Decision-making across cultures: cancer counseling of low-income Latina women using medical interpreters

Language and cultural barriers hinder communication and are contributing factors to health disparities in the provision of medical services. The use of medical interpreters has been shown to alleviate some of the issues in cross-cultural medical encounters, yet many challenges remain. In the genetic counseling setting, a model of practice based on facilitating shared decision-making further challenges the communication in sessions with limited English proficiency (LEP) patients. In order to facilitate shared decision-making, genetic counselors must present information in a manner that can be comprehended by the patient, ensure accurate and complete translation by the interpreter, and engage the patient in a dynamic discussion that integrates patient concerns and psychosocial issues with the information presented by the counselor. Few studies have been published on the decision-making process of low-income LEP patients in genetic counseling, and the majority of these studies focused on the prenatal setting. The purpose of this study was to identify points of weakness and strength in communication with low-income LEP Latina women in the cancer genetics setting, and to propose recommendations to improve effective communication and the shared decision-making process. This involved qualitative analysis of 24 audio-recorded cancer genetic counseling sessions of low-income LEP Latina women utilizing professional medical interpreter services via telephone. Communication gaps and facilitators were identified as they inhibited or facilitated shared decision-making. Presenting information in the form of abstract hypothetical situations and misinterpretation on the part of the interpreter were found to hinder decision-making. Additionally, specific strengths on the part of the genetic counselor, interpreter, and patient were identified as facilitators of communication. Further research will assist in generalizing the findings of this study to broader populations.