Table 1.

Recommended Best Practices When Conducting a Family Meeting with an Interpreter

Recommendation	Rationale	Words to say
Use a professional interpreter, whenever possible.	Less likely to make errors.	If a family member has been acting as interpreter:
	Trained to protect patient privacy and confidentiality.	“I really appreciate your help with interpretation, but I fear I am not doing a good job of understanding and listening to all the members of your family. I would like to ask a hospital interpreter to assist us so that you can focus on participating in our discussion, rather than interpreting.”25
	Minimizes burden on family members.
Brief the interpreter before the meeting.	Allows clinicians to warn the interpreter that sensitive or end-of-life issues will be discussed.	“Before we go in the room, I want to clarify the goals of this meeting.”
	Allows clinicians to orient the interpreter to the family structure and the interpreter's expected role.	“I would like you to translate everything that is said, word for word.”
	Provides an opportunity for the clinician to learn about culturally important considerations from the interpreter.	“I will be explaining some of the technical terms I am using such as ‘hospice,’ but let me know in the meeting if there is a potential misunderstanding, or if something is not clear to the family.”
		“In this meeting we will discuss withdrawing life-sustaining treatment. Are there any cultural concerns I should be aware of before we get started?”
Introduce the interpreter to the family, set expectations, and address confidentiality concerns.	Setting expectations and clarifying confidentiality issues may reassure patients and facilitate communication.	“I want to introduce you to the hospital's medical interpreter.”
	Undocumented immigrants may fear reporting of immigration status, should the topic arise, to government authorities.	“S/he is available to us free of charge.”
		“I will be speaking directly with you, and the interpreter will interpret everything that is said.”
		“All professional interpreters are trained to protect patient privacy and confidentiality.”
		If immigration status is discussed:
		“I want to assure you that neither I nor the interpreter will report on your status to the government immigration authorities.”
Acknowledge the difficulty of not being able to speak directly when a loved one is critically ill.	Expresses empathy and encourages clear communication.	“We are using an interpreter because the topics we are discussing are important and we need to communicate as clearly as possible with each other.”
		“I know it is difficult not to be able to speak directly when your loved one is very sick.”
		“Please know that we want to understand you. I think the interpreter will help us a lot, but there may still be areas where we are unclear. Please do not hesitate to interrupt or ask for clarifications.”
Communication style	Respects the clinician-family interaction as the central focus.
Make eye contact and speakdirectly to the family.	Greater opportunity for clinician and family to perceive nonverbal communication.
Use short phrases and simple language.	Interpreters most often cannot improve on what is said.	“What do you understand so far about your loved one's condition?”
Assess prior knowledge.	Shorter phrases are easier to interpret accurately.	Say “the cancer has spread” rather than “metastatic disease.”
Encourage questioning.	Strategies for clear health communication are recommended for all patients and may be particularly important in discussions about end-of-life issues and/or in the setting of language barriers.	“What kinds of questions do you have about what we've talked about so far?” “I know I have said a lot. Tell me what you have understood, in your own words, so I can be sure I am speaking clearly.”
Assess understanding by askingpatients to teach-back key elements.
Debrief with the interpreter after the meeting.	Provides an opportunity for clinicians to give emotional support to the interpreter.	“How did that meeting go for you?”
	Provides an opportunity for the interpreter to give feedback about the meeting.	“Do you have any concerns about the family's understanding?”
		“Do you have any concerns about the impact of our discussion on the family?”
		“Is there anything the family said that you did not have the chance to interpret?”

Source: Adapted from Smith et al.²³