Picture this: You, a genetic counselor (GC), walk into an appointment, ask a patient “how are you,” and receive the patient’s response in the only English she knows: “I am good.” After introducing yourself to the patient’s daughter, you ask the patient what’s bothering her – only for her to turn to her daughter and converse quickly in a language you do not recognize. The daughter says, “She has some pain.”  Now you know:  your patient is not good. 

Medical and family interpreters bridge not just language gaps between providers and patients, but also increase confidence during appointments for both parties. Interpreters empower patients to confidently ask the questions they have and take charge of their healthcare. They also reassure providers that we understand the patient’s needs and that the patient understands the education we provide. Without training on the best way to collaborate with interpreters, providers feel less confident, and their patients with limited English proficiency (LEP) receive less care (Padilla et al., 2025; Joseph et al., 2017). 

As the daughter in the example interaction and as a genetic counseling student training at a hospital where interpreters are common, I valued a class day devoted to learning from and roleplaying with an interpreter. Noticing the disconnect many healthcare providers have with interpreters during both my personal and GC training experiences made me question whether all genetic counselors were given training on working with interpreters. I quickly learned they were not. Every GC program should include training with interpreters to increase both our patients with LEP’s confidence along with the GC’s. 

Failed Training Leads to Failed Patients

The way that genetic counselors work with interpreters is not effective. Cheng et al. (2018) looked into patterns of communication that genetic counselors have with LEP, low-income Chinese cancer GC patients. Genetic counselors often did not clarify patient misconceptions, did not give direct responses to questions and fell into traps of conveying nuances, uncertainty and evolving science of genetics. This all combined to leave these patients, despite having had multiple GC appointments, with a poor understanding of VUS results, genetics, genes, genetic testing, risk and syndromes (Cheng et al., 2018). 

When patients leave without these essential pieces of information, we can never be confident that they made the choices that most align with their values. 

Hypothetical scenarios used by genetic counselors to describe potential test results also left patients confused. The long stories were hard for interpreters to follow and interpret and did not align with the patients' needs of wanting to know what genetic testing meant for them specifically (Kamara et al., 2018, Joseph et al., 2017). All of these aspects leave patients with LEP with lower quality care simply because we do take the time to learn best interpreter practices. 

When taking a deeper look at the ACGC practice-based competencies for genetic counselors, under communication, a recommendation for “tailoring communication to specific individuals and audiences” is noted. However, this recommendation does not explicitly mention learning to work with interpreters as a way to fulfill it. A lack of formal training on working with interpreters has forced many genetic counselors to learn this skill on the job, relying on online resources and discussions with bilingual colleagues, interpreters, patients and members of the community (Padilla et al., 2025). Self-teaching can be time-consuming and may not actually lead to learning the correct methods, potentially causing more harm than good. 

When genetic counselors are taught to use plain language, avoid information overload and assess comprehension by engaging patients with questions, patients with LEP’s understanding of appointment material increases (Joseph et al., 2017). Additionally, defining jargon, avoiding hypotheticals, stating that certain details would only be discussed if that result came up and explicitly stating not testing as an option allowed for more decision making and engagement by GC patients with LEP (Kamara et al., 2017). 

Combatting Vague Guidelines 

All GC programs need to train their students on how to work with interpreters, as this is a learned skill that can be taught to everyone. Some strategies include:

• Advocating to include explicit language of interpreter training into ACGC practice-based competencies
• Including at least one day of interpreter training in all GC training programs
• Making clear resources on best practices for working with interpreters available to all working genetic counselors through continuing education credit distribution 

With these changes, we can limit the care disparity our patients with LEP receive, allowing them to make decisions and state how they actually feel with full confidence. 

References

Cheng, J. K. Y., Guerra, C., Pasick, R. J., Schillinger, D., Luce, J., & Joseph, G. (2018). Cancer genetic counseling communication with low-income Chinese immigrants. Journal of Community Genetics, 9(3), 263–276. https://doi.org/10.1007/s12687-017-0350-4

Joseph, G., Pasick, R. J., Schillinger, D., Luce, J., Guerra, C., & Cheng, J. K. Y. (2017). Information Mismatch: Cancer Risk Counseling with Diverse Underserved Patients. Journal of Genetic Counseling, 26(5), 1090–1104. https://doi.org/10.1007/s10897-017-0089-4

Kamara, D., Weil, J., Youngblom, J., Guerra, C., & Joseph, G. (2018). Cancer Counseling of Low-Income Limited English Proficient Latina Women Using Medical Interpreters:  Implications for Shared Decision-Making. Journal of Genetic Counseling, 27(1), 155–168. https://doi.org/10.1007/s10897-017-0132-5

Padilla, L. K., Hodges, P. D., Ricker, C., & Geurts, J. L. (2025). Interpreter use in telehealth genetic counseling sessions. Journal of Genetic Counseling, 34(2), e2026. https://doi.org/10.1002/jgc4.2026

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