RPD206 - Serious Illness Communication for Hospitalized Spanish-Speaking Patients: Insights from Patients and Clinicians

Key Message : Interpreter-mediated serious illness communication with Spanish-speaking patients requires more than language translation; it demands cultural humility, structured preparation, and emotional connection. Training clinicians, supporting interpreters, and addressing family and spiritual contexts are essential strategies to improve communication and care and reduce disparities for this patient population.

Abstract:

Background:
Spanish-speaking patients face challenges in serious illness communication (SIC) due to language barriers and interpreter use, which can foster miscommunication, mistrust, and care that misaligns with patient/family preferences, highlighting the need to understand patient and clinician experiences to improve interpreter-mediated SIC (1-3).

Objective:
To explore how Spanish-speaking patients, their healthcare proxies (HCPs), and clinicians experience interpreter-mediated SIC, identify barriers and facilitators, and elicit guidance to develop interventions that improve communication quality.

Methods:  
We individually interviewed hospitalized Spanish-speaking patients, HCPs, and palliative and non-palliative care clinicians at an academic medical center. Discussions focused on interpreter use, communication dynamics, and strategies for improving SIC. Thematic analysis identified patterns across and within patient and clinician perspectives.

Results:
We engaged 25 participants: 13 Spanish-speaking patients/HCPs (24-72 years old, 61% women, 61% HCPs) and 12 clinicians (67% palliative care, 25% ICU, 8% Oncology).

Patients/HCPs emphasized the importance of interpreter accuracy, completeness, and emotional conveyance. In-person professional interpreters were strongly preferred over iPad modalities for SIC. Patients trusted and sometimes preferred family interpreters; HCPs were willing to interpret but noted emotional strain and sometimes shielded patients from difficult information.

Clinicians noted challenges when family members had different levels of English proficiency and when side conversations were not interpreted. Clinicians highlighted the value of pre-briefing with interpreters to share context, conversation goals, and terminology, and debriefing after meetings to assess collective understanding and interpreter well-being.

Both groups reported concerns about misinterpretation, particularly among patients with partial English proficiency and clinicians with partial Spanish proficiency. Cross-cutting barriers included limited in-person interpreter availability and time constraints.

Conclusion: Our findings highlight opportunities to improve SIC for Spanish-speaking patients by training clinicians in effective interpreter partnership; implementing structured pre-brief/debrief practices; and expanding access to in-person interpreters and Spanish-speaking staff. These strategies may strengthen trust, reduce disparities, and improve communication.

References: (1) Smedley BD, Stith AY, Nelson AR. Unequal treatment: confronting racial and ethnic disparities in health care. Washington, DC: National Academies Press; 2003:1-764.
(2) Sharma RK, Cowan A, Gill H, Miyagawa LA. Understanding the role of caseworker–cultural mediators in addressing healthcare inequities for patients with limited English proficiency: a qualitative study. J Gen Intern Med. 2023;38(5):1190-1199.
(3) Ashana DC, D’Arcangelo N, Gazarian PK, et al. “Don’t talk to them about goals of care”: understanding disparities in advance care planning. J Gerontol A Biol Sci Med Sci. 2022;77(2):339-339. doi:10.1093/gerona/glab091.