Table 3.

Interpretation modality

Modality	Modality advantages
In-person	3.1. “… So my experience tells me that this [Interpretation] is best done face-to-face, best done with an interpreter who understand the cultural norms for that particular group, and the interpreter can oftentimes give cues to the team or providers, things to establish this relationship, which is the cornerstone for effective care”. (Physician) 3.2. …“Because, oftentimes, they [Interpreters] have cultural understandings that I don’t know. Then sometimes then they’ll ask me, “I’d like to say this to the family. Does this make sense to you?” and so it can be a little bit—not just a direct translation, but also help with cultural interpretation”. (Physician) 3.3. “It would be nice to actually have a relationship with an interpreter … I think having an in-person interpreter and having the cultural background would probably be the best”. (Nurse) 3.4. “I think the in-person interpreter for them [patients and families with LEP], it’s a familiar face. Someone who they can connect with better than they can connect with someone who doesn’t speak their language or understand their culture”. (Nurse) 3.5. “Only certain interpreters can be there during that time [end of life conversations]. It will give great support for the doctors, for the nurses, for the family, that bridge for everyone. You really have to have that cultural expert”. (Interpreter) 3.6 “You [healthcare team] have the interpreter here, and then you have the cultural broker, who is an interpreter, but plays more at a cultural”. (Interpreter) 3.7. “I’ve been seeing that the in-person interpreter is better than the iPad interpreter. Cuz this person can translate sometimes the emotions of the family, and also can resurrect any doubts, concerns or anything that probably being an English speaker we could not understand. I think that’s helpful”. (Physician) 3.8 “I know when we got an in-person interpreter, things got better as far as understanding, especially the family understanding a little bit more what was going on”. (Nurse)
Videoconferencing interpretation	3.9. “With the iPad, really they’re available 24/7. It’s much easier to use for interpretation. I do find myself using it all the time. Does that still impair communication? I’m sure it does”. (Physician) 3.10. “I would say in the past, waiting for the interpreter was not very easy. Now, we have a tool for communication and interpretation [iPad] at our disposal that we should not even think about not using it”. (Physician) 3.11. “I mean it’s been a lot more helpful having the iPad interpreter, because its pretty much 24/7, for the most part, for most of the languages anyway that we see up here”. (Nurse)
Family members	3.12. “We [Healthcare team] are often – maybe even overly – reliant on that family member to either translate for the patient or to communicate what they believe the patient’s wishes would be. I think oftentimes for convenience sake, unfortunately, and for time sake, we utilize those family members”. (Physician) 3.13. “There are some advantages to using family because they have insight into the patient and culture. The disadvantage is that sometimes you’re getting their filtered view and not the parent, or whatever, the family member’s view. (Physician) 3.14. “I think they [Patients and families with LEP] engage the best when there’s actually a family member there to be the arbiter back and forth to the patient. Because like I’ve said before, some of the personal issues and nuances can get lost in the translation because the patient is speaking with somebody who is a stranger to them”. (Nurse)
Modality	Modality disadvantages
In-person	3.15. “I will always use an interpreter if I can for [verbatim] interpretation. Or an iPad interpreter or the phone, or something. Realistically, we use family more than I wish we did, because sometimes it’s the middle of the night, or sometimes you’re popping into the room for five minutes and you’ve got 15 other patients to see. You don’t have time to wait for an interpreter to be paged and to come. (Physician) 3.16. “I think that we need more availability of in-person interpreters. In-person interpreter’s availability for interpretation… I find it very difficult”. (Physician) 3.17. “I’ve found in the past that the interpreter can—the in-person interpreter can be hard to get a hold of and be frequently late. They’re hard to schedule correctly for interpretation. (Nurse)
Videoconferencing interpretation	3.18. “The in-person interpreters, I think, generally do a better job interpreting than the iPad interpreters, particularly with the fact that the ICU is noisy, a lot of background noise, oxygen, et cetera”. (Physician) 3.19. “Sometimes, of course, you [Healthcare team] have to use the iPad for translation, which still works way better than the phone, but still, they’re [Interpreters] not in the room. They’re not sensing maybe the tension or the lack of tension or understanding the dynamics”. (Physician) 3.20. “Especially if we [Healthcare team] have the iPad interpreter we can always use, but they’re not always the kind of cultural interpreter that might be necessary”. (Nurse) 3.21. “The availability of interpreters is beneficial. If we could have more and have them more readily available, that would be ideal. Because like I was saying, the iPad interpreter doesn’t necessarily help with the cultural context of things”. (Nurse) 3.22. “For the ICU and end of life, I will never recommend use of the iPad for interpretation. That will be something—I will not say it’s bad, but it’s not very nice. We’re talking and interpreting about death and dying situations, and just having the machine here sounds to me not very personal, however, it has been done many times”. (Interpreter) 3.23. “I feel like a lot of our Spanish speaking patients aren’t quite prepared for the fact that their loved one could actually die there in the hospital. I think a lot of that is due to the fact that they don’t get an interpreter consistently or maybe they try to use the iPad”. (Interpreter)
Family members	3.24. “Even when they [Patients with LEP] have a family member there who speaks fluent English, I still try to have an interpreter as much as possible to make sure that they’re not just covering up with their English”. (Physician) 3.25. “I don’t really feel like that's a great thing to use family as interpreters just in case, again, I don't know what they're saying, and if they're truly telling what I'm saying, and repeating what the patient's saying back. (Nurse) 3.26. “Sometimes staff doesn’t call the interpreters. They use a family member. They think that the family's speak and understand more English than they actually do. That could lead to many misunderstandings. Maybe even false information”. (Interpreter)