HEALTH CARE WORKERS’ PERSPECTIVES ON PROVIDING PALLIATIVE CARE TO MULTILINGUAL POPULATIONS WITH DEMENTIA

Abstract Importance Persons living with dementia (PLWD) who prefer a language other than English (PLOE) are at high risk for sub-optimal palliative care. Although data suggest that multi-level (individual, clinical, healthcare system, community/policy-level) interventions may help address inequities, few studies have identified specific targets. Objective: To identify targets for multi-level interventions to improve palliative care for PLWD and PLOE. Methods We conducted qualitative interviews with social workers and medical interpreters who work with Chinese, Spanish, or Vietnamese speaking PLWD. Interviews were conducted from October 2022-October 2023, audiotaped, transcribed, and coded by an interdisciplinary investigator team using an inductive iterative approach. Results Interviews were conducted with 5 Spanish, 2 Chinese, and 2 Vietnamese interpreters and 5 social workers. Four themes emerged: 1) interpretation when the patient ‘wasn’t making sense’; 2) complexity with patient/family dynamics in decision-making; 3) barriers to anticipatory communication about dementia trajectory and quality of life; and 4) lack of culturally- and language appropriate resources. These data suggest multi-level intervention targets to improve palliative care in the context of dementia and linguistic diversity: 1) training interpreters about palliative care and how to navigate interpretation with PLWD, and providing clinicians communication skills training; 2) facilitating clinician-interpreter pre-meetings; 3) improving staffing and resources for social workers to shift from a crisis-focus to facilitating goals-of-care communication; and 4) increasing culturally and linguistically-appropriate and accessible resources. Impact: Our findings contribute to a gap in the literature about how to address the unique barriers PLWD with PLOE face, informing future intervention development.