Graduate Program in Genetic Counseling, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
Department of Pediatrics, Rush University Medical Center, Chicago, IL, USA.
J Genet Couns. 2020 Jun;29(3):352-364. doi: 10.1002/jgc4.1246. Epub 2020 Mar 10.
Culture bump theory provides a practical and goal-oriented framework for addressing cultural differences that can impact communication and patient care. Differences in language and culture, coupled with a lack of knowledge or competency regarding these differences, often contribute to 'culture bumps' between healthcare providers and patients. Interpreters serve the unique role of 'cultural brokers', going beyond bridging the linguistic divide to close cultural gaps. Research from the perspective of interpreters focused on culture bumps and cultural competency within genetic counseling sessions is lacking. We aimed to assess interpreters' experiences with significant 'culture bumps' in genetic counseling sessions, obtain interpreters' perspectives regarding genetic counselors' gaps in cultural competency, and explore interpreters' perceptions of the impact of cultural competency on the genetic counseling sessions. Spanish and Polish interpreters experienced in working in person with genetic counselors were recruited through interpreter supervisors at medical centers, hospitals, and interpreter training and service agencies in the Chicagoland area. Using a semi-structured interview guide, phone interviews were conducted with eligible participants and transcribed verbatim. A codebook was developed between two coders, and inter-rater reliability was assessed (κ = 0.82). Grounded theory was used as a guiding principle to code data. The results of this study revealed significant culture bumps identified by interpreters in genetic counseling sessions in the areas of exchange of information, gender and family dynamics, and incorporation of religious and faith beliefs. Interpreters identified the impact on rapport, both negative and positive, due to gaps and strengths in cultural competency, respectively. These responses offer useful insight for training and providing practicing genetic counselors with tools to promote cultural competency, in order to provide optimal care for patients with limited English proficiency (LEP). Further research is necessary to explore these concepts within other languages and cultures, as well as to determine the most appropriate methods for implementing these suggestions for improvement.
文化碰撞理论为解决可能影响沟通和患者护理的文化差异提供了一个实用且目标导向的框架。语言和文化的差异，加上对这些差异缺乏了解或能力，往往会导致医疗保健提供者和患者之间出现“文化碰撞”。口译员扮演着“文化掮客”的独特角色，不仅要跨越语言鸿沟，还要弥合文化差距。从口译员的角度研究遗传咨询中与文化碰撞和文化能力相关的研究还很缺乏。我们旨在评估口译员在遗传咨询中遇到重大“文化碰撞”的经历，了解口译员对遗传咨询师文化能力差距的看法，并探讨口译员对文化能力对遗传咨询的影响的看法。通过医学中心、医院的口译员主管以及口译培训和服务机构，招募了在遗传咨询方面有西班牙语和波兰语口译经验的口译员。对符合条件的参与者进行了电话访谈，并逐字记录。两位编码员之间制定了一个编码手册，并评估了重测信度（κ=0.82）。采用扎根理论作为指导原则对数据进行编码。这项研究的结果揭示了口译员在遗传咨询中遇到的重大文化碰撞，包括信息交流、性别和家庭动态以及宗教和信仰信念的融合。口译员确定了由于文化能力的差距和优势，分别对医患关系产生的积极和消极影响。这些回应为培训和为有一定英语水平（LEP）的患者提供最佳护理的实践遗传咨询师提供了有用的见解，以促进文化能力。需要进一步研究以探索其他语言和文化中的这些概念，并确定实施这些改进建议的最合适方法。
