Image from Tridindia [Image], 2022, https://pixabay.com/photos/different-language-international-7389469/ Pixabay CC BY 2.0
Background: End-of-life discussions can be difficult when a patient and their provider speak the same language and come from similar cultural backgrounds. Adding a medical interpreter into the mix adds on a whole layer of complexity and a third person who has thoughts, feelings, and a unique cultural identity that I have never taken time to think about before.
Design and Participants: A 60-question survey was sent to 1,660 medical interpreters working at or contracted with two academic hospitals affiliated with Indiana University. The survey assessed demographics and work experience, frequency and experiences of interpreting for patients nearing end of life (EOL), self-efficacy with Palliative Care, personal concerns surrounding EOL, educational needs and preferences, and experience with work discrimination, as well as an open text box for comments. 162 medical interpreters (9.7%) responded, and the data was analyzed using a variety of statistical methods and a qualitative thematic analysis of the free text responses. The goal of the study was to characterize the experiences of medical interpreters as they provide interpretation services for patients and their families who are near EOL.
Results: Most of the respondents in the study participated in EOL conversations infrequently in a face-to-face setting. The longer they had been working, the more comfortable they were with topics related to death. By and large, they rated their comfort discussing EOL symptoms with the patients as higher than discussions of EOL care concerns. They often took pride in being able to participate in these important discussions, with the words “priviledge,” “honor,” and “rewarding” appearing frequently in the free text box. They identified themselves as a vital member of the patient’s care team and were dismayed that medical professionals did not always treat them as such and very rarely engaged in a pre-visit preparatory conversation. Most identified that they would like to have additional training in regards to EOL topics and listed self-paced online education (59.3%) as their preference for a learning format. The primary languages interpreted in this group of respondents was Spanish (42.6%), American Sign Language (27.5%), and Burmese dialects (6.8%).
Commentary: I had my first experience with medical interpretation as a medical student in Swaziland. I would ask a question, the nurse would turn to the patient, the two of them would talk for 5-10 minutes, and then the nurse would turn back to me and say, “No, Doctor.” It was wonderful to read this study that was well-designed to capture the experiences of the medical interpreter both as a human being and as a medical professional and vital part of the care team. Because my own organization provides in-home hospice care, we rely on a language line for translation services, and I wonder how much education those folks on the phone have with EOL discussions or how their heart must sink when it is the Elizabeth Hospice calling again, because there is no way for me to have a pre-visit conversation with my interpreter when I am calling from the patient’s living room or bedroom. The authors point out that, of the three modern methods of medical interpretation service available, telephone line, video conferencing, or face-to-face, they only looked at face-to-face visits. It is so much nicer when I can read the body language of the interpreter during face-to-face and video conference encounters I have had in Family Practice in the past. I am finding it extremely difficult to use the phone to have these sensitive conversations, especially when I have no cultural context to go by. I am glad I speak Spanish fluently enough to not need the language line, but not fluently enough that the patients might think I am trying to trick them or lie to them. They know I am doing an honest job and telling it to them like it is. I think about the majority of interpreters in the survey requesting a self-paced online education platform, and I feel like I, as a physician, would really miss an opportunity to learn from the medical interpreters through the discussions and conversations that would be provoked by having live, interactive sessions either online or in-person. This article gives me so much to think about, but the main thing I want to remember is to express my gratitude towards the living and feeling human being on the other end of the language line in front of the patient during every session I have in the future. They do so much more than, “Yes, Doctor.”
Bottom Line: The medical interpreter is a key member of any healthcare team containing individuals with a non-English language preference. As EOL discussions are often challenging, acknowledging both their professional expertise and their human feelings and supporting their growth and development as individuals and team members is very important.
Source: Howard J, Torke AM, Hickman SE, et al. Medical interpreters' experiences with patients who are near end-of-life and their family members. J Pain Symptom Manage. 2025;70(3):221-229. doi:10.1016/j.jpainsymman.2025.02.468
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