Assessing the LGBT cultural competency of dementia care providers

Nowaskie, Dustin Z.; Sewell, Daniel D.

doi:10.1002/trc2.12137

Cited by 25 publications

(20 citation statements)

References 23 publications

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“…Older lesbian, gay, bisexual, and transgender (LGBT) adults have unique risks and needs associated with dementia, for example, often experiencing barriers to accessing dementia care or disclosing their sexual orientation or gender identity due to fear of discrimination [ 83 , 84 ]. Although healthcare workers report having affirming attitudes towards LGBT people with dementia [ 85 ], they lack knowledge and preparedness about the needs and management of this community [ 85 , 86 ]. Same-sex relationships are still illegal in some places, so we would not expect all countries to have related recommendations in their guidelines, but we still think it is important to aim for these rights for people living with dementia in all countries.…”

Section: Discussionmentioning

confidence: 99%

Protection against discrimination in national dementia guideline recommendations: A systematic review

et al. 2022

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Background National dementia guidelines provide recommendations about the most effective approaches to diagnosis and interventions. Guidelines can improve care, but some groups such as people with minority characteristics may be disadvantaged if recommended approaches are the same for everyone. It is not known if dementia guidelines address specific needs related to patient characteristics. The objectives of this review are to identify which countries have national guidelines for dementia and synthesise recommendations relating to protected characteristics, as defined in the UK Equality Act 2010: age, disability, gender identity, marriage and civil partnership, pregnancy and maternity, race, religion or belief, sex, and sexual orientation. Methods and findings We searched CINAHL, PsycINFO, and Medline databases and the Guideline International Network library from inception to March 4, 2020, for dementia guidelines in any language. We also searched, between April and September 2020, Google and the national health websites of all 196 countries in English and in each country’s official languages. To be included, guidelines had to provide recommendations about dementia, which were expected to be followed by healthcare workers and be approved at a national policy level. We rated quality according to the iCAHE guideline quality checklist. We provide a narrative synthesis of recommendations identified for each protected characteristic, prioritising those from higher-quality guidelines. Forty-six guidelines from 44 countries met our criteria, of which 18 were rated as higher quality. Most guidelines (39/46; 85%) made at least one reference to protected characteristics, and we identified recommendations relating to age, disability, race (or culture, ethnicity, or language), religion, sex, and sexual orientation. Age was the most frequently referenced characteristic (31/46; 67%) followed by race (or culture, ethnicity, or language; 25/46; 54%). Recommendations included specialist investigation and support for younger people affected by dementia and consideration of culture when assessing whether someone had dementia and providing person-centred care. Guidelines recommended considering religion when providing person-centred and end-of-life care. For disability, it was recommended that healthcare workers consider intellectual disability and sensory impairment when assessing for dementia. Most recommendations related to sex recommended not using sex hormones to treat cognitive impairment in men and women. One guideline made one recommendation related to sexual orientation. The main limitation of this study is that we only included national guidelines applicable to a whole country meaning guidelines from countries with differing healthcare systems within the country may have been excluded. Conclusions National guidelines for dementia vary in their consideration of protected characteristics. We found that around a fifth of the world’s countries have guidelines for dementia. We have identified areas of good practice that can be considered for future guidelines and suggest that all guidelines provide specific evidence-based recommendations for minority groups with examples of how to implement them. This will promote equity in the care of people affected by dementia and help to ensure that people with protected characteristics also have high-quality clinical services.

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Section: Discussionmentioning

confidence: 99%

Protection against discrimination in national dementia guideline recommendations: A systematic review

et al. 2022

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“…These differences in cultural competency are very common among healthcare professionals, including students, 15,26 psychiatry residents, 22 and dementia care providers. 27 Moreover, while there is much attention given to HIV/AIDS care in U.S. dermatology residency programs, there is strikingly less integration of other important topics that are just as relevant to LGBT patients, including pronoun use, history taking and physical examination, skin cancer risks, puberty blockers, and gender-affirming hormones and surgeries. 25 Given the present circumstances, many LGBT patients are likely not receiving culturally competent care from their dermatologists.…”

Section: Discussionmentioning

confidence: 99%

The current state of lesbian, gay, bisexual, and transgender cultural competency among U.S. dermatology residents

Nowaskie

Garcia-Dehbozorgi

Cortez

2022

International Journal of Women’s Dermatology

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Background: Lesbian, gay, bisexual, and transgender (LGBT) people interface with dermatology providers for many reasons. Implementing culturally competent LGBT dermatologic care necessitates evaluating provider competency to identify where gaps remain. Objectives: To assess the LGBT cultural competency among U.S. dermatology residents. Methods: A self-reporting, cross-sectional survey was emailed to U.S. dermatology program coordinators (N = 143).LGBT patient exposure, LGBT educational hours, and LGBT cultural competency via the LGBT-Development of Clinical Skills Scale (with the subscales Clinical Preparedness, Attitudinal Awareness, and Basic Knowledge) were measured. Results: Dermatology residents (N = 119) across the United States completed the survey. They reported caring for less than 20 LGBT patients per year and receiving less than 75 minutes of LGBT education per year. They reported significantly higher Attitudinal Awareness than both Clinical Preparedness and Basic Knowledge; they reported significantly higher Basic Knowledge than Clinical Preparedness. They reported significantly less adequate clinical training and supervision, experience, and competence to assess transgender patients compared to lesbian, gay, and bisexual patients. In general, dermatology residents who reported more LGBT patients and LGBT education also reported higher LGBT cultural competency. Limitations: A larger national sample of U.S. dermatology residents is necessary for generalizability. Conclusions: Currently, there is a lack of LGBT education in U.S. dermatology residency curricula, which may delay addressing the health disparities that exist in this patient population. Due to such dearth of standardized LGBT education, dermatology residents likely do not feel adequately knowledgeable or prepared to address LGBT needs. Both LGBT education and LGBT patient experiences may help alleviate these shortcomings and help LGBT patients feel affirmed in their dermatologic care.

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“…Deidentified data was aggregated from recent three independent studies that evaluated healthcare professionals’ LGBT cultural competency with the same study methodology but with entirely different healthcare professional samples, including healthcare professional students [ 9 ], psychiatry residents [ 8 ], and dementia care providers [ 10 ]. In each of those studies, demographics (i.e., age, gender identity, sexual orientation, race, ethnicity, type of healthcare discipline, and region), experiential variables (i.e., total hours of LGBT education received), and the LGBT-Development of Clinical Skills Scale (LGBT-DOCSS) [ 14 ] were collected, with the exception that total LGBT hours was not collected in the provider study [ 10 ]. Information pertaining to specific demographics, experiential variables, and LGBT-DOCSS scores of each pooled sample can be found in respective publications [ 8 – 10 ].…”

Section: Methodsmentioning

confidence: 99%

“…In each of those studies, demographics (i.e., age, gender identity, sexual orientation, race, ethnicity, type of healthcare discipline, and region), experiential variables (i.e., total hours of LGBT education received), and the LGBT-Development of Clinical Skills Scale (LGBT-DOCSS) [ 14 ] were collected, with the exception that total LGBT hours was not collected in the provider study [ 10 ]. Information pertaining to specific demographics, experiential variables, and LGBT-DOCSS scores of each pooled sample can be found in respective publications [ 8 – 10 ].…”

Section: Methodsmentioning

confidence: 99%

Lesbian, gay, bisexual, and/or transgender (LGBT) cultural competency across the intersectionalities of gender identity, sexual orientation, and race among healthcare professionals

Nowaskie

Najam

2022

PLoS ONE

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Background There is some data regarding lesbian, gay, bisexual, and transgender (LGBT) cultural competency among healthcare professionals. While few studies have indicated differences in competency between heterosexual and sexual minority professionals, no known studies have assessed LGBT cultural competency among diverse groups with multiple minority identities. This study aimed to characterize healthcare professionals’ LGBT cultural competency by comparing twelve different demographically diverse healthcare professional groups based on gender identity, sexual orientation, and race. Methods Deidentified data (N = 2254) was aggregated from three independent studies (i.e., healthcare professional students, psychiatry residents, and dementia care providers). A series of multivariate analyses of covariance were conducted with groups (based on gender identity, sexual orientation, and race), other demographic variables as independent variables, and LGBT-Development of Clinical Skills Scale scores (Overall LGBT-DOCSS, Clinical Preparedness, Attitudinal Awareness, and Basic Knowledge) as dependent variables. Findings Compared to men, women reported significantly higher LGBT-DOCSS scores, except significantly lower Clinical Preparedness. Compared to cisgender, heterosexual professionals, cisgender, sexual minority professionals and gender minority professionals reported significantly higher LGBT-DOCSS scores. There were several other differences among groups, such as heterosexual, cisgender, White/Caucasian men reporting low LGBT-DOCSS scores but high Clinical Preparedness; heterosexual, cisgender, White/Caucasian women with high LGBT-DOCSS scores except Clinical Preparedness; heterosexual, racial minority professionals with low LGBT-DOCSS scores; and gender, sexual, and racial minority professionals with the highest LGBT-DOCSS scores. Conclusions There are subtle, yet important, differences in LGBT cultural competency among healthcare professionals. More diversity, intersectionality, and multiple minority identities appear to lead to higher competency. Appreciating these gender, sexual, and racial minority professionals’ unique perspectives may promote the development of better, more culturally affirming LGBT health education.

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Assessing the LGBT cultural competency of dementia care providers

Cited by 25 publications

References 23 publications

Protection against discrimination in national dementia guideline recommendations: A systematic review

Protection against discrimination in national dementia guideline recommendations: A systematic review

The current state of lesbian, gay, bisexual, and transgender cultural competency among U.S. dermatology residents

Lesbian, gay, bisexual, and/or transgender (LGBT) cultural competency across the intersectionalities of gender identity, sexual orientation, and race among healthcare professionals

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