Motivations for advance care and end-of-life planning among lesbian, gay, and bisexual older adults

Abstract

Lesbian, gay, and bisexual older adults are more likely than their heterosexual peers to experience health disparities, discrimination from healthcare providers based on sexual orientation, and rejection from their family of origin, all of which can complicate medical care and decision making, as well as end-of-life arrangements. Yet, relatively few studies of lesbian, gay, and bisexual seniors have looked at motivations for advance care and end-of-life planning, which are strategies that can help ensure that healthcare treatment and end-of-life wishes are enacted as desired. The present qualitative study investigated this topic with a purposive sample of nine lesbian, gay, and bisexual and same-gender-loving adults in a metropolitan region of the Southeastern United States. The study involved in-depth face-to-face interviews, followed by a brief pen-and-paper survey. Participants’ ages ranged from 65 to 77; the sample included five men and four women. Six individuals were white/Caucasian, while three were African American/Black. We identified three themes related to motivations for advance care and end-of-life planning: wanting a sense of agency, learning from others, and reducing conflict and confusion for loved ones. We discuss the importance of these findings for social work practice with lesbian, gay, and bisexual older adults and for social work education, as well as implications for future research.

A rapid review of end-of-life needs in the LGBTQ+ community and recommendations for clinicians

“…Most included articles reported findings from quali-tative research studies. 13 , 15 , 19 – 21 , 40 – 57 , 59 – 61 Roughly half of the studies were conducted in the United Sta-tes 21 , 41 , 43 , 45 , 47 – 49 , 54 , 56 , 57 , 59 , 62 – 64 , 10 in Canada. 15 , 40 , 46 , 51 – 53 , 55 , 60 , 65 , 66 No articles in Portuguese or French were included.…”

“…Nineteen articles reported on the healthcare practitioner experience and/or were expressed in the “voice” of an LGBTQ+ person recounting someone else’s experience with the end-of-life care system. 19 , 21 , 41 – 43 , 45 – 47 , 49 , 51 , 53 – 58 , 62 , 65 , 66 The stories retold from peers indicated a high distrust of healthcare practitioners. While they provide insight into the perceptions of end-of-life care in LGBTQ+ adults they do not capture a complete landscape.…”

“…Out of the 33 articles reviewed only 11 distinguished distinct groups (e.g., lesbian, gay, bisexual, transgender, and queer) within the LGBTQ+ community. 21 , 42 , 43 , 48 , 49 , 52 , 53 , 57 , 59 – 61 The majority applied results generically to the LGBTQ+ community. Some of the articles collected participants’ gender preference and sexual orientation data separately yet described results collectively to LGBTQ+ participants.…”

“… 41 , 51 , 56 Interestingly, the lesbian, gay, bisexual group was the focus of the majority of articles that did differentiate between groups. 42 , 47 , 49 , 57 , 59 , 61 …”

Situation of non-heteronormative (LGBT+) people in palliative care

“…Seelman i wsp. zbadali, co motywuje starsze (≥ 65 lat) osoby LGBT do planowania opieki u końca życia [29]. Z przeprowadzonych wywiadów badacze wysunęli wnioski odnośnie do trzech czynników motywujących: potrzeba sprawczości, wiedza o ACP zaczerpnięta od innych i chęć zmniejszenia zagubienia oraz konfliktów wśród najbliższych.…”