Focus Topics

topic 4 | Activity 4: Intercultural communication

Communicating well is at the heart of palliative care, and a key part of helping a person and their family deal with the effects of life-limiting illness. Effective communication across diverse groups, requires care that is responsive to the person’s cultural background and individual needs.

If you have not already completed PCC4U Module 2: Communicating with people affected by life-limiting illness, please review the key principles for communication in palliative care before continuing with this content.

Intercultural communication shares information between people of different cultures where language, cultural background, and beliefs and values differ. Intercultural communiction can be challenging due to possible misunderstanding of the words that are used, or various aspects of nonverbal communication. It is important for health professionals to consider ways to support verbal or written communication to enable understanding. [1]

Effective intercultural communication requires consideration of:

  • Communication styles and nonverbal communication
  • Ways that emotions are expressed
  • Use of humour
  • Topics that are considered appropriate or not appropriate to talk about
  • Silences in conversations
  • The amount of information people can cope with in one conversation.

It is always advisable to ask rather than make assumptions about what is or isn’t appropriate. The Patient Dignity Question is helpful to consider when interacting with anyone affected by life-limiting illness, and especially with individuals from diverse backgrounds. It can be used to identify needs and plan care:[2]

“What do I need to know about you as a person to give you the best care possible?”

 

The PEPA/IPEPA Communication Guide: Supporting access to palliative care for everyone is a valuable resource to support culturally-responsive communication. Some key questions that health professionals are encouraged to consider in approaching a conversation about palliative care are covered in this resource, including:[1]

  • How does the person like to be addressed?
  • What kinds of spiritual practices are important to them?
  • Is showing respect for Elders important to them?
  • Do we think of time in the same way?
  • What do they believe about preventative health and the causes of serious illness?
  • Are there gender preferences that I should be sensitive to?
  • How are their past experiences of the healthcare system influencing their choices now?
  • What behaviours or actions might seem impolite to them?
  • Can I talk openly about serious illness, dying and death? What words should I use?
  • What will I share about myself to make a personal connection and build trust?
  • Is the language I’m using inclusive of people of all sexualities and gender identities?
  • Who would the person like to be present for the conversation?
  • What aspects of nonverbal communication do I need to think more about with this person and their family?
  • Are my clothing and appearance demonstrating respect?
  • Do we need interpreter assistance for this conversation?
  • What can I do to help this person feel safe, listened to and cared for?

 

Working with interpreters

If English is not the person’s strength in communication, it is helpful to find out if there is another person in the family who can support communication. This can be helpful for day-to-day conversations. However, professional interpreter assistance should always be arranged for the first conversation with a person and their family, and any further discussions focusing on illness progression, prognosis, and decision-making regarding care options.[1]

The Translating and Interpreting Service (TIS National) is an interpreting service provided by the Australian Government, Department of Home Affairs for people with limited English proficiency and for agencies and businesses that need to communicate with their non-English speaking clients. Interpreters provide face-to-face, videoconferencing and over-the-phone interpretation throughout Australia.[3]

Interpreters experienced in healthcare will often have an understanding of clinical terminology. However, they may not have skills in conveying bad news. Information can be altered or poor prognosis not interpreted  in delivering messages. Confidentiality can also be an issue where they are a part of a small community or they know the person and their family.[4-5]

When engaging an interpreter to assist with communication, the following principles should be considered:[4-5]

Principles for working with an interpreter
  • Inform the interpreter service of the nature of the meeting, gender and/or age preference, especially if sensitive matters will be discussed, and provide brief information on the person’s condition
  • Speak with the interpreter prior to the meeting to gauge their understanding of the terminology and concepts that will be mentioned during the conversation
  • Introduce the interpreter to the person and their family, and explain the role of the interpreter as a non-clinical member of the healthcare team
  • In a face-to-face meeting, interact directly with the person and family – not the interpreter, and use direct speech
  • Speak clearly, use plain language and explain any complex concepts and terminology
  • Speak at a resonable speed, with appropriate pauses and avoid overlapping speech
  • Clarify information with the interpreter regularly throughout the conversation
  • Ask the person and their family about their understanding and thoughts on new information and allowing time for a response
  • Allow time at the end of the meeting for any questions or concerns to be raised
  • Debrief wtih the interpreter afterwards if possible and exchange feedback. Offer support to the interpreter if the nature of the conversation was distressing.

Family and friends, and especially children, should not be used in the place of professional interpreters. Asking a person who has not been professionally trained as a healthcare interpreter can result in inaccuracies in information provided, altered or distorted information being provided and suppression of information possibly related to ‘truth telling’, breaches of confidentiality, and invalid consent processes.[4, 6]

Resources to support communication

There are numerous resources available to support healthcare intercultural communication. These include:

  1. Consider the principles when communicating with a person whose strength in communication is not English. Outline strategies you would use to:
    • Say good morning and ask how they are feeling
    • Explain how and why vital signs are taken
    • Explain the goals of palliative care as opposed to active treatment
    • Explain the purpose of an advance care plan.
  2. Consider a scenario that requires an interpreter to be involved. What information would you give to the interpreter prior to commencing the interview with the person with a life-limiting illness?
  1. PEPA/IPEPA Project. 2022. PEPA/IPEPA Communication Guide: Supporting access to palliative care for everyone.
  2. Dignity in Care. 2016. The Patient Dignity Inventory.
  3. TIS National. 2022. Translating and Interpreting Service National Website.
  4. Sharma, RK & Dy, S M. 2011. Cross-Cultural Communication and Use of the Family Meeting in Palliative Care. American Journal of Hospice and Palliative Medicine, 28(6), 437-444.
  5. Queensland Health. 2019. Guide for clinicians working with interpreters in healthcare settings.
  6. Broom, A et al, 2013. Negotiating palliative care in the context of culturally and linguistically diverse patients. Internal Medicine Journal, 43(9), 1043-1046.