Gaze and body orientation as an apparatus for patient inclusion into/exclusion from a patient-centred framework of communication

Dialogue interpreter training has traditionally focused on the way in which the interpreter manages, and maintains, verbal interaction between the primary participants while it seems to overlook the importance of specific non-verbal aspects that are inherent in mediated interaction. This article presents an alternative method for the training of medical interpreters by drawing on research on non-verbal communication in interpreter-mediated consultations with a view to drawing attention to the interpreter's impact on the patient's inclusion in a patient-centred framework during mediated consultations. More specifically, it provides evidence of non-verbal interaction that might open up new trajectories in the interpreters' training by foregrounding the impact of the interpreter's and others' direction of gaze and body orientation on the accomplishment and maintenance - or lack thereof - of a patient-centred framework of communication. The present article reports on findings that emerged from the analysis of selected excerpts of authentic interpreter-mediated consultations within the framework of a training experiment. Coded instances of interaction are analysed by relying on Goffman's 'ratification process', Goodwin's 'participation and engagement frameworks' and Norris' 'modal density foreground-background continuum'. Hospital ethical approval and participants' written informed consent were obtained prior to the collection of data

Healthcare teams as complex adaptive systems : understanding team behaviour through team members’ perception of interpersonal interaction

Background: Complexity science has been introduced in healthcare as a theoretical framework to better understand complex situations. Interdisciplinary healthcare teams can be viewed as Complex Adaptive Systems (CAS) by focusing more on the team members' interaction with each other than on the characteristics of individual team members. Viewing teams in this way can provide us with insights into the origins of team behaviour. The aim of this study is to describe the functioning of a healthcare team as it originates from the members' interactions using the CAS principles as a framework and to explore factors influencing workplace learning as emergent behaviour. Methods: An interview study was done with 21 palliative home-care nurses, 20 Community nurses and 18 general practitioners in Flanders, Belgium. A two-step analysis consisted of a deductive approach, which uses the CAS principles as coding framework for interview transcripts, followed by an inductive approach, which identifies patterns in the codes for each CAS principle. Results: All CAS principles were identified in the interview transcripts of the three groups. The most prevalent principles in our study were principles with a structuring effect on team functioning: team members act autonomously guided by internalized basic rules; attractors shape the team functioning; a team has a history and is sensitive to initial Conditions; and a team is an open system, interacting with its environment. The other principles, focusing on the result of the structuring principles, were present in the data, albeit to a lesser extent: team members' interactions are non-linear; interactions between team members can produce unpredictable behaviour; and interactions between team members can generate new behaviour. Patterns, reflecting team behaviour, were recognized in the coding of each CAS principle. Patterns of team behaviour, identified in this way, were linked to interprofessional competencies of the Interprofessional Collaboration Collaborative. Factors influencing workplace learning were identified. Conclusions: This study provides us with insights into the origin of team functioning by explaining how patterns of interactions between team members define team behaviour. Viewing healthcare teams as Complex Adaptive Systems may offer explanations of different aspects of team behaviour with implications for education, practice and research

Study protocol of OncoTolk : an observational study on communication problems in language-mediated consultations with migrant oncology patients in Flanders (Belgium)

Introduction Effective doctor-patient communication in oncology settings can be challenging due to the complexity of the cancer disease trajectory. The challenges can become greater when doctors and patients do not share a common language and need to rely on language mediators. The aim of this study is to provide evidence-based recommendations for healthcare professionals, patients and language mediators on how to interact with each other during language-mediated consultations in oncology settings. Methods and analysis A systematic review of the literature on communication problems in monolingual and multilingual oncology settings will be conducted. Thirty language-mediated consultations with Turkish-speaking or Arabic-speaking cancer patients, language mediators and Dutch-speaking oncologists/haematologists will be video-recorded in three urban hospitals in Flanders, Belgium. All participants will be interviewed immediately after the consultation and 2 weeks after it by means of video-stimulated recall. Multimodal interaction analysis will be combined with qualitative content analysis to allow for the identification of communication practices when communication problems occur. Ethics and dissemination The study has been approved by the following ethics committees: Ghent University Hospital, Antwerp University Hospital, Antwerp Hospitals Network (ZNA). Results will be published via (inter)national peer-reviewed journals and the findings of the study will be communicated using a comprehensive dissemination strategy aimed at healthcare professionals, patients and language mediators

Understanding uptake and experience of interpreting services in primary care in a South Asian population in the UK

Addressing language barriers in accessing health care may improve equitable access in line with current United Nations Sustainable Development Goals. English proficiency is associated with socioeconomic position, social segregation, and employment, and the intersectionality of ethnicity, immigration status, and lack of language proficiency results in cumulative disadvantage. Guidance for commissioners in the UK states that language and communication requirements should not prevent patients from receiving equitable care. Limited evidence is available on interpreting service uptake and patient experience that is crucial to ensure services reduce ethnic and socioeconomic health inequalities. We aimed to address this evidence gap