Palliative Care Professionals’ Perceptions of Communication With Sexual and Gender Minority Patients

Abstract

Purpose For sexual and gender minority (SGM) individuals who identify as lesbian, gay, bisexual, transgender, queer, or any other sexual orientation or gender identity (LGBTQ+), the quality of palliative care can depend upon how clinicians view and communicate with this historically minoritized group. Prior literature has demonstrated that SGM patients access care at lower rates, and palliative care clinicians have suggested that SGM patients are more likely to experience discrimination than heterosexual patients. This study examined palliative care clinicians’ perspectives and experiences regarding patient communication, care settings, the built environment, and inclusive care for SGM older adults with serious illness. Methods The health disparities research framework informed a descriptive qualitative analysis of interview data with palliative care professionals (N = 20) across diverse healthcare settings within Colorado regarding their experiences and beliefs about communication and the care of SGM patients. Results Three main themes emerged: (1) Limited sexual orientation and gender identity (SOGI) data collection; (2) Organizational and environmental inclusivity, and the “neutral” space viewed as safe; (3) Missing training platforms regarding SGM patients and a lack of opportunity to identify and discuss SGM patient needs. Conclusion Study findings illuminated the following barriers to providing SGM-inclusive care: perspectives around (1) limitations and preferences regarding collection of SOGI data, (2) organizational and environmental inclusivity, and (3) education and training regarding cultural humility and communication with SGM patients. Findings indicate the need for multidimensional research to better understand and address SGM health disparities and promote equitable care.

My Partner Is My Family

“…Cisnormativity is used to describe the assumption that all individuals identify as the sex to which they were assigned at birth and those who diverge from this self-identification are considered “abnormal.” 7 Implicit bias is defined as “the association of negative attributes to a particular group without conscious awareness.” 8 p1) Previous research has shown that a significant number of clinicians have implicit biases against sexual and gender minority populations and act upon these biases in myriad ways, including through microaggressions, gendered language, patient/partner communication, decision making, and other patient interactions 8-11 . Most health care clinicians were trained with a heteronormative lens, 1,12,13 and there is scant literature documenting how to interact with and support patients using an approach tailored specifically for lesbian, gay, bisexual, transgender, and queer (LGBTQ) patients 14 . Emerging research has illustrated the positive impact LGBTQ awareness and communication training has on patient outcomes 15-18 ; however, many clinician education programs have yet to incorporate this training in their curricula.…”

“…Also critical is how health professionals' education plays a large role in communication, specifically how to facilitate conversations that allow the patient not only to feel safe to disclose their identity but also to be inclusive of all support systems, including family of choice and other chosen support beyond or instead of biological family 14,22,24 . This analysis of the GOC conversation is based on a framework built on the respect for autonomy and beneficence, combined with the health equity promotion model, 25 (p6) which situates LGBTQ+ adults within “multiple levels and intersecting influences on the full continuum of LGBTQ+ health, especially as they relate to equity and resilience.” Using the health equity promotion model, we apply the understanding that multiple factors including external influences such as heteronormative and cisnormative assumptions by health care professionals may inform health outcomes.…”