(364) Shared Decision-Making in the ICU With Patients Who Speak a Language of Lesser Diffusion

Introduction: Effective communication is crucial in end-of-life decision-making, when clear understanding between patients/families, and clinicians is fundamental. However, patients who speak languages of lesser diffusion (LLDs), languages spoken by a relatively small population such as Karen spoken in Thailand and Myanmar, may face challenges. This case report aims to draw attention to difficulties experienced by patients who speak a LLD and clinicians caring for them.

Description: A frail Karen-speaking male patient in his 90s with multiple co-morbidities including hypertension, atrial fibrillation, and stage-2 kidney disease was admitted to hospital with abdominal pain and found to have a hepatic abscess. His electronic medical record indicated full code measures. He was managed in the ICU for tachycardia and respiratory failure with non-invasive ventilatory support. Palliative care recommended using interpreter services for all decision-making conversations. Despite some improvement, on day 7, he experienced acute worsening hypoxia requiring intubation and mechanical ventilation. Given the patient’s lack of decision-making capacity, the medical team approached the family to discuss the treatment goals, expectations, and recommendations. The patient's son, who did not speak English, and three grandsons, who spoke some English, gathered for a family conference. Interpreter services were contacted but no Karen interpreters were available. The next day, a remote video Karen interpreter was identified and participated in the family conference confirming that the family understood the conversation and agreed it was appropriate to change the patient's status to DNR/DNI. Following extubation, he was transferred back to the floor. Palliative care re-engaged with the patient and his family, who elected to forego any future escalation of care. The patient was discharged home with hospice care.

Discussion: End-of-life decision-making requires clear bidirectional communication between clinicians and patients/family members to understand treatment options, preferences and goals of care. Despite the increasing population of those speaking LLDs, resources are lacking to address patient needs causing challenges to this patient population and their clinicians during decision making.