Table 3:

Facilitators of end of life decision making for ICU patients and families with LEP

Category	Illustrative Quotes
Pre-meeting between clinician and interpreter (to plan and clarify how to optimally deliver the message)	A physician told of how they usually talk with the interpreter beforehand: “If nothing else, for me to talk with [the interpreter] ahead of time and just say, ‘This is our understanding. Can you help me communicate this? If I’m not being clear, can you help me?’” A physician said: “I will always introduce myself to the interpreters, make sure they know who I am and what problem I’m hoping to address that day.”
Interpretation that communicates empathy and caring	One physician commented: “I remember working with one interpreter in general, and he was fantastic and really took his job seriously. I loved working with him. I mean, he would turn to me and be like—he’d want to get some more information about how to convey this better.” A physician said: “Even with the limitations of language and even working with interpreters, I think it’s crucially vital that there is signalling, both verbal and non-verbal signals that we care about the patient and we care about the family.”
Interpretation that communicates cultural perspectives and context bidirectionally	An interpreter explained that physicians might ask for help: “How would I say this … ‘How do I present this?’ if there’s an in-person interpreter,[it helps] just to know the culture more.” A physician stated: “Oftentimes, [the interpreter] will have cultural understandings that I don’t know…. and so it can be a little bit-not just a direct translation, but also help with cultural interpretation.”
Interpretation that improves messaging including with appropriate word use	Another interpreter said: “maybe the word of dying. Maybe you should change it. Maybe you can talk about…something more sweet than just dying. Something that makes the patient and t the family members more at ease.”
Clinician cultural competency and humility	A nurse stated: “Are we truly understanding what the (LEP) patient’s values are? It’s amazing how it’s night and day change. Once you do that and you readdress it when the dust settles. I think we could do a little better job of that”. A nurse noted: “Usually with our [Healthcare Team] admission, we ask “what are your religious preferences? What’s important to you? Who makes decisions in your family?” An interpreter recommended: “I think we [Healthcare Team] need all our providers to have enough education from the perspective of culture differences”. A physician stated: “Even if we think, ‘This is a futile process,’ [the patients and families] have their belief system. I think that every interaction I’ve had once I’ve understood that belief system, has actually been very straightforward.”