Development and evaluation of an LGBT+ education programme for palliative care interdisciplinary teams

Abstract

Background: Despite national policy recommendations to enhance healthcare access for LGBT+ (lesbian, gay, bisexual, transgender, and those who do not identify as cisgender heterosexual) people, education on LGBT+ issues and needs is still lacking in health and social care curricula. Most of the available resources are focused on primary care, mental health, and sexual health, with little consideration to broader LGBT+ health issues and needs. The limited available educational programmes pertaining to LGBT+ individuals outside the context of sexual or mental health have mainly focused on cancer care or older adults. Aim: To support palliative care interdisciplinary teams to provide LGBT+ affirmative care for people receiving and needing palliative and end-of-life care. Methods: A 1½-h workshop was developed and evaluated using Kotter’s eight-step process for leading change. Across four hospices, 145 health and social professionals participated in the training. A quasi-experimental non-equivalent groups pre–post-test design was used to measure self-reported levels of knowledge, confidence, and comfort with issues, and needs and terminology related to LGBT+ and palliative care. Results: There was a significant increase in the reported levels of knowledge, confidence, and comfort with issues, needs, and terminology related to LGBT+ and palliative care after attending the training. Most participants reported that they would be interested in further training, that the training is useful for their practice, and that they would recommend it to colleagues. Conclusion: The project illustrates the importance of such programmes and recommends that such educational work is situated alongside wider cultural change to embed LGBT+-inclusive approaches within palliative and end-of-life care services.

Barriers to LGBTQIA-Inclusive Palliative Care

“…4,5 This is due in part to historical social stigma, lack of legal protections and medical stigma in the form of identity-pathologizing, the overall effect of which is an observed increase in mental health issues and engagement in dangerous health behaviors. 6 Each of these factors has personal, institutional and financial effects on LGBTQIA individuals, the sum of which serve as barriers to accessing appropriate palliative care.…”

“…22 Evidence has shown that some health care professionals do discriminate against patients based on their gender identity and/or sexual orientation, whether consciously or unconsciously. 6,23,24…”

“…28 Evidence has shown that training programs offered in palliative healthcare settings aided employees’ knowledge and comfort in providing LGBTQIA-specific palliative care. 6…”

“…Similarly the work of Javier 25 as well as Dhawan and colleagues 30 provide an overview and guidance to overcoming barriers to LGBTQIA-inclusive palliative care. Chidiac and colleagues 6 demonstrated a positive effect in provider knowledge and confidence after developing a training workshop designed to teach strategies for delivering LGBT+ affirmative care in patients receiving EOL palliative care.…”

“…22 Evidence has shown that some health care professionals do discriminate against patients based on their gender identity and/or sexual orientation, whether consciously or unconsciously. 6,23,24 Secondly, LGBTQIA individuals who receive highly active anti-retroviral therapy (HAART) or those receiving genderaffirming hormone therapy may be concerned about whether their medications will be continued while enrolled in hospice care. Sometimes in the transition to comfort-focused hospice care, HPM providers may abruptly discontinue hormone therapy, potentially causing injury to an individual's sense of identity and dignity, contrary to the central aim of hospice care.…”