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Lost in Translation: Google’s Translation of Palliative Care to ‘Do-Nothing Care’

by: Cynthia X. Pan, MD, FACP, AGSF (@Cxpan5X)

My colleagues often ask me: “Why are Chinese patients so resistant to hospice and palliative care?” “Why are they so unrealistic?” “Don’t they understand that death is part of life?” “Is it true that with Chinese patients you cannot discuss advance directives?”

As a Chinese speaking geriatrician and palliative care physician practicing in Flushing, NY, I have cared for countless Chinese patients with serious illnesses or at end of life.  Invariably, when Chinese patients or families see me, they ask me if I speak Chinese. When I reply “I do” in Mandarin, the relief and instant trust I see on their faces make my day meaningful and worthwhile.

At my hospital, the patient population is about 30% Asian, with the majority of these being Chinese. Most of these patients require language interpretation.  It becomes an interesting challenge and opportunity, as we often need to discuss advance directives, goals of care, and end of life care options with the help of language interpretation.  It is challenging because we can barely conduct these sensitive discussions in English, much less having to interpret through a third party.  To make matters more difficult, the translation of key terms into Chinese are archaic and actually scary to patients and family members.

For, example, the Google translation of Palliative Care is “姑息治疗.”  Back translated, the meaning is essentially “Do Nothing Care.”  Similarly, the Google translation of Hospice is “临终关怀”, literally meaning “Last Minute Care.”  Is it any wonder that patients whose goals are comfort oriented end up declining hospice and palliative care once they hear the translated words?

Words Do Matter.

Chinese patients, by philosophy, are usually fairly realistic and matter-of-fact about accepting the life cycle, as evidenced by a well-known proverb: “生老病死.”  Translated into English, it signifies:
“You are born, you age, you become ill, you die.”

In a community survey that I conducted among residents in Queens, NY, I found that when surveyed in their preferred language, Asian (including Chinese and Korean) and Hispanic adults reported variable levels of familiarity with hospice services; most responded positively to receiving future information and would tell friends and family members about hospice.

As a Chinese-American physician, I think of myself as serving as a cross-cultural bridge.  Not only provide excellent medical care and palliative care, but also to help bridge these nuanced conversations. I have found certain differences when approaching Chinese patients compared to American patients.

  1. For American patients, the standard of care to discussing advance care planning is to ask patients for their values and preferences, and if they would apply certain interventions to themselves directly, thus establishing a standard of “clear and convincing evidence.” For Chinese patients, whose cultural norm is more conservative and reserved, this approach is too direct and not well accepted.  Chinese patients would respond more favorably to a more indirect and less threatening approach.  Physicians can describe sample cases of serious illness or end-of-life scenarios, and ask their Chinese patients for their opinions about these scenarios, thus gleaning patients’ perspectives indirectly.
  2. Many Chinese patients respect their physicians’ opinions. However, many Chinese physicians, in my experience, are fearful of advance care planning, end of life discussions, and projecting these fears and lack of acceptance to their patients. 
  3. Many Chinese patients do wish to participate in their own medical decision making. They just need to be asked. Even if they do wish to participate, many Chinese patients still subscribe to a family-based decision-making process, and would wish to involve their families, rather than making decisions completely autonomously. 

Getting back to Words Do Matter. What can we do about proper translation of the terms “palliative care” and “hospice” in Chinese?  I reached out to Google to inquire.  It turns out that there is no direct way to fix it, but we can try to improve the translation through the translate community:
At translate.google.com/community, you can help improve Google Translate in your language, by providing translations for common or important queries and verifying the correctness of translations provided by others.  If enough people can help make suggestions, that will help!
Here are my proposals for proper and modern translations of palliative care and hospice:
For Palliative Care, “舒缓治疗” – meaning “a gentler, kinder approach to care.”  This is the most common expression of palliative care in China.
For Hospice, “安宁照顾” - meaning “care focused on comfort and peace.”

What’s my next step? Contacting Pacific Interpreter and propose that they use the above translations.
Any other thoughts, please contact me!

Cynthia X. Pan, MD, FACP, AGSF

Comments

Jim Deming MD said…
Thank you, Dr. Pan, for this thoughtful and articulate article. My understanding grew a little bit bigger and you have re-invigorated my cultural curiosity.
Karen Purze said…
So interesting! Thanks for posting.
Great blog post and a good example of why diversity and language concordance matters in medicine. Also great example of how translation and interpretation efforts are necessarily limited when conceptual equivalence does not exist.
I was part of a study examining the accuracy of google translate for simple discharge instructions -- this is a necessary cautionary tale for those who think machine translation algorithms can be applied readily to all of medicine.
Thank you for posting and good luck with your work.
Alicia Fernandez, MD
Director, UCSF Latinx Center of Excellence
Noreen Chan said…
You may be interested to know that each of the main Chinese speaking nations - China, Hong Kong, Taiwan, Singapore etc. has a different name for hospice palliative care. The Google translation is China's term. HK uses 临终关怀, Singapore 慈怀疗护 (see https://singaporehospice.org.sg). The Singapore term was chosen only recently in the last couple of years, and there was much discussion before the decision was made. Does it remove confusion? Not really, we still need to explain ourselves.

Noreen Chan


Sandra Shi said…
I'm not sure I understand why "姑息治疗" is being translated as "do nothing care".

姑息 itself means to be appease excessively or overindulge. It's still not a perfect translation, but it is definitely not to 'do nothing'. Some of why is sounds bad may be because this is being transliterated rather than translated. By this measure:
"Geriatrics" would be "old age sickness study".
"Surgery" would be "outside studies" or "foreign studies"
"Oncology" would be "Swelling Tumor studies"

I completely agree that palliative care and hospice are very much in their infancy in mainland China. That said, when I've worked with hospice and palliative care providers in China, the name of the specialty was never mentioned as a barrier to acceptance, as much as feelings of suffering from disparities in healthcare from socioeconomic discrimination and decades of being deprived of opportunities.
Cynthia Pan MD said…
Given some of the above comments and interpretations, it may be worthwhile to have an international conversation about what would be best, uniform translations for palliative care and hospice into Chinese.
Unknown said…
Trishla Foundation offers a range of Cerebral Palsy treatments, including physiotherapy for children and adults, occupational, and speech & language therapy, plus more.
Jamie said…
This is a great post. I have experienced these barriers and did not know about these translations. Please continue doing this work and working to clarify this moving forward!

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