Cultural dimensions
Language access
Working across a language barrier, and what the evidence says about how it should be done.
Context
A language barrier changes what a person can say about their own care, not what they value. The evidence here is unusually clear and unusually ignored: professional interpreters measurably outperform family members and untrained staff, and the difference shows up in comprehension, outcomes, and satisfaction. Reaching for a bilingual relative is the intuitive move and the wrong one, not because families are unwelcome but because interpreting is a clinical skill and the relative is also a person receiving hard news.
What this changes in practice
Use a professional interpreter rather than a family member or untrained staff, including for consent conversations and in pediatrics.
Do not assume a shared preference about how much a person wants to be told; how directly a diagnosis should be disclosed varies, and asking is the only way to know.
What to ask
- “Which language would you prefer for this conversation?”
- “Would a professional interpreter help, even if someone with you speaks English?”
- “How much detail would you like about your condition, and who else should hear it?”
The underlying studies, including where the evidence is weak, are set out on Care Frameworks. They are not restated here, so the two cannot drift apart.
Sources
- Karliner, L. S., Jacobs, E. A., Chen, A. H., Mutha, S. (2007). Do professional interpreters improve clinical care for patients with limited English proficiency? A systematic review of the literature.
- Luan-Erfe, B. M., Erfe, J. M., DeCaria, B., Okocha, O. (2022). Limited English Proficiency and Perioperative Patient-Centered Outcomes: A Systematic Review.
- Boylen, S., Cherian, S., Gill, F. J., Leslie, G. D., Wilson, S. (2020). Impact of professional interpreters on outcomes for hospitalized children from migrant and refugee families with limited English proficiency: a systematic review.
- Blackhall, L. J., Murphy, S. T., Frank, G., Michel, V., Azen, S. (1995). Ethnicity and attitudes toward patient autonomy.