• Demi Krystallidou, Aline Remael, Esther de Boe, Kristin Hendrickx, Giannoula Tsakitzidis, Sofie van de Geuchte, and Peter Pype.
• Faculty of Arts (Sint Andries Campus), University of Leuven, Sint-Andriesstraat 2, B-2000, Antwerp, Belgium. Electronic address: demi.krystallidou@kuleuven.be.
• Patient Educ Couns. 2018 Jan 1; 101 (1): 33-42.

ObjectiveTo explore i) the ways in which empathic communication is expressed in interpreter-mediated consultations; ii) the interpreter's effect on the expression of empathic communication.MethodsWe coded 9 video-recorded interpreter-mediated simulated consultations by using the Empathic Communication Coding System (ECCS) which we used for each interaction during interpreter-mediated consultations. We compared patients' empathic opportunities and doctors' responses as expressed by the patients and doctors and as rendered by the interpreters.ResultsIn 44 of the 70 empathic opportunities there was a match between the empathic opportunities as expressed by the patients and as rendered by the interpreters. In 26 of the 70 empathic opportunities, we identified 5 shift categories (reduced emotion, omitted emotion, emotion transformed into challenge, increased challenge/progress, twisted challenge) in the interpreter's rendition to the doctor. These were accompanied by changes in the level of empathy and in the content of the doctors' empathic responses.ConclusionThe interpreters' renditions had an impact on the patients' empathic opportunities and on the doctors' empathic responses in one third of the coded interactions.Practice ImplicationsCurricula with a focus on intercultural communication and/or empathy should consider the complexity of interpreter-mediated interaction and the interpreter's impact on the co-construction of empathy.Copyright © 2017 Elsevier B.V. All rights reserved.

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