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Families with limited English proficiency receive less information and support in interpreted intensive care unit family conferences*

Thornton, J Daryl MD, MPH; Pham, Kiemanh MD; Engelberg, Ruth A. PhD; Jackson, J Carey MD, MPH; Curtis, J Randall MD, MPH

Critical Care Medicine:
doi: 10.1097/CCM.0b013e3181926430
Clinical Investigations
Abstract

Objective: Family communication is important for delivering high quality end-of-life care in the intensive care unit, yet little research has been conducted to describe and evaluate clinician-family communication with non-English-speaking family members. We assessed clinician-family communication during intensive care unit family conferences involving interpreters and compared it with conferences without interpreters.

Design: Cross-sectional descriptive study.

Setting: Family conferences in the intensive care units of four hospitals during which discussions about withdrawing life support or delivery of bad news were likely to occur.

Participants: Seventy family members from ten interpreted conferences and 214 family members from 51 noninterpreted conferences. Nine different physicians led interpreted conferences and 36 different physicians led noninterpreted conferences.

Measurements: All 61 conferences were audiotaped. We measured the duration of the time that families, interpreters, and clinicians spoke during the conference, and we tallied the number of supportive statements issued by clinicians in each conference.

Results: The mean conference time was 26.3 ± 13 mins for interpreted and 32 ± 15 mins for noninterpreted conferences (p = 0.25). The duration of clinician speech was 10.9 ± 5.8 mins for interpreted conferences and 19.6 ± 10.2 mins for noninterpreted conferences (p = 0.001). The amount of clinician speech as a proportion of total speech time was 42.7% in interpreted conferences and 60.5% in noninterpreted conferences (p = 0.004). Interpreter speech accounted for 7.9 ± 4.4 mins and 32% of speech in interpreter conferences. Interpreted conferences contained fewer clinician statements providing support for families, including valuing families’ input (p = 0.01), easing emotional burdens (p < 0.01), and active listening (p < 0.01).

Conclusions: This study suggests that families with non- English-speaking members may be at increased risk of receiving less information about their loved one’s critical illness as well as less emotional support from their clinicians. Future studies should identify ways to improve communication with, and support for, non-English-speaking families of critically ill patients.

Author Information

From the Center for Reducing Health Disparities (JDT), Division of Pulmonary, Critical Care, and Sleep Medicine, Case Western Reserve University, MetroHealth Medical Center, Cleveland, OH; Department of Emergency Medicine (KP), Kern Medical Center, Bakersfield, CA; Division of Pulmonary and Critical Care Medicine (RAE, JRC), Department of Medicine, University of Washington, Seattle, WA; Division of General Internal Medicine (JCJ), Department of Medicine, University of Washington, Seattle, WA.

Supported, in part, by grant RO1-NR-05226 from National Institute of Nursing Research, the Greenwall Foundation, and from the Open Society Institute Project on Death in America. Supported by the Robert Wood Johnson Amos Medical Faculty Development Program and the National Center on Minority Health and Health Disparities (1-P60MD002265-01; to JDT).

The authors have not disclosed any potential conflicts of interest.

For information regarding this article, E-mail: jrc@u.washington.edu

© 2009 by the Society of Critical Care Medicine and Lippincott Williams & Wilkins