education and training about EOL care may help them to not only convey information accurately but also cope with emotional nuances characteristic of these significant conversations, ultimately elevating the quality of care for patients and family members in vulnerable and important moments.