2026-01-16
Blog
This is and English translation of the Swedish article “Sista samtalen ska förstås: digital vårdtolk i palliativ vård”, published 2025-12-12 in the paper Cancervården (Cancer care)
Sara Westerberg
Specialist Nurse in Advanced Home Care (ASIH), Dalen Hospital, Stockholm
Caring for a person at the end of life is, above all, about meeting another human being. This meeting takes place beyond language, culture, and words – because in palliative care, communication is not merely a tool, but a cornerstone. It is the very carrier of care. Communication makes it possible to create safety, relief, and meaning, even when time is limited. But what happens when words are not enough?
In our daily work, we meet patients and family members with varying levels of proficiency in the Swedish language, and in certain areas, language differences are a recurring challenge. When communication breaks down, there is a risk of missing important signals of pain, anxiety, or end-of-life wishes. This affects both patient safety and the working environment of healthcare professionals.
When words are missing, the deepest function of the relationship is threatened – the ability to see and acknowledge the patient as a human being.
Research on language barriers –such as Implications of Language Barriers for Healthcare: A Systematic Review (Al Shamsi et al., 2020) – demonstrates how they affect the quality of care and the relationship between patients and nurses. The findings show that this is not only about the transfer of information, but about how trust, safety, and participation in the care encounter are compromised when language fails. Nurses also describe increased stress and feelings of inadequacy when they are unable to meet patients in a way that feels caring and authentic. Communication is not merely a means of conveying information; it is the fabric of the relationship itself. When words are missing, the deepest function of the relationship is threatened – the ability to see and acknowledge the patient as a human being.
To address this challenge, we initiated the project The final conversations should be understood, a collaboration between Capio ASIH Dalen, SPSV, and the company Care to Translate, funded by the Regional Cancer Centre (RCC). The project aims to adapt and evaluate a digital interpreter specifically for palliative care, with the goal of making the final phase of life more comprehensible, participatory, and humane – regardless of language.
In the first phase, a needs assessment and phrase development were carried out in collaboration with assistant nurses, allied health professionals, registered nurses, specialist nurses, and physicians working in palliative care. Based on these experiences, a broad set of palliative-care phrases was developed, translated into 48 languages, and reviewed by medical experts. The phrases address themes central to palliative conversations, including existential questions, cultural needs, and end-of-life preferences. Examples include:
We know that healthcare providers, regardless of language, ask these questions too infrequently. Asking them in the patient’s own language can be decisive – not only for understanding the answers, but for demonstrating respect and a genuine willingness to connect.
It was essential to choose a solution that is not only technically functional, but also ethically and linguistically reliable.
The digital interpreting tool used in the project, Care to Translate, is based on a robust and patient-safe translation method in which all phrases are professionally translated and medically reviewed. The tool is specifically developed for healthcare and meets the requirements for data security, confidentiality, and medical terminology necessary for use in patient-facing situations. For us, it was essential to choose a solution that is not only technically functional, but also ethically and linguistically reliable.
During the pilot phase, healthcare professionals have tested the app in encounters with patients and their families. My observations so far are not primarily about the technology itself, but about what happens between people when the language barrier is temporarily lifted. I have seen nurses approach patients more confidently when supported by a linguistic tool. The digital interpreter does not become an obstacle – it becomes a bridge.
When it becomes possible to ask questions that previously felt impossible – such as “Would you like me to stay with you for a while?” – a genuine human connection can emerge, even if another voice from a device conveys the words. There is reassurance in knowing that correct terminology is used, especially when communicating difficult or distressing messages – perhaps even more so then.
For patients, this means being able to express their needs, emotions, and wishes in their own language, fostering dignity, safety, and participation. For healthcare professionals, uncertainty and stress are reduced. Confidence grows when support is available – and it is in this courage, not in the app itself, that care becomes truly human.
Research on digital tools in palliative care shows that they can create “communicative bridges” when used with empathy and awareness. Technology becomes caring only when used with the intention to understand, listen, and acknowledge.
The humanity of the encounter lies not in perfection, but in the willingness to understand one another.
Several studies, including Language Barriers Between Nurses and Patients: A Scoping Review (Gerchow et al., 2021) and Are They Saying It How I’m Saying It? (Dressler et al., 2021), describe how nurses develop their own strategies to foster understanding when language falls short – by reading body language, using tone of voice, or drawing on cultural experience. At the same time, nurses report feelings of stress, isolation, and moral frustration when they are unable to provide the care they aspire to give. Patients, meanwhile, often describe a deep sense of relief when they notice that staff are making an effort to reach them – even with the help of technology. The humanity of the encounter lies not in perfection, but in the willingness to understand one another.
At its best, technology can enable the caring encounter – not replace it. When used with the intention of fostering understanding and clarity, it can support the nurse’s ability to interpret what is unspoken, to listen to the language of the body, and to attend to the interpersonal space between people. Usability of Technological Tools to Overcome Language Barriers in Healthcare (Kreienbrinck et al., 2025) also highlights how crucial it is that technology feels safe and intuitive for healthcare professionals. Usability is influenced by how easily the tool integrates into workflows, how confident staff feel using it, and the availability of training and support.
Digital tools reach their full potential only when healthcare organizations actively invest in implementation, training, and continuous reflection.
For technology to be perceived as a genuine aid, it must be both practically functional and emotionally grounded within the care culture. When nurses trust the tool, both efficiency and communication quality improve. Digital tools work best as a complement to human interaction – not a replacement – and reach their full potential only when healthcare organizations actively invest in implementation, training, and continuous reflection.
Language barriers are also a leadership issue. Research on language barriers between nurses and patients shows that multilingual nurses are rarely consulted during the implementation of interpreting systems or translation processes, despite often possessing valuable experiential knowledge. At the same time, cultural competence and deeper insight into its importance are frequently lacking at leadership levels, which risks reducing issues of language and understanding to technical matters rather than ethical ones.
In palliative care, leadership must create conditions for reflection, supervision, and ethical awareness in linguistically complex encounters. Communication must be recognized as a component of care quality – not as a temporary challenge. Caring leadership must also acknowledge the courage of staff. When nurses are given the mandate to use technological tools as support for human conversations, a culture of trust is fostered rather than one of control. Only then can technology truly become caring.
Multilingual nurses are also an underutilized resource. When their linguistic and cultural competence is recognized – not merely as practical assistance but as part of the learning and development of care – healthcare culture as a whole is strengthened in its ability to communicate equitably. Leadership’s responsibility then becomes creating structures where multilingualism and reflection are seen as assets rather than exceptions.
When leadership enables safety and reflection, technology does not become a filter between people, but a support for the courage to meet one another.
The pilot phase will continue through autumn 2025 and will be followed by an evaluation using surveys completed by patients, family members, and healthcare professionals. The results will form the basis for recommendations for further development and broader implementation across palliative care services.
The goal is clear: Every person, regardless of language, has the right to understand and be understood – even in life’s final conversations.