A Conduit for a Culturally Competent Consent: Medical Interpreters' Perspectives on Surgical Informed Consent Discussions

Benjamin G Allar; Cristina Ponce; James Wallace; Gezzer Ortega; Amanda J Reich; Shari Gold-Gomez; Sidhu P Gangadharan; Tara S Kent

doi:10.1097/SLA.0000000000006160

A Conduit for a Culturally Competent Consent: Medical Interpreters' Perspectives on Surgical Informed Consent Discussions

Ann Surg. 2023 Nov 22. doi: 10.1097/SLA.0000000000006160. Online ahead of print.

Authors

Benjamin G Allar^{1

2}, Cristina Ponce¹, James Wallace¹, Gezzer Ortega², Amanda J Reich², Shari Gold-Gomez³, Sidhu P Gangadharan¹, Tara S Kent¹

Affiliations

¹ Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston MA.
² Center for Surgery and Public Health, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston MA.
³ Division of Interpreter Services, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston MA.

PMID: 37990875
DOI: 10.1097/SLA.0000000000006160

Abstract

Objective: To understand medical interpreter's perspectives on surgical informed consent discussions and provide feedback for surgeons on improving these conversations.

Summary background data: Informed consent is a critical component of patient-centered surgical decision-making. For patients with limited English proficiency (LEP), this conversation may be less thorough, even with a medical interpreter, leaving patients with an inadequate understanding of their diagnosis or treatment options.

Methods: A semi-structured interview guide was developed with input from interpreters and a qualitative research expert. We purposively sampled medical interpreters representing multiple languages until thematic saturation was achieved. Participants discussed their experience with the surgical consent discussion and process. Interview transcripts were analyzed using emergent thematic analysis.

Results: Among 22 interpreters, there were ten languages represented and an average experience of 15 years (range 4-40 y). Four major themes were identified. First, interpreters consistently described their roles as patient advocates and cultural brokers. Second, interpreters reported unique patient attributes that influence the discussion, often based on patients' cultural values/expectations, anticipated decisional autonomy, and family support. Third, interpreters emphasized the importance of surgeons demonstrating compassion and patience, using simple terminology, conversing around the consent, providing context about the form/process, and initiating a pre-encounter discussion. Finally, interpreters suggested reducing legal terminology on consent forms and translation into other languages.

Conclusions: Experienced interpreters highlighted multiple factors associated with effective and culturally tailored informed consent discussions. Surgeons should recognize interpreters' critical and complex roles, be cognizant of cultural variations among patients with LEP, and improve interpersonal and communication skills to facilitate effective understanding.