Are Good Intentions Good Enough?: Informed Consent Without Trained Interpreters

OBJECTIVE: To examine the informed consent process when trained language interpreters are unavailable. BACKGROUND: Ensuring sufficient patient understanding for informed consent is especially challenging for patients with Limited English Proficiency (LEP). While US law requires provision of competent translation for LEP patients, such services are commonly unavailable. DESIGN AND PARTICIPANTS: Qualitative data was collected in 8 prenatal genetics clinics in Texas, including interviews and observations with 16 clinicians, and 30 Latina patients. Using content analysis techniques, we examined whether the basic criteria for informed consent (voluntariness, discussion of alternatives, adequate information, and competence) were evident for each of these patients, contrasting LEP patients with patients not needing an interpreter. We present case examples of difficulties related to each of these criteria, and compare informed consent scores for consultations requiring interpretation and those which did not. RESULTS: We describe multiple communication problems related to the use of untrained interpreters, or reliance on clinicians’ own limited Spanish. These LEP patients appear to be consistently disadvantaged in each of the criteria we examined, and informed consent scores were notably lower for consultations which occurred across a language barrier. CONCLUSIONS: In the absence of adequate Spanish interpretation, it was uncertain whether these LEP patients were provided the quality and content of information needed to assure that they are genuinely informed. We offer some low-cost practice suggestions that might mitigate these problems, and improve the quality of language interpretation, which is essential to assuring informed choice in health care for LEP patients

Coordination and management of information for construction design projects - a framework for Portugal

In the construction industry in Portugal, the coordination and management of information for construction design projects has been neglected. The use of classification systems and protocols for the communication of information amongst the different stakeholders is poor and inefficient. This research aims to explore the viability of developing a systematic approach to the coordination of information amongst the multiple project stakeholders in the Portuguese Construction Industry. Bearing this in mind, the core research question of this doctoral thesis is: What sort of framework and guidelines are needed for the successful implementation of a classification information system for construction project design data in Portugal, which is accessible to all stakeholders involved? A mixed methods approach was developed for this purpose, with emphasis given to qualitative research techniques. Methods used comprised: literature review, quantitative survey, semi-structured interviews and focus group discussions. Whereas quantitative research methods contributed to a more rigorous interpretation process, qualitative research methods offered a solid description of the former. This methodology was used in order to establish and design a conceptual classification framework model for information coordination and management throughout the design project and construction in Portugal. First, constraints and enablers to framework development and implementation were identified at all levels: political, cultural and behaviour, legal, technical and educational, economic and financial, and organizational issues. Three overarching issues were also identified: corruption, lack of accountability and non-compliance timelines/deadlines. Then, a conceptual framework was developed, detailing 1) content, 2) characteristics of an environment conductive to a successful development, implementation and use of the framework, and 3) guidelines to its dissemination