Measuring recall of medical information in non-English-speaking people with cancer: A methodology

Background Many patients who require an interpreter have difficulty remembering information from their medical consultations. Memory aids such as consultation audio-recordings may be of benefit to these patients. However, there is no established means of measuring patients’ memory of medical information. Objectives This study aimed to develop a method for eliciting and coding recall of medical information in non-English-speaking patients. Design This method, called Patient-Interpreter-Clinician coding (PICcode), was developed in the context of a phase II trial conducted in two outpatient oncology clinics in Melbourne, Australia, and was refined iteratively through consultation with an expert panel and piloting. Between-coder differences in early versions of the coding system were resolved through discussion and consensus resulting in refinements to PICcode. Results The final version of PICcode involved transcribing, translating and coding of audio-recorded consultations and semi-structured interviews (SSI). The SSIs were designed to elicit patients’ free-recall of medical information. Every unit of medical information in the consultation was identified and categorized in a coding tree. SSIs were coded to identify the extent to which information was recalled from the consultation. Discussion The iterative changes involved in developing PICcode assisted in clarifying precise details of the process and produced a widely applicable coding system. PICcode is the most comprehensively described method of determining the amount of information that patients who use an interpreter recall from their medical consultations. PICcode can be adapted for English-speaking patients and other healthcare populations

Including migrant oncology patients in research : a multisite pilot randomised controlled trial testing consultation audio-recordings and question prompt lists

Background: Oncology patients who are migrants or refugees face worse outcomes due to language and communication barriers impacting care. Interventions such as consultation audio-recordings and question prompt lists may prove beneficial in mediating communication challenges. However, designing robust research inclusive of patients who do not speak English is challenging. This study therefore aimed to: a) pilot test and assess the appropriateness of the proposed research design and methods for engaging migrant populations, and b) determine whether a multi-site RCT efficacy assessment of the communication intervention utilising these methods is feasible. Methods: This study is a mixed-methods parallel-group, randomised controlled feasibility pilot trial. Feasibility outcomes comprised assessment of: i) screening and recruitment processes, ii) design and procedures, and iii) research time and costing. The communication intervention comprised audio-recordings of a key medical consultation with an interpreter, and question prompt lists and cancer information translated into Arabic, Greek, Traditional, and Simplified Chinese. Results: Assessment of feasibility parameters revealed that despite barriers, methods utilised in this study supported the inclusion of migrant oncology patients in research. A future multi-site RCT efficacy assessment of the INFORM communication intervention using these methods is feasible if recommendations to strengthen screening and recruitment are adopted. Importantly, hiring of bilingual research assistants, and engagement with community and consumer advocates is essential. Early involvement of clinical and interpreting staff as key stakeholders is likewise recommended. Conclusion: Results from this feasibility RCT help us better understand and overcome the challenges and misconceptions about including migrant patients in clinical research

Descriptions of interpreting and their ethical consequences

The current array of descriptions that are given of interpreting outside the conference room has bedeviled the field: from ‘community interpreting’ to ‘dialogue interpreting’ to ‘public service interpreting’ to ‘ad hoc interpreting’ to ‘non-professional interpreting’. Some descriptions avoid ‘interpreting’ altogether – ‘linguistic mediation’, ‘cultural mediation’, etc. Significantly, self-ascription by the practitioners themselves often does not match these imposed descriptions. Yet each description carries with it, implicitly or explicitly, a specific view of ethics, tied closely to perceived roles of interpreters, but often encompassing assumptions about tasks, personal or professional characteristics, or status. This messy terminological terrain is surveyed to reveal some altogether clear distinctions that can help our understanding of differentiating and common elements in interpreting. Building on that, the ethical implications of different descriptions are categorised to show that ethical responsibility in interpreting situations rests not with the interpreters alone, but with other players, particularly institutional players, in contracting language services.La actual variedad de descripciones que se dan sobre la interpretación fuera de la sala de conferencias ha dañado al campo: desde “interpretación social” a “interpretación de diálogo”, “interpretación en los servicios públicos”, “interpretación ad hoc” o “interpretación no profesional”. Algunas descripciones evitan decir “interpretación” tal cual – “mediación lingüística”, “mediación cultural”, etc. De manera significativa, la auto-adscripción por parte de los profesionales a menudo no coincide con estas descripciones impuestas. Aunque cada descripción entraña, implícita o explícitamente, una mirada específica a la ética, ligada estrechamente a los papeles desempeñados por los intérpretes, a menudo incluye suposiciones sobre tareas, características personales o profesionales, o estatus. Este desorganizado terreno terminológico se analiza para revelar muy claras diferencias que pueden ayudar a nuestra comprensión de la diferenciación y elementos comunes en la interpretación. Al hilo de ello, se clasifican las implicaciones éticas de las diferentes descripciones para mostrar que la responsabilidad ética en situaciones interpretativas descansa no sólo en los intérpretes, sino en otras partes, especialmente las institucionales, en la contratación de servicios de idiomas

It's not about the interpreter : objectives in dialogue interpreting teaching

While a central objective of any interpreter training is to develop professional language transfer skills, dialogue interpreting sets additional challenges in coping with the interpersonal dynamics and often significantly divergent institutional status, discourse styles and communicative intent of participants. An interpreted encounter exists not for the interpreter, but for these other two or more parties, and the interpreter must perform an often complex act of transferring meaning between two parties with perhaps quite varying dispositions and expectations. Achieving this synthesis of translation competence, interpersonal performance and contextual knowledge describes the objectives of dialogue interpreting education. Such preparation differs in degree and in kind from preparation in other interpreting fields, demanding focus on social and interactional as much as on linguistic features of encounters

Social workers, the law and interpreters

Social workers may work with interpreters in any of the fields outlined in this volume. While social workers are among the professionals who most encourage the use of interpreters to meet client needs, the legal system still has difficulties in some cases in ensuring access to interpreters or being confident in working with them. While the right to an interpreter is recognised in criminal case law and is widely supported in general government policy, the use of interpreters by magistrates, lawyers, tribunal members or others who assess the level of English of witnesses or participants in various settings can be inconsistent. Social workers need to not only make use of interpreters in their own client work, but also need to advocate for the use of interpreters in areas as varied as criminal matters, guardianship, family law, mental health, disability and Native Title. Further difficulties arise from the patchy availability of competent interpreters in some languages and some regions, and this chapter briefly outlines interpreter credentials and training systems. Effective use of interpreters can enhance social work practice in all legal areas, many of which are often likely to be culturally quite impenetrable to non-English speakers

Factors that determine the provision of Public Service interpreting : comparative perspectives on government motivation and language service implementation

This paper undertakes a comparative examination of language service policy, as various countries struggle to meet multilingual communication needs. Four macro factors are posited that affect provision of public service interpreting: • Increasing linguistic diversity • Reliance on public sector finance • Institution-led, rather than profession-led standards and practices • Cross-sectoral interpreting needs that conflict with usual sector-specific policy development While these factors affect policy in all countries, it is argued that countries differ widely in other crucial aspects that affect language service policy, including overall attitudes to immigrants; divergent models of government service provision; federalism or unitarianism in government; whether legal/court interpreting is favoured over other sectors; and even variation in response to the very concept of ‘interpreting.’ Examination of these factors allows us to understand differences in such outcomes as provision of interpreter training, certification, allocation of resources and reach of language services. Specific motivations for government interpreting policy are examined to see how governments can be persuaded to take initiatives to develop language services, looking at normative factors, building of coalitions to press for services, and attending to the interactions between such factors as training, certification and finance to ensure quality language services

Ethics and the role of the interpreter

Issues of ethics have always attended interpreting, as practitioners will often be privy to complex or highly privileged information - whether related to national security, or personal trauma or difficulty, or sensitive business negotiations. Trust in those doing the interpreting is paramount for participants who lack command of the other language, and recognition of ethical practice is fundamental to recognition as a profession. Moreover, unlike other professions where there is a direct relationship between a practitioner and client, interpreters always work between two parties - either a speaker and listeners (as in conference interpreting) or between two interlocuters in liaison situations; ethical issues can crucially arise for interpreters from the behaviour and disposition of either party, and trust has to be obtained from both. This chapter first looks at how ethical considerations and resulting codes of ethics have arisen in diverse interpreting settings; it then goes on to examine often unresolved ethical issues over role and ethics, linking debates in interpreting to cognate debates in translation studies

A small national language and its multilingual challenges : the case of Latvian

The Baltic language of Latvian is spoken as a first language by just over one million speakers, largely in Latvia but with a scattering of speakers around the world, principally in Europe, North America and Australia. Almost 500,000 people speak it as a second language, with varying degrees of proficiency. With this number of speakers, Latvian is roughly the 250th largest language in the world (Latvia State Language Agency, 2005:21). As one of the official languages of the EU, a highly developed literary language, and a language with official status in its nation, the future of Latvian – like neighbouring Estonian and Lithuanian – would appear to be secure. Particularly interesting is the fact that Latvian has not only gained (or more precisely regained) official status for itself through the law, but has also succeeded in increasing the number of people who speak it as a second language, an unusual example of a small language spreading as a lingua franca among speakers of much larger languages. At the same time, the past, and particularly the recent Soviet past, places constraints upon the spread of Latvian throughout its territory and in all linguistic domains. During the Soviet period hundreds of thousands of Soviet settlers were brought to Latvia, as in the case of Estonia, but were taught nothing about Latvia, its history or culture, and were never encouraged to learn the local language (Agarin, 2010). While, as we shall see, many have now accepted Latvian and are in many cases proficient in the language, there are significant exceptions, and language attitudes from the Soviet period continue to be held. Moreover, these constraints are not only a relic of the Soviet past but are actively exploited by Russia in seeking to exercise its influence over former Soviet citizens living in what it sees as its ‘near abroad'. As a consequence, European organizations have also been drawn into appraisals of Baltic language and citizenship policies. In the midst of these political pressures, Latvian also needs to be developed as a language, in particular to cope with technological change and European administrative and cultural developments, while also paying attention to its own diversity in terms of regional and dialectical variations. The emphasis on the conflicts between Latvian and Russian has tended to overshadow these other linguistic considerations, and while this chapter pays particular attention to this central issue, it also looks more broadly at other challenges facing the Latvian language today

Language policy and smaller national languages : the Baltic States in the new millenium

Language policy in the post-independent Baltic States Estonia, Latvia and Lithuania has attracted considerable political and academic interest. Regaining their independence in 1991 after half century of Soviet rule, the Baltic States have pursued a range of language policy initiatives to ensure this status, even though at the time of renewed independence the countries had sizable portions of their population who did not know the national languages in each case - Estonian, Latvian, Lithuanian. This chapter investigates these competing responses to Baltic language policy politically and institutionally, tempering this with a historical and sociolinguistic analysis that shows that the complex language practices and attitudes of Baltic residents often differ sharply from the political rhetoric