Thesis

Attitudes towards interpretation services provided to underserved patients during cancer genetic counseling sessions in the public hospital setting: perspectives from genetic counselors and interpreters

The participation of medical interpreters during medical encounters is essential for limited English proficient (LEP) patients in accessing the healthcare services that they need and deserve, mainly by overcoming the communication barrier. However, interpreters’ involvement is accompanied by many challenges. Cancer genetic counseling entails the discussion of large amounts of complex information, frequently associated with a psychosocial component, which can result in overwhelming and, at times, confusing low health literacy LEP patients. The participation of a medical interpreter in such sessions incorporates another layer of complexity, especially if the interpreter is not familiar with key aspects of the genetic counseling encounter, and if interpreters and provider do not establish a collaborative relationship. Some literature is available in regards to the perspectives and experiences of providers working with medical interpreters in a variety of medical settings. Less is known about interpreters’ perspectives about working in bilingual healthcare settings, and to our knowledge, no studies have been done to evaluate interpreters’ points of view in terms of their participation in cancer genetic counseling encounters. For this reason, the aim of the present study was to gain in-depth knowledge about medical interpretation services in the context of hereditary cancer genetic counseling involving underserved patients, by conducting semi-structured interviews with 11 medical interpreters and 10 genetic counselors at two major public medical centers in San Francisco, California. Five themes were identified representing the overarching perspectives of medical interpreters and genetic counselors working with LEP patients: 1) Interpreters as more than Conduits; 2) Challenges faced by Medical Interpreters during Cancer Genetic Counseling encounters; 3) Lack of respect/appreciation by providers; 4) Genetic Counselor “correcting” the interpreter; and 5) Trust as foundation of the Interpreter-Provider dyad. The findings of the present study identified key aspects of the interpreter and provider professional inner worlds, which allowed the development of strategies and practice recommendation to help overcome the many challenges inherent to the process of translation/interpretation in the cancer genetic counseling setting, thus ultimately promoting better service to the patients.

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