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Compassionate Language Access – Professional Interpreting Services at the End of Life

Older woman with a cane holding hands with a smiling nurse

You treat a disease, you win, you lose. You treat a person, I guarantee you, you’ll win, no matter what the outcome.

Dr. Patch Adams, physician, comedian, author, social activist, and more.

The Critical Importance of Interpreting for the US-LEP Population

It isn’t an easy conversation to have, and that’s a gross understatement. When it comes to the end of life, medical professionals are charged with the overwhelming responsibility of delivering the unsettling news to patients and their family members. As if that isn’t stressful enough, what happens when the patient is Deaf, doesn’t speak English, or at the very least, doesn’t speak English well enough to understand the gravity of what they are being told? This is where specially-trained medical interpreters become a critical part of the palliative care process, bridging the linguistic and cultural gap.

Current data shows that approximately 8 percent of the US population identifies as limited-English proficient (LEP). This means that potentially one in every twelve patients who present to an emergency room or who are admitted to the hospital will not have the ability to proficiently speak, read, write, or understand the English language. And in some states, the LEP population is much higher than the national average.

*When we factor in the Deaf and Hard of Hearing (HoH) communities, the LEP-US population rises to 10.9% – this then increases the fraction to more than one in every ten.1

Without readily-accessible, professional interpreters on hand, the risk increases for improper diagnoses and therefore, an increased risk for adverse events. For the vulnerable palliative care patient population, even one miscommunicated word can be a catalyst for a cascade of negative outcomes.

There have been countless studies conducted that show the critical importance of professional interpreters in medical settings. In one particular study that took place at two of the largest pediatric emergency departments in Massachusetts, researchers conducted “a cross-sectional error analysis of audiotaped emergency department (ED) visits during 30 months.”2 The study involved Spanish-speaking LEP patients, their caregivers, and their interpreters. The results speak for themselves.

The median errors with potential clinical consequences among all the professional interpreters involved in the study (regardless of the number of training hours) was 12 percent versus 22 percent among ad hoc (untrained) interpreters. It seems clear that experienced, professional medical interpreters help to improve patient safety – and for the underserved, more vulnerable populations, this need is critically important.

Palliative Care — Just What Is This?

When a patient is not expected to recover from a traumatic injury, disease, or illness, palliative care is likely the next step. As an interdisciplinary approach to specialized medical care, palliative care helps to reduce pain and discomfort in order to improve the patient’s quality of life.

Due to the highly-sensitive and emotional nature associated with palliative care, medical professionals who are uniquely trained offer a great many comforts to the patient, the patient’s family, and caregivers. For starters, these individuals understand and use appropriate vocabulary and tone of voice. They also coordinate with an extended care team, including social workers, hospice workers, and chaplains. But for patients with limited English proficiency, medical staff must also learn to work in partnership with professionally-trained medical interpreters.

Medical Interpreting for Palliative Care

Although medical interpreting already requires highly specialized training, palliative care medical interpreting must go even further. Virtually every other area of medical interpreting involves facilitating communication and cultural understanding between the medical staff and the patient with regard to a recovery plan. But palliative care medical interpreting requires a much more intimate and sensitive partnership with the medical staff, the patients, and their loved ones. Instead of a recovery plan, the entire team must be focused on developing a plan that involves pain management and quality of life. Everyone on the care team must also be in unison about the most appropriate and compassionate way of discussing this plan with the patient and the patient’s family.

Unique Partnership

Dr. Anne Kinderman, Director of Supportive & Palliative Care Service at the San Francisco General Hospital (SFGH) and an Associate Clinical Professor of Medicine at the University of California, San Francisco (UCSF), offers expert advice regarding best practices for partnering with medical interpreters in palliative care settings.

Not only does Dr. Kinderman encourage interpreters new to palliative care to shadow seasoned interpreters, but she also encourages medical staff to include interpreters in staff meetings that immediately precede and follow patient encounters.This unique partnership allows the staff the opportunity to ensure everyone is using the same terminology and affords everyone the opportunity to discuss anticipated challenges. As Dr. Kinderman states, “[t]hese interactions provide practical solutions to problems, but also foster an atmosphere of mutual respect with the interpreter.”3

By bringing interpreters into the fold, medical staff gain a better understanding of cultural nuances and learn how to improve future communication.

Partner With Trained, Professional Interpreters

When patients and their loved ones are faced with the challenging, emotionally-charged news of a terminal illness, compassionate, competent, and effective medical care is of the utmost importance. Palliative care teams are tasked with the awesome responsibility of administering appropriate pain relief while also discussing end-of-life arrangements with patients and their family members. For patients with communication barriers, the need for professional interpreters cannot be understated.

For over 16 years, Akorbi has been a trusted partner within the medical community, building and maintaining compassionate human connections. With Akorbi’s qualified and certified linguists, your medical team will have the added support they need to effectively communicate with your patients and their families, and provide an enhanced sense of comfort at a critical time in their lives. It is not only important for patients and families to understand the clinicians and the palliative care team, but it is equally as important that the patients be heard and understood as well. Akorbi aims to bridge this communication gap through supporting patient and family involvement, assisting with patient comfort, and discussing goals of care at the end of life.

We encourage you to partner with Akorbi to enhance communication for both your patients and their loved ones. Please reach out to us to learn more about our dedicated interpreters and our highly skilled and trained translators who are dedicated to supporting your Deaf and LEP patients at the end of life. Together, we can make a difference. Call Akorbi today.


Created in partnership with GIM Writing Services.


1  Mitchell, Ross E. “How Many Deaf People Are There in the United States? Estimates from the Survey of Income and Program Participation.” Journal of Deaf Studies and Deaf Education, U.S. National Library of Medicine, 2006, https://www.ncbi.nlm.nih.gov/pubmed/16177267.

2  Flores, Glenn, et al. “Errors of Medical Interpretation and Their Potential Clinical Consequences: a Comparison of Professional versus Ad Hoc versus No Interpreters.” Annals of Emergency Medicine, U.S. National Library of Medicine, Nov. 2012, https://www.ncbi.nlm.nih.gov/pubmed/22424655.

3 Kinderman, Anne. “Working with Interpreters in Palliative Medicine.” Working with Interpreters, Palliative Care Quality Network, 10 Oct. 2013, https://www.pcqn.org/wp-content/uploads/2012/11/Oct-Call_Working-with-Interpreters.pdf.
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