Table 2 Overview of physician perspectives on language and cultural discordance in end-of-life care
Theme | Subthemes and descriptions |
|---|---|
Visible barriers to access and quality of care | Inability to communicate • Biased and filtered translation when relying on family interpreters • Loss of non-verbal emotional communication and rapport when relying on professional interpreters • Multilingual physicians not comfortable with medical terminology when speaking patient’s language • Patients unable to express their preferences and gain an in-depth understanding of treatment options |
Insufficient time with patients • More time and effort spent when facing language discordance • Physicians resort to a quick menu of options, rather than counselling • Some remuneration models (ie. fee-for-service) prioritize efficiency over patient-centered care | |
Invisible barriers to access and quality of care | Eurocentric approach to palliative care • Canada’s palliative care model inherently favours English-speaking patients with Western values • Patients’ lack of knowledge on nature of palliative care and navigating healthcare system • Major differences arise when approaching conversations on death and patient autonomy |
Physician’s lack of awareness of cultural discordance • Difficult to overcome cultural discordance if physicians are not culturally self-aware, sensitive or curious • Physicians having to figure it out themselves due to insufficient emphasis on culture during training • Lack of institutional initiatives in emphasizing cultural resources or competencies at the workplace | |
Workplace supports | Currently existing interventions • Physician interpersonal skills for those who are aware of these challenges • Translator services like Google translate, families, and professional interpreters (scarce and costly in community settings) • Workplace colleagues who provide administrative support or mentorship |
Interventions that physicians would like to see • 24/7 professional interpreters, as well as making it standard protocol • More systemic and early training emphasis on enhancing cultural sensitivity in healthcare workers • More linguistically and culturally diverse healthcare workers • More culturally-friendly long-term care homes |