Archive for October, 2010
We spend a lot of time speaking of physician, nursing, social work, pharmacist expertise in palliative care. We often see and support formal training for volunteers. (www.volunteertrainingonline.com/hospice; www.hospicevolunteertraining.webs.com) We teach the importance of culturally competent care and use of interpreter services to enhance communication with patients and families of other cultures and with limited English. Studies have shown the miscommunication that occurs when interpreters are not used in medical encounters.
At the European Association of Communication in Healthcare (EACH) conference in Verona Italy the opening keynote speaker, Phyllis Butow, a psychologist and professor of psycho-oncology and medical communication, presented research that caused me pause and concern. Her research, conducted in Australia, demonstrated that our assumptions about accuracy of language transmitted to patients/families when interpreters are used may be flawed – especially when interpreters lack training in giving bad news, end-of-life care, etc.
Her interviews with interpreters also revealed that professional interviewers define their role as cultural (as well as language) interpreters. In doing so, “cancer” sometimes was described as “mass” or “tumor” according to her presentation. Interpreters expressed similar cultural biases and fear of giving bad news as many other healthcare professionals.
- How often does this happen in North America, as it seems to in Australia?
- How much training do medical interpreters in the US, Canada, and other countries receive in delivering bad news, end-of-life care, death and dying?
Mandating the presence of a medical interpreter may not be enough when it comes to improving cross-cultural and inter-language communication in palliative care scenarios: we need to include medical interpreters in our definition of interdisciplinary teams, provide them training (not just teach physicians and advance practice nurses how to work with interpreters) in giving bad news.
On September 27 and 28 the Society of Critical Care Medicine (SCCM) held a conference of stakeholders at their headquarters in Chicago, to discuss the problems patients face after a stay in intensive care. In addition to ICU physicians and nurses, physiatrists, psychiatrists, counselors, and representatives of patients and other groups (including palliative care) were invited. I was honored to represent AAHPM.
After a presentation of the evidence to date and some discussion, it became clear that many of us are concerned about the common, often severe, new and worsening impairments of physical, cognitive, and mental health that affect patients and their families following intensive care. Even though it is abundantly clear that their are many likely etiologies and sub-classes, we felt it would be helpful to name this group of disorders Post Intensive Care Syndrome (PICS).
We identified a number of promising approaches, but there are obvious and extensive gaps in our knowledge that require well-designed research studies. Included in these gaps are the needs and outcomes of palliative care patients in the ICU.
We all returned to our home institutions with a deeper knowledge and renewed commitment to raise awareness and do research on the needs and potential treatments for our most vulnerable patients. I am very pleased that hospice and palliative medicine is seen as an important partner in this effort.