Table 1.
Communication guidelines in EOL care.
| Working with Inuit health interpreters at end of life: guidelines for nurses and physicians |
|---|
| Time, time, take time – establish relational foundation for care, ensure clear communication |
| Keep sentences short |
| Learn about moral dilemmas faced by interpreters |
| Recognise that not all medical terms and procedures are translatable in Inuktitut |
| Explain why questions are asked of patient and families, sometimes repeatedly – avoid intrusion |
| Use visual illustrations with the patient and with interpreter at the same time |
| Shift the power dynamic when possible – recognise patient, family and interpreter knowledge, efforts and expertise |
| Welcome patient request for interpreters who appear to understand – interpreters may be requested as cultural mediators and providers of emotional support |
| Model through example – mentor caregiving techniques for families |
| Invite family to participate in care in home and hospital care settings |
| Explain difficult news to the interpreter ahead of time as this allows time for clarification and allows time for interpreter to address own emotions before speaking with patient |
| Explain the rationale of potentially controversial or emotionally loaded messages to interpreter – this equips the interpreter to communicate the spirit of a message and to address patient’s reactions more clearly |
| When using a telephone in interpretation, do so progressively rather than just one long conversation |
| Familiarise with worldviews, spiritual beliefs of patient and family – i.e. let patients know that even doctors cannot know the time of death |
| Attune to non-verbal messages looking at the patient, not the interpreter when speaking |
| Respectfully invite input from interpreters concerning how to communicate difficult messages, community contextual factors, and cultural knowledge |
| Be clear, provide potential scenarios concerning the potential impact of extraordinary life-sustaining treatment |
| Let go and let it be, attuning to patients who do not want life-saving interventions |
| Recheck the comprehension of patient – clarify when misunderstanding is not necessarily a problem with interpretation |
| Learn some words in the patient’s Inuktitut dialect and use them |
| Attend funerals when appropriate, asking if this is perceived as a gesture of support or an intrusion |
| Guide families and patients in communicating frustration – recognise causes of stress, set limits, clarify communication expectations |
| Seek help to address the social suffering surrounding patient care |
| Educate communities about medical procedures, dying process through public health announcements – radio, Facebook, video, illustrated brochures, in Inuktitut |
| (See [28]) |