Communication as an Unequal Game: Insights Into Language Barriers and Missed Opportunities From the Perspectives of Nurses, Doctors, and Professional Interpreters

Abstract

Objective: In the context of serious illnesses, such as cancer, effective communication is vital. This study explores how registered nurses (RNs), medical doctors (MDs), and professional interpreters (PIs) experience communication in cancer care with patients who have limited proficiency in the dominant language.

Methods: A phenomenological-hermeneutic approach was employed using focus group interviews. A total of 23 informants participated and were divided into six groups: three groups of nurses, two groups of doctors, and one group of interpreters. All interviews were audio-recorded and transcribed verbatim, with Paul Ricoeur’s critical hermeneutics serving as the theoretical framework for analysis and interpretation.

Results: The overarching theme identified was Communication as an Unequal Game, with three subthemes: (1) Communicating on unequal terms, (2) Lack of agreed roles and shared rules, and (3) Missing opportunities as an invisible consequence. The findings reveal an experience across professions of being at a disadvantage from the start due to strict time constraints and lack of access to essential knowledge. Differing views on the roles of interpreters, including whether they should act as robots or engage as human beings, further complicate communication. Without clearly agreed-upon roles and shared rules, decisions about briefing or booking interpreters come to rely on individual perceptions, leading to inconsistent practices and communication inequalities among professional groups. The findings highlight the less visible consequences of language barriers in healthcare encounters, including lack of treatment options being presented to patients and the mental and physical withdrawal of nurses when no interpreters are available to facilitate verbal communication.

Conclusion: While it is necessary to embrace the inherent complexity of language-discordant communication, it is equally important to establish a more level and stable “playing field,” including targeted interprofessional collaboration. In the current unequal game of communication, language barriers not only impede effective communication but also make choices—and care—disappear.