Informed consent is a communicative process between a patient and health care provider (HCP) in which treatment explanations are provided and risks associate with such treatments are explained. This process allows opportunity for a patient to ask questions. It culminates with the patient signing a Health Authority consent form that states he/she is informed and understands the treatment and risks. Obtaining informed consent is an ethical and legal obligation.   

According to the Health Care Consent Act (HCCA), the 4 legal requirements for Informed Consent are that:

• Patient must be capable
• Consent must be voluntary  
• Consent must be informed
  
• Consent must be treatment specific

Lack of Informed Consent in clinical practice can cause:  

• Health events with adverse effects
• Extends the length of hospital stay
• Inappropriate use of testing
• Unauthorized procedures such as surgeries

Consent Documents  

• Should not state that the interpreter translated the information
• Translation refers to written rendering of a language.
• Should not be sight translated by the interpreter
•  Sight translation I s the oral rendering of written text from one language into another
• Should be interpreted which implies that in addition to the interpreter, the HCP and patient are involved
• As stated above informed consent in completed by a HCP with the assistance of an interpreter
• Should not include a section in which the interpreter indicated the patient understood the information given as interpreters canon attest to whether the patient understood
• An interpreter can only attest that the interpreting was delivered faithfully and that the use of vocabulary, language structure, syntax, etc. when going from source to target language was appropriate
  
• Should include a section that indicates an interpreter was used
  

Informed consent as a communicative process between the patient and the health care provider allows for an opportunity to ask questions. Informed consent is an integral, ethical and legal component of the treatment process therefore language barriers that negate informed consent must be addressed. For BC's limited English proficiency population, informed consent for procedure or participation in clinical trials can only be achieved by the use of an interpreter. The need for an interpreter is even more pronounced in clinical trial as in addition to the information exchange being more substantive (i.e. the study objectives, participant expectations, expected benefits, what is known or unknown about the drug or procedure, etc.), the trials in‐ form future treatment processes and drug utilization. If population groups are excluded due to language barriers, the numbers of eligible participants is reduced and the results of the study are not inclusive of the diversity of the population. Without an interpreter an inequity prevails as one group is allowed access to treatment while another group is robbed of the same. Disease and illness are not impeded by languages barrier; opportunities to treatment should not be either.  

When working with an interpreter HCPs should consider what their role would be if the patient were an English speaking patient and remember that their role does not change in an interpreter‐assisted appointment. It is important maintain control of the session and cultivate a relationship with the patient, not the interpreter.  

It is always best practice to meet the interpreter a few minutes ahead of time for four main purposes:

• Briefly identify who you are and your role with the patient
• Provide a brief overview of the nature of the study and the types of terminology that might be used
• Provide general information about the nature of the session.
• Review your expectations of the process

Tips for during the session:

1. Have all parties introduce themselves.
2. Explain the role of the interpreter to the client. Position yourself to maintain eye contact with and talk directly to the client.
3. Use the first/second person 'I" and "you" rather than "him/her."
4. Avoid jargon, technical terms and idioms.
5. Keep statements short.
6. Keep control of the conversation.
7. Do not ask the interpreter to speak as a cultural liaison.  
8. If you and the interpreter need a conversation to explain terms or for clarification, ask the interpreter to explain to the patient the nature of the exchange
   

Using apps, computer programs and other resources to communicate with patients with low English proficiency. 

There are many apps and programs that are intended to support communication with patients with low English proficiency. Effective communication with patients is extremely important, however, these electronic and digital tools are not recommended for use within the healthcare setting. While some of these tools may seem helpful to communicate very simple messages, they can be risky.

All available machine translation or interpreting devices that are currently available pose a risk for misinterpretation. While misinterpretation can also occur with human to human interpreting, machine interpreting does not include the same opportunities for clarification that human to human interpreting provides.

Here are some questions that will also help you think about how a specific tool might be helpful or harmful in your work:

• Are there positive reviews in the literature from users of this tool? Are any negative impacts of using the tool described?
• Do you have sufficient information about how/when the tool should be used in order for it to be safe and effective?
• Was the tool developed in consultation with, or at least tested by, those who would use it in a healthcare setting?
• Was the tool reviewed by language and communication experts?
• Does the tool protect patient confidentiality as per the PHSA PRIVACY AND CONFIDENTIALITY policy?
• Do the images and functions included in the tool seem culturally appropriate for the patient?
• Does the tool address any issues for which consent are needed? When discussing issues that need consent with patients with low English proficiency, professional interpreters should always be used.
• Are you confident that the tool uses the appropriate dialect, tone and language for your patient?
• Does the tool seem to be sufficiently patient-centered, rather than solely allowing for the care provider to receive some of the information they want?
• Does the tool transfer any information directly into a patient's chart? This should never occur—all information that is input into a chart should be reviewed by a human for accuracy.
  

The purpose of this guideline is to provide direction to health care staff, including Contractors and students (hereto known as Staff) regarding protocols for using spoken language interpreters when language assistance is required during the care of a patient infected with or suspected of a high risk communicable disease.

When language assistance is required:

Staff must take all reasonable efforts to use a professional interpreter when receiving or providing information to:

1. A patient infected with or suspected of a high risk communicable disease;  
2. Their family and/or any individual that has had unprotected contact with patient  
3. The interpreting may take place via telephone or in‐person.
4. Interpreters required in‐person should not enter the room of the infected patient an the interpreter may have limited knowledge and practice with infection control measures. To ensure disease containment, interpreters should stand outside the room and use the telephonic equipment provided by the facility to interpret.
   
5. Staff using interpreters for communication with those infected or suspected of high risk communicable disease must ensure appropriate equipment is available in the room and on the floor. Appropriate equipment includes:
   

• A telephonic device with speaker phone capacity in the patient's room  
• A telephonic device for the interpreter's use if in‐person interpreter is required  

For spoken language interpreters, call Provincial Language Service at 604‐297‐8400/1‐877‐BC TALKS (228‐2557) to connect directly to a telephone interpreter or to request an in‐person interpreter. In‐person interpreters may not be available at the requested time, therefore Staff requesting the interpreter must be flexible with the requested time.  

Note: Emergency rooms with direct dial access to phone interpreters should continue to use the direct dial access method.