By Romayne Gallagher
IAHPC App Reviewer
While the funny side of communication between those who don’t speak the same language is a source for stand-up comedy routines, in health care faulty communication can lead to bad outcomes. I’m sure that most of us recall care episodes where we feel we are “just getting by” and may miss significant information. Not everyone has access to professional interpreters, yet research shows that interpreters significantly improve the care of non-English-speaking patients in English countries1 (as must occur with other languages).
This led me to wonder: Are current apps capable of professional interpretation in palliative care?
Many apps exist to enhance communication between people. Google Translate is helpful for basic conversation, but published reviews show its accuracy to be unacceptably low in many languages when used in a clinical setting.2
Health-care-specific interpretation apps exist and are useful for basic care and obtaining a person’s health history. Some newer apps include icons and written phrases to aid in communication. To ensure accuracy, only set questions are available, phrased to lead to a “yes” or “no” answer. Clearly, this is too simple for the complex conversations required in goals-of-care and prognosis discussions.
A 2016 systematic review of the impact of in-person interpreters on the provision of palliative care in cancer patients found only 10 eligible studies, with most focusing on diagnosis/prognosis and goals-of-care discussions. Significant differences in disease understanding and worse symptom management occurred with non-professional interpreters (family including minors, staff, etc.) as compared with professional interpreters.3 The same researchers did a qualitative study of professional interpreters involved in end-of-life discussions with patients and families, and noted that the job entails two skills: interpretation and being a cultural broker.4 In the latter role, the intepreters often chose more culturally appropriate words, softening the approach, and explaining a concept or the meaning of the word in its specific context.
I spent some hours looking at reviews of interpretation apps and noted that many have complaints about language accuracy. Most of the apps require Internet access, which may be problematic in hospital and community visits. I came across two apps that may be of value.
CALD Assist (CALD stands for: culturally and linguistically diverse) is an Australian app developed with the involvement of health care providers. It provides written and spoken translations of 10 languages of phrases used in basic care, including COVID screening questions. Intended primarily for allied staff, this app was trialed in hospital.5 When using the app, staff rated communication and care as being significantly more successful, and their frustration level was lower. However, the study involved only a few patients. The app is available for free and is usable offline. It occupies 82MB on Apple iOS and 78MB on Google Play.
UniversalDoctorSpeaker, based in Europe and the UK, calls itself a social enterprise that collaborates with multiple partners (including the World Health Organization) to develop technical solutions for global health. Its app won a global award for best health app in 2014, and all phrases have been medically and linguistically verified. The app provides written and spoken translations of phrases of assessment, diagnosis, and treatment of common conditions in the emergency room. It works offline and is available free on Apple and Google Play. Strangely, the file size is 330MB on Apple, but 5.6MB on Google. The group subsequently developed UniversalNurse, UniversalPharmacist, HIV, RefugeeSpeaker, and multiple interpretation apps for specific diseases.
My conclusion is: there is no good app to recommend for complex medical conversations involving in serious illness. As we all know, relatives are compromised linguistically and emotionally in interpretation for their loved ones. Having access to professional interpreters—either in person or by telephone—is the ideal solution. This is a significant cost for any health care organization. Universal Doctor is open to partnerships! Could a universal palliative care app for conversations between those who speak different languages be a future partnership for IAHPC?
1. Karliner LS, Jacobs EA, Chen AH, Mutha S. Do Professional Interpreters Improve Clinical Care for Patients with Limited English Proficiency? A systematic review of the literature. Health Serv Res 2007; 42(2): 727-54. DOI: 10.1111/j.1475-6773.2006.00629.x.
2. Panayiotou A, Gardner A, Williams S, Zucchi E, Mascitti-Meuter M, et al. Language Translation Apps in Health Care Settings: Expert opinion. JMIR Mhealth Uhealth 2019; 7(4): e11316. DOI: 10.2196/11316.
3. Silva, M. D., Genoff, M., Zaballa, A., Jewell, S., Stabler, S., et al. Interpreting at the End of Life: A systematic review of the impact of interpreters on the delivery of palliative care services to cancer patients with limited English proficiency. J Pain Symptom Manage 2016; 51(3): 569-580. DOI: 10.1016/j.jpainsymman.2015.10.011
4. Silva MD, Tsai S, Sobota RM, Abel BT, Reid MC, Adelman RD. Missed Opportunities When Communicating with Limited English-Proficient Patients during End-of-Life Conversations: Insights from Spanish-speaking and Chinese-speaking medical interpreters. J Pain Symptom Manage 2020; 59(3): 694-701. DOI: 10.1016/j.jpainsymman.2019.10.019.
5. Silvera-Tawil D, Pocock C, Bradford D, Donnell A, Freyne J, et al. Enabling Nurse-Patient Communication with a Mobile App: Controlled pretest-posttest study with nurses and non-English-speaking patients. JMIR Nurs 2021; 4(3): e19709. DOI: 10.2196/19709.