ABS 032: Barriers and Facilitators to Palliative Care Delivery Among Patients with non-English Language Preferences: a Qualitative Study of Clinicians

Nikita Bhatnagar ¹ , Keren Ladin ¹ , Talha Ali ¹

¹ Tufts University, Department of Community Health

Van Wickle (2025) Volume 1, ABS 032

Introduction: Timely palliative care delivery is associated with lower healthcare utilization and improving patient autonomy, physical and psychological symptoms, and satisfaction with care. High-quality care is especially important for patients with Non-English Language Preferences (NELP) and serious illnesses, who are disproportionately burdened with poor healthcare outcomes, and experience higher healthcare utilization, more intensive end-of-life care interventions, and less goal-concordant care than their English-speaking counterparts. Disparities in palliative care outcomes in this population are largely attributed to challenges in communication and working with interpreter services. However, the mechanisms through which language, culture, and other multilevel factors affect PC delivery and practices have yet to be studied further.

Methods: Qualitative study using semi-structured interviews with purposively sampled palliative care clinicians from across the U.S. Interviews were recorded, transcribed, and coded using NVIVO 14 software. Thematic analysis involved grounded theory techniques and emergent themes were categorized using the structural vulnerability framework in palliative care contexts.

Results: Twenty-three clinicians participated in interviews, including 21 physicians and two social workers. Participants noted the difficulty of assessing symptoms and preferences for patients with NELP, reporting that patients often had more misunderstandings around palliative care and were referred later in their disease progression. Clinicians identified in-person interpreters and flexible care approaches as facilitators to care provision. Four themes emerged at the individual, interpersonal, community, and institutional levels: 1) correcting patients’ misconceptions and misunderstandings of palliative care, 2) variable interpreter quality compromises palliative care, 3) navigating culture and language in palliative care, and 4) structural and resource constraints complicate meeting dynamics.

Discussion: PC delivery in patients with NELP does not consistently follow best practices around health literacy, decision-making, identifying goals of care, and symptom management. To meet quality PC standards and improve quality of care in this vulnerable population, healthcare centers should improve interpreter training in PC, address interpreter workforce shortages, regulate assessments of culture and health literacy, mandate PC clinician training around working with interpreters, and expand partnerships between health centers and community groups.