Survey
* Your assessment is very important for improving the workof artificial intelligence, which forms the content of this project
* Your assessment is very important for improving the workof artificial intelligence, which forms the content of this project
Examining discourse in healthcare: Pedagogy, practice, and research in ASL-English interpreting AMPHL April 5-7-2013 Laurie Swabey, PhD St. Catherine University Brenda Nicodemus, PhD Gallaudet University Video Scenario: Acid Reflux Impetus for our study • The critical importance of the medical interview • The growing number of Deaf healthcare professionals • Ultimately, to provide better access to Deaf patients specifically in the intake process Questions • What linguistic features of ASL are used in direct and mediated discourse in healthcare settings? • How can this knowledge inform our practice? Research design Interpreters Deaf Physicians – Interviews – Background Info – Medical concepts – Medical concepts – Medical questions and dosages – Video simulations of Deaf patients English Translations – Medical questions and dosages – Video simulations of Deaf patients Research design Interpreters Deaf Physicians – Interviews – Background Info – Medical concepts – Medical concepts – Medical questions and dosages – Video simulations of Deaf patients English Translations – Medical questions and dosages – Video simulations of Deaf patients Medical questions Questions 1. Are you allergic to any medications? 2. Do you have a history of glaucoma in your family? 3. Do you take any over-the-counter medications? 4. Are you sexually active? Are you allergic to any medications? Discuss with another person: - What is the purpose of this question? - What challenges are faced when interpreting this question? Why? Are you allergic to any medications? Purpose of the question • Ascertain which medications should not be given to patients Are you allergic to any medications? Purpose of the question • Ascertain which medications should not be given to patients • Learn relationship between allergies and other physical illnesses, e.g., asthma, ezcema, and lupus (Strom, et al, 1994) Are you allergic to any medications? Linguistic challenges? • Temporal quality of allergies • Emphasizing “any” • To contextualize or not? - allergic reactions - medication Physician: Are you allergic to any medications? Interpreter: Are you allergic to any medications? Chris Moreland Physician: Are you allergic to any medications? Amy Interpreter: Are you allergic to any medications? Contextualization: Allergic reaction Contextualization Items DP1 REACT, NOT AGREE DP2 No contextualization DP3 NAUSEA, FLUSH, RASH-on-arm, R-A-S-H INT1 RASH-on-chest, RASH-on-cheeks, THROAT-SWELL, CAN’T-BREATHE INT2 MAKE-SICK, RASH-on-arm INT3 THROAT-SWELL, RASH-on-face-and-body Do you have a history of glaucoma in your family? Discuss with another person: - What is the purpose of this question? - What challenges are faced when interpreting this question? Why? Do you have a history of glaucoma in your family? Purpose of question? • Gauging genetic factors, possible chronic conditions, present and future • Identifying high risk individuals who may need additional screening (Orlando et al, 2011) Do you have a history of glaucoma in your family? Linguistic challenges? • Patients’ knowledge of family health history (Kaufmann and Hedding, 2012; Qureshi, et al, 2009) • History in your family” and “glaucoma” do not have standard translations in ASL Different Orientation Interpreters Physicians HAVE G-L-A-U-C-O-M-A EYE+, PRESSURE EYE+ EYE DISEASE CALL G-L-A-U-C-O-M-A CALL G-L-A-U-C-O-M-A EYE PRESSURE++ EYE PROBLEM CALL G-L-A-U-C-O-M-A Different Focus Interpreters Two interpreters included four examples of family members Physicians Two physicians signed only FAMILY (no examples of family members) Fingerspelling: Glaucoma Misspellings Emphasis* DP1 no yes DP2 yes yes DP3 no yes INT1 no yes INT2 yes yes INT3 no yes • Mouthing, careful fingerspelling, eye gaze, reduced body, movement, indexing, use of eyes, duration, lexical marking MIKE MCKEE Physician: Do you have a history of glaucoma in your family? Interpreter: Do you have a history of glaucoma in your family? Do you take any over-the-counter medications? Discuss with another person: - What is the purpose of this question? - What challenges are faced when interpreting this question? Why? Do you take any over-the-counter medications? Purpose of question • Identify possible reactions with prescription medications • Look for misuse or abuse of self-medication (Wazaifya, et al 2005) Do you take any over-the-counter medications? Linguistic challenges • There is no 1:1 corresponding phrase for OTC in ASL • The phrase OTC may or may not be familiar to patient • There are many over-the-counter items Length (in sec) Contextualization OTC type Contextualization OTC place Compare Rx vs OTC DP1 40 MOTRIN, TYLENOL STORE, PHARMACY yes DP2 6 __ STORE, COUNTER no DP3 5 __ DRUGSTORE no INT1 27 TYLENOL, ADVIL, PRESCRIPTION PHARMACY yes INT2 40 __ INT3 41 ASPIRIN, IBUPROFEN CVS, WALGREENS, DRUGSTORE PHARMACY, STORE yes yes Physician: Do you take any over-the-counter medications? Interpreter: Do you take any over-the-counter medications? Are you sexually active? Discuss with another person: - What is the purpose of this question? - What challenges are faced when interpreting this question? Why? Are you sexually active? Purpose of question • Discussion of sexual history with patients in an important part of a physical and emotional health assessment (Lewis, 1990) • Inform provider about certain risks, including STDs and pregnancy Are you sexually active? Linguistic challenge • No standard translation in ASL • To explicate or not? If yes, what to explicate? • Social and cultural challenges Contextualization: sexual activity & partners Sexual Activity Partners DP1 INTERCOURSE, SLEEP, INTERCOURSE, SEX, DIFFERENT KINDS OF SEX, INTERCOURSE, ORAL, SEX, ALL-LIST PARTNER, MAN, WOMAN DP2 INTERCOURSE, ORAL SEX, ETCETERA OTHER PERSON DP3 SEX ACTIVE, INTERCOURSE, ANAL, ORAL, ACTIVE -- INT1 Sex, intercourse, etcetera -- INT2 SLEEP TOGETHER, SEX, SEX PARTNER, HUSBAND, GIRLFRIEND, ANYONE INT3 INTERCOURSE, MASTURBATION PARTNER, MAN, WOMAN, OTHER PERSON Physician: Are you sexually active? SUSAN Interpreter: Are you sexually active? Summary of results • No standard ASL translations emerged for common medical questions in this data set • Explication is a prominently used linguistic feature in both direct and interpreted discourse • Judicious use of explication by physicians and interpreters • Other linguistic features employed: comparison, fingerspelling, orientation, and emphatic markers Conclusion • Develop and teach a range of standard translations from English into ASL for common medical questions. • How? Community-based participatory research – a collaborative process between researchers and community partners, deaf and hearing. • Enhancing the dialogue between interpreters, deaf bilingual healthcare providers, and Deaf patients. Acknowledgements The physicians and interpreters who graciously participated in this study