Interpreter Accuracy and Informed Consent Among Spanish-speaking Families with Cancer

ABSTRACT Language interpreters mediate a growing number of health care communication events, including the informed consent process, which underlies the ethical conduct of clinical research. This article explores a key interpretive outcome, accuracy, in 21 Spanish/English informed consent consultations. Discussions were transcribed, translated, and coded according to established techniques. Most (74%) discussion was accurately interpreted (range: 47%–98%; std. deviation: .137). Accuracy was lower in the more technical portions of the discussion when compared with nontechnical portions such as discussion of coping and quality-of-life issues (p = .024). The concept of “randomization” often was poorly communicated and interpreted. These differences may be due in part to the use of long, uninterrupted, and jargon-filled sentences by clinicians explaining research, among other factors. The article concludes that accuracy may be promoted if clinicians used less technical language and shorter sentences, and are more “process driven.” Interpreters may need to be better informed about research-related concepts such as randomization. Further research is needed to determine the effects of interpretive accuracy on the informed consent process, the decision to participate in research, and other outcomes.

[1]  K. Ryan,et al.  Determination of Secretary regarding recommendation on psychosurgery of the National Commission for the Protection of Human Subjects. , 1978, Federal register.

[2]  D. Drotar,et al.  Communication of randomization in childhood leukemia trials. , 2004, JAMA.

[3]  R. C. Silver,et al.  When nurses double as interpreters: a study of Spanish-speaking patients in a US primary care setting. , 2001, Social science & medicine.

[4]  R. Lilford,et al.  Informed consent for clinical trials: in search of the "best" method. , 1998, Social science & medicine.

[5]  C. Carver,et al.  Coping and distress among women under treatment for early stage breast cancer: comparing african americans, hispanics and non‐hispanic whites , 2002, Psycho-oncology.

[6]  J. de Haes,et al.  Doctor-patient communication: a review of the literature. , 1995, Social science & medicine.

[7]  J. Stoddard,et al.  Enhancing the Racial and Ethnic Diversity of the Pediatric Workforce , 2000, Pediatrics.

[8]  T. Erb,et al.  Permission and Assent for Clinical Research in Pediatric Anesthesia , 2002, Anesthesia and analgesia.

[9]  J J Stoddard,et al.  The Respective Racial and Ethnic Diversity of US Pediatricians and American Children , 2000, Pediatrics.

[10]  B. Zebrack Cancer survivors and quality of life: a critical review of the literature. , 2000, Oncology nursing forum.

[11]  L. Haffner,et al.  Translation is not enough. Interpreting in a medical setting. , 1992, The Western journal of medicine.

[12]  S. Hirschfeld,et al.  Pediatric oncology: regulatory initiatives. , 2000, The oncologist.

[13]  M. Solomon From What’s Neutral to What’s Meaningful: Reflections on a Study of Medical Interpreters , 1997, The Journal of Clinical Ethics.

[14]  J. Kaufert,et al.  Communication through Interpreters in Healthcare: Ethical Dilemmas Arising from Differences in Class, Culture, Language, and Power , 1997, The Journal of Clinical Ethics.

[15]  B. Sleath,et al.  Influence of ethnicity and language concordance on physician-patient agreement about recommended changes in patient health behavior. , 2004, Patient education and counseling.

[16]  B. Zuckerman,et al.  Errors in medical interpretation and their potential clinical consequences in pediatric encounters. , 2003, Pediatrics.

[17]  J. O’Neil,et al.  Biomedical Rituals and Informed Consent: Native Canadians and the Negotiation of Clinical Trust , 1990 .

[18]  D. Smith Ethics in the doctor-patient relationship. , 1996, Critical care clinics.

[19]  R. Gurung,et al.  Relating ethnic identity, acculturation, and attitudes toward treating minority clients. , 2001, Cultural diversity & ethnic minority psychology.

[20]  C. Schur,et al.  Language, Sociodemographics, and Health Care Use of Hispanic Adults , 1996, Journal of health care for the poor and underserved.

[21]  B. Kapp,et al.  A history and theory of informed consent , 1986 .

[22]  D. Roter Patient Participation in the Patient-Provider Interaction: The Effects of Patient Question Asking on the Quality of Interaction, Satisfaction and Compliance* , 1977, Health education monographs.

[23]  G. Geller,et al.  Children in research: new perspectives and practices for informed consent. , 2003, IRB.

[24]  Henri C. Barik,et al.  A Description of Various Types of Omissions, Additions and Errors of Translation Encountered in Simultaneous Interpretation , 1971 .

[25]  B. Davidson Questions in Cross-Linguistic Medical Encounters: The Role of the Hospital Interpreter , 2001 .

[26]  L. Siminoff,et al.  Groups potentially at risk for making poorly informed decisions about entry into clinical trials for childhood cancer. , 2003, Journal of clinical oncology : official journal of the American Society of Clinical Oncology.

[27]  L. Siminoff,et al.  Toward improving the informed consent process in research with humans. , 2003, IRB.

[28]  L. Siminoff,et al.  Comparison of the informed consent process for randomized clinical trials in pediatric and adult oncology. , 2004, Journal of clinical oncology : official journal of the American Society of Clinical Oncology.