SDM in interpreter-mediated communication in general practice: Presenter(s): Anke Woudstra, LUMC, Netherlands

Given the lack of research on shared decision making (SDM) in informal interpreted-mediated intercultural medical encounters and its growing importance in clinical practice, we aimed to investigate SDM preferences and behaviors of Turkish-Dutch migrant patients and informal interpreters. The following two research questions were addressed: 1) What are the SDM preferences of Turkish-Dutch patients and informal interpreters in general practice? and 2) How is SDM in general practice achieved in informal interpreter-mediated encounters, and to what extent is this achievement in alignment with patients’ and informal interpreters’ SDM preferences? Turkish-Dutch patients (n=91) and informal interpreters (n=91) completed a survey assessing their SDM preferences in the waiting room of their general practitioner (n=26) just before the consultation. Audiotaped consultations (n=84) were transcribed verbatim and SDM communication patterns were coded according to: 1) who initiated the medical treatment decision; 2) whether or not the informal interpreter translated the speech turn containing the initiated medical treatment decision to the general practitioner or patient, 3) whether each of the other parties agreed or disagreed with the initiated medical treatment decision. Turkish-Dutch patients most often preferred the involvement of an informal interpreter in the medical treatment-decision making process. A key finding is that there is a lack of concordance between patients’ preferences for SDM and their actual involvement in shared decision making during the consultation. This lack of concordance may contribute to a misguided view among healthcare providers that migrant patients do not want to be involved in the medical treatment decision process. To bridge the gap between patients’ preferences for SDM and their actual communicative behaviors in informal interpreter-mediated medical consultations, healthcare providers have to be made aware of the existence of this gap and be trained in communication skills that engage migrant patients in interpreter-mediated consultations in SDM.