Language Justice as Health Equity in Palliative Care: A Scoping Review

Abstract

Context

Communication is the foundation of optimal healthcare provision. Linguistic diversity is a reality in palliative care settings.

Objectives

To identify the state of the literature on language interpreting in palliative care and to examine inclusion of stakeholders in dissemination products.

Methods

Our scoping review included three databases using search terms “advance care planning,” “goals of care,” “hospice care,” “palliative care,” combined with “communication barriers,” “interpreter,” and “translating.” We included original research, reports on tools or curricula, and opinion pieces. Four National Consensus Project (NCP) Guidelines were selected a priori to inform the coding schema. Health equity, specific to language justice, framed the study.

Results

In 31 included products, we identified four themes. Some reflected more than one theme: Language discordance as a communication barrier, gap, or challenge (n = 27), value added by qualified medical interpreters (n = 13), training for interpreters and palliative care professionals (n = 12), and inclusion of interpreters in the palliative care team (n = 9). All studies reflected at least one, and up to four, of the NCP guidelines. Eighteen products acknowledged language-based inequity, 8 described steps to mitigate language-based inequity, 3 described language-justice-based interventions associated with outcomes, and none described accomplishing language justice.

Conclusion

To provide equitable care reflecting language justice, investigators and clinicians should include interpreters, patients, and families as integral team members. The increase in number of interventional studies suggests evidence of the value interpreters add to the palliative care team. Collaborating with linguistically diverse stakeholders reflects language justice and holds promise for ensuring optimal communication.