Allar Benjamin G, Ponce Cristina, Wallace James, Ortega Gezzer, Reich Amanda J, Gold-Gomez Shari, Gangadharan Sidhu P, Kent Tara S
Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston MA.
Department of Surgery, Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston MA.
Ann Surg. 2024 Jul 1;280(1):66-74. doi: 10.1097/SLA.0000000000006160. Epub 2023 Nov 22.
To understand medical interpreters' perspectives on surgical informed consent discussions and provide feedback for surgeons on improving these conversations.
Informed consent is a critical component of patient-centered surgical decision-making. For patients with limited English proficiency, this conversation may be less thorough, even with a medical interpreter, leaving patients with an inadequate understanding of their diagnosis or treatment options.
A semistructured interview guide was developed with input from interpreters and a qualitative research expert. We purposively sampled medical interpreters representing multiple languages until thematic saturation was achieved. Participants discussed their experience with the surgical consent discussion and process. Interview transcripts were analyzed using emergent thematic analysis.
Among 22 interpreters, there were 10 languages represented and an average experience of 15 years (range: 4-40 yr). Four major themes were identified. First, interpreters consistently described their roles as patient advocates and cultural brokers. Second, interpreters reported unique patient attributes that influence the discussion, often based on patients' cultural values/expectations, anticipated decisional autonomy, and family support. Third, interpreters emphasized the importance of surgeons demonstrating compassion and patience, using simple terminology, conversing around the consent, providing context about the form/process, and initiating a pre-encounter discussion. Finally, interpreters suggested reducing legal terminology on consent forms and translation into other languages.
Experienced interpreters highlighted multiple factors associated with effective and culturally tailored informed consent discussions. Surgeons should recognize interpreters' critical and complex roles, be cognizant of cultural variations among patients with limited English proficiency, and improve interpersonal and communication skills to facilitate effective understanding.
了解医学口译员对外科手术知情同意讨论的看法，并为外科医生改善这些交流提供反馈。
知情同意是以患者为中心的外科手术决策的关键组成部分。对于英语水平有限的患者，即使有医学口译员，这种交流可能也不够深入，导致患者对自己的诊断或治疗选择理解不足。
在口译员和定性研究专家的参与下制定了一份半结构化访谈指南。我们有目的地抽取代表多种语言的医学口译员样本，直至达到主题饱和。参与者讨论了他们在手术同意讨论和过程中的经历。使用新出现的主题分析法对访谈记录进行分析。
在22名口译员中，代表了10种语言，平均从业经验为15年（范围：4 - 40年）。确定了四个主要主题。首先，口译员一致将自己的角色描述为患者权益倡导者和文化中介。其次，口译员报告了影响讨论的独特患者特征，这些特征通常基于患者的文化价值观/期望、预期的决策自主性和家庭支持。第三，口译员强调外科医生表现出同情心和耐心、使用简单术语、围绕同意书进行交流、提供关于表格/过程的背景信息以及在会诊前进行讨论的重要性。最后，口译员建议减少同意书上的法律术语并翻译成其他语言。
经验丰富的口译员强调了与有效且符合文化特点的知情同意讨论相关的多个因素。外科医生应认识到口译员的关键且复杂的角色，意识到英语水平有限的患者之间的文化差异，并提高人际和沟通技巧以促进有效理解。
