Rationale Many family conferences in the ICU occur with families of patients with limited English proficiency requiring a medical interpreter. Despite the importance of medical interpretation, little is known about the alterations that occur and their effect on communication. Objectives This study characterizes the types, prevalence, and potential effects of alterations in interpretation during ICU family conferences involving end-of-life discussions. Methods We identified ICU family conferences in 2 hospitals in which a medical interpreter was used. Ten conferences were audiotaped, 9 physicians led these conferences, and 70 family members participated. Research interpreters different from those attending the conference translated the non-English portions of the audiotaped conferences. We identified interpretation alterations, grouped them into four types, and categorized their potential effects on communication. Results For interpreted exchanges between clinicians and family, there was a 55% chance that an alteration would occur. These alterations included additions, omissions, substitutions, and editorializations. Over three-quarters of alterations were judged to have potentially clinically significant consequences on the goals of the conference. Of the potentially significant alterations, 93% were likely to have a negative effect on communication; the remainder, a positive effect. The alterations with potential negative effects included interference with transfer of information, reduced emotional support, and reduced rapport. Those with potential positive effects included improvements in conveying information and emotional support. Conclusions Alterations in medical interpretation seem to occur frequently and often have the potential for negative consequences on the common goals of the family conference. Further studies examining and addressing these alterations may help clinicians and interpreters improve communication with family members during ICU family conferences.

Pham K, Thornton JD, Engelberg RA, Jackson JC, Curtis JR.