Cox Antoon, Larocque Marianne Couillard, Dauby Nicolas, Leanza Yvan
Research Group Interpreting Studies & Leuven Interdisciplinary Language Institute (LILI), KU Leuven, Leuven, Belgium.
Brussels Centre for Language Studies, Vrije Universiteit Brussel, Brussels, Belgium.
Int J Equity Health. 2025 May 7;24(1):126. doi: 10.1186/s12939-025-02425-2.
Patient companions (PCs) can have an ambiguous impact on the quality of communication during multilingual medical consultations and therefore on health outcomes. Studies of multilingual medical consultations have focused mainly on PCs' role as interpreters, with less regard to other roles they may take up. This paper uses mixed methods to investigate PC role dynamics in multilingual PC-mediated consultations and how they affect the management of a patient's Lifeworld, a crucial element for history taking and rapport building.
Nine recordings of multilingual PC-mediated consultations from a Brussels emergency department, complemented with ethnographic notes and clinician interviews, were subjected to linguistic-ethnographic analysis and a codification of communication patterns and PC roles to explore the link between PC roles and Lifeworld management. PC roles were grouped into four stances (Linguistic agent, Lifeworld agent, System agent, and Principal). The communication patterns were grouped into three categories ("strictly medicine", "Lifeworld heard/included", and "Lifeworld interrupted").
In ED consultations, patients' Lifeworld frequently remains inadequately addressed, primarily due to physician interruptions. Significant associations are observed between roles taken up by PCs and the way patients' Lifeworld is managed. Successful integration of Lifeworld aspects is best supported by PCs taking up the role of System agent, possibly because it allows them to link the Lifeworld directly to medical issues. Linguistic-ethnographic analysis reveals how language barriers, PC role changes and Lifeworld management strategies are taking shape organically (often implicitly) determined by a wide range of situational factors, such as the complexity of the topic, the available (non)verbal linguistic repertoire, the level of meta-communication, explicit role negotiation and timing.
Since poor Lifeworld management negatively impacts care, clinicians should be trained to detect and manage role dynamics and relevant situational factors in PC-mediated multilingual consultations to protect patients' right to high-quality communication and healthcare.
患者陪伴者（PCs）在多语言医疗会诊期间对沟通质量可能会产生模糊的影响，进而影响健康结果。多语言医疗会诊的研究主要集中在患者陪伴者作为口译员的角色上，而较少关注他们可能承担的其他角色。本文采用混合方法研究多语言患者陪伴者介导的会诊中患者陪伴者角色的动态变化，以及这些变化如何影响患者生活世界的管理，而生活世界管理是病史采集和建立融洽关系的关键要素。
对布鲁塞尔一家急诊科的9次多语言患者陪伴者介导的会诊录音进行了语言民族志分析，并对沟通模式和患者陪伴者角色进行了编码，同时辅以民族志笔记和临床医生访谈，以探讨患者陪伴者角色与生活世界管理之间的联系。患者陪伴者角色分为四种立场（语言代理、生活世界代理、系统代理和主体）。沟通模式分为三类（“严格医学”、“生活世界被倾听/被纳入”和“生活世界被打断”）。
在急诊科会诊中，患者的生活世界常常得不到充分关注，主要原因是医生的打断。观察到患者陪伴者所扮演的角色与患者生活世界的管理方式之间存在显著关联。患者陪伴者扮演系统代理的角色最有助于成功整合生活世界方面的内容，这可能是因为这使他们能够将生活世界直接与医疗问题联系起来。语言民族志分析揭示了语言障碍、患者陪伴者角色变化和生活世界管理策略是如何由广泛的情境因素（如话题的复杂性、可用的（非）语言语言资源、元沟通水平、明确的角色协商和时机）有机地（通常是隐含地）形成的。
由于生活世界管理不善会对护理产生负面影响，临床医生应接受培训，以检测和管理患者陪伴者介导的多语言会诊中的角色动态变化和相关情境因素，以保护患者获得高质量沟通和医疗保健的权利。
