Whether or not interpreters are needed, literacy level should be assessed, as well as English language skills. Many Indian languages do not have equivalent words or concepts for many English words, especially medical language. The cultural nuance of language (e.g., voice inflection and accent) can influence the meaning of words and phrases.
Some Indian cultures do not speak of death, dying, or of negative outcomes to medical procedures, as “thought” and “speech” can cause the negative outcome to occur (e.g., Navajo). Speaking the name of a deceased person may hold that person’s spirit in limbo, and delay their journey to the next world.
Ample time should be given for consideration of information given, and consultation with other persons in the American Indian community. Consultation may be sought from Clan leaders, matriarchs, patriarchs, religious leaders, and/or medicine persons. Also, translation of written material and medical jargon may be sought from other sources. Medical procedures may be appropriate only on certain dates for an individual in consultation with traditional Indian healers.
After slow and deliberate consideration of treatment options, an elder may choose not to accept the procedure or treatment, or in some Indian traditions, an elder may choose not to allow treatment for a member of his/her family (Alvord, 1999). Use of a cultural guide or spiritual leader may be helpful if not already engaged, but ethical and confidentiality issues are at stake. Ultimately, empowerment lies with the patient.