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Nouri S, Pantilat SZ, Meier DE, Nicolla JM, Friedman FAP, Chan RY, Candrian C. REaL and SOGI Data Collection: Results from a Palliative Care Quality Collaborative Survey. J Pain Symptom Manage 2024; 68:e82-e85. [PMID: 38670296 DOI: 10.1016/j.jpainsymman.2024.04.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2024] [Revised: 03/27/2024] [Accepted: 04/12/2024] [Indexed: 04/28/2024]
Affiliation(s)
- Sarah Nouri
- Division of Palliative Medicine(S.N., S.Z.P.), University of California San Francisco, San Francisco, California, USA.
| | - Steven Z Pantilat
- Division of Palliative Medicine(S.N., S.Z.P.), University of California San Francisco, San Francisco, California, USA
| | - Diane E Meier
- Department of Geriatrics and Palliative Medicine(D.E.M.), Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Jonathan M Nicolla
- Palliative Care Quality Collaborative(J.M.N., F.A.P.F., R.Y.C.), Chicago, Illinois, USA
| | - Fred A P Friedman
- Palliative Care Quality Collaborative(J.M.N., F.A.P.F., R.Y.C.), Chicago, Illinois, USA
| | - Robin Y Chan
- Palliative Care Quality Collaborative(J.M.N., F.A.P.F., R.Y.C.), Chicago, Illinois, USA
| | - Carey Candrian
- Division of General Internal Medicine(C.C.), University of Colorado School of Medicine, Aurora, Colorado, USA
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Robinson L, Matamoros C. Applied patient-level palliative care interventions designed to meet the needs of sexual and gender minorities: A scoping review and qualitative content analysis of how to support sexual and gender minorities at end of life. Palliat Med 2024; 38:69-84. [PMID: 38062858 PMCID: PMC10798012 DOI: 10.1177/02692163231214123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2024]
Abstract
BACKGROUND Sexual and gender minorities experience considerable health disparities across the life span. End of life presents unique challenges for this population, further exacerbating existing disparities. AIM We aimed to identify applied patient-level palliative care interventions for sexual and gender minorities and describe how said interventions met the needs of these populations at end of life. DESIGN We conducted a scoping review in keeping with the updated Arksey and O'Malley Framework. All included reports were analyzed qualitatively to describe the intervention and summarize thematically how it met the needs of sexual and gender minorities at end of life. DATA SOURCES We conducted searches in MEDLINE, EMBASE, PsychInfo, and CINAHL from 1946 to June 10, 2023. Reports were eligible for inclusion if they described a palliative care intervention delivered to sexual and gender minorities, and if the palliative care intervention responded to at least one specific need of the sexual and gender minority population(s) in question. RESULTS We included and summarized 27 reports. We identified three overarching themes describing how palliative care interventions responded to the needs of sexual and gender minorities at end of life. CONCLUSIONS This review responds to a need to improve palliative care delivery for sexual and gender minorities. Recommendations derived from these interventions, including how to center and advocate for sexual and gender minorities at end of life, can be applied by any interdisciplinary palliative care provider.
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Affiliation(s)
- Lilian Robinson
- Temmy Latner Centre for Palliative Care, Sinai Health System, Scarborough Health Network, Toronto, ON, Canada
| | - Cam Matamoros
- Scarborough Health Network, Scarborough Center for Healthy Communities, Department of Family and Community Medicine, Temerty School of Medicine, University of Toronto, Toronto, ON, Canada
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Lampe NM, Barbee H, Tran NM, Bastow S, McKay T. Health Disparities Among Lesbian, Gay, Bisexual, Transgender, and Queer Older Adults: A Structural Competency Approach. Int J Aging Hum Dev 2024; 98:39-55. [PMID: 37122150 PMCID: PMC10598237 DOI: 10.1177/00914150231171838] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
Abstract
Lesbian, gay, bisexual, transgender, and queer (LGBTQ+) older adults experience significant health disparities. Examining these disparities has become an international research priority, but gaps remain. In this review article, we summarize major contributions of and ongoing gaps in health disparities research among LGBTQ+ older adults, while focusing on four major content areas: (a) social determinants of health disparities, (b) mental, cognitive, and physical health disparities, (c) reproductive and sexual health disparities, and (d) seeking LGBTQ+-affirming and age-friendly care. Using a structural competency approach, we develop a four-part agenda for this research area that enhances our understanding of how macro-level systems, institutions, and structures drive health disparities among aging LGBTQ+ communities. We also outline future research on structural competency in LGBTQ+ older adult health, while providing recommendations for researchers and clinicians. These recommendations illuminate potential best practices for bettering the health and quality of life of LGBTQ+ older populations.
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Affiliation(s)
- Nik M. Lampe
- Department of Medicine, Health, and Society, Vanderbilt University, Nashville, TN, USA
- Vanderbilt University LGBTQ+ Policy Lab, Vanderbilt University, Nashville, TN, USA
| | - Harry Barbee
- Department of Health, Behavior and Society, Johns Hopkins University, Baltimore, MD, USA
| | - Nathaniel M. Tran
- Vanderbilt University LGBTQ+ Policy Lab, Vanderbilt University, Nashville, TN, USA
- Department of Health Policy, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Skyler Bastow
- Department of Sociology, Florida State University, Tallahassee, FL, USA
- Department of Geriatrics, Florida State University College of Medicine, Tallahassee, FL, USA
| | - Tara McKay
- Department of Medicine, Health, and Society, Vanderbilt University, Nashville, TN, USA
- Vanderbilt University LGBTQ+ Policy Lab, Vanderbilt University, Nashville, TN, USA
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Ghebrehiwet M, Cox K, Nees D, Dunford B, Jacobsen SM, Bacani R, Vassar M. Inequities in Epilepsy: A Scoping Review. Neurol Clin Pract 2023; 13:e200211. [PMID: 37795499 PMCID: PMC10547471 DOI: 10.1212/cpj.0000000000200211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Accepted: 08/21/2023] [Indexed: 10/06/2023]
Abstract
Objectives The objective of this study was to complete a scoping review of current literature surrounding health inequities in epilepsy while providing recommendations for future research. Methods During July 2022, we searched MEDLINE and Ovid Embase to find published articles pertaining to epilepsy and health inequities. Initially, authors received training. Authors then screened, and data were extracted in a masked duplicate manner. Studies published within the time frame of 2011-2021 in all countries were deemed appropriate. We screened 5,325 studies for titles and abstracts and then 56 studies for full text. We evaluated the inequities of race/ethnicity, sex or gender, income, occupation status, education level, under-resourced/rural population, and LGBTQ+. To summarize the data and descriptive statistics of our study, we used Stata 17.0 (StataCorp, LLC, College Station, TX). Results We obtained a sample size of 45 studies for study inclusion. The most reported health inequities were income (18/45, 40.0%), under-resourced/rural population (15/45, 33.3%), and race/ethnicity (15/45, 33.3%). The least reported health inequity was LGBTQ+ (0/45, 0.0%). Discussion The findings of our study suggest that gaps exist in literature concerning epilepsy and inequities. The inequities of income status, under-resourced/rural population, and race/ethnicity were examined the most, while LGBTQ+, occupation status, and sex or gender were examined the least. With the ultimate goal of more equitable and patient-centered care in mind, it is vital that future studies endeavor to fill in these determined gaps.
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Affiliation(s)
- Merhawit Ghebrehiwet
- Office of Medical Student Research (MG, KC, DN, BD, SMJ, RB, MV); and Department of Psychiatry and Behavioral Sciences (MV), Oklahoma State University Center for Health Sciences, Tulsa
| | - Katherine Cox
- Office of Medical Student Research (MG, KC, DN, BD, SMJ, RB, MV); and Department of Psychiatry and Behavioral Sciences (MV), Oklahoma State University Center for Health Sciences, Tulsa
| | - Danya Nees
- Office of Medical Student Research (MG, KC, DN, BD, SMJ, RB, MV); and Department of Psychiatry and Behavioral Sciences (MV), Oklahoma State University Center for Health Sciences, Tulsa
| | - Bryan Dunford
- Office of Medical Student Research (MG, KC, DN, BD, SMJ, RB, MV); and Department of Psychiatry and Behavioral Sciences (MV), Oklahoma State University Center for Health Sciences, Tulsa
| | - Samuel M Jacobsen
- Office of Medical Student Research (MG, KC, DN, BD, SMJ, RB, MV); and Department of Psychiatry and Behavioral Sciences (MV), Oklahoma State University Center for Health Sciences, Tulsa
| | - Rigel Bacani
- Office of Medical Student Research (MG, KC, DN, BD, SMJ, RB, MV); and Department of Psychiatry and Behavioral Sciences (MV), Oklahoma State University Center for Health Sciences, Tulsa
| | - Matt Vassar
- Office of Medical Student Research (MG, KC, DN, BD, SMJ, RB, MV); and Department of Psychiatry and Behavioral Sciences (MV), Oklahoma State University Center for Health Sciences, Tulsa
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MacWilliams B, McArthur E. Hospice and Palliative Care-Men and Gender-Specific Roles. Nurs Clin North Am 2023; 58:607-615. [PMID: 37833002 DOI: 10.1016/j.cnur.2023.06.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2023]
Abstract
All people face end of life as the final health outcome. When a person's health focus shifts from quantity to quality of life, palliative care comes into view. Clinicians serving patients across the health care spectrum must be aware of the nature and efficacy of palliative and hospice care, indications for referral to services, and current best practices. Creating an end-of-life trajectory requires an individualized and global personal plan, which palliative and hospice care can provide. Gender-specific care that includes gender minorities provides special and unique challenges to those seeking palliative and hospice care.
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Affiliation(s)
- Brent MacWilliams
- University of Wisconsin-Oshkosh, College of Nursing, 800 Algoma Boulevard, Oshkosh, WI 54901, USA.
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6
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Stein GL, Berkman C, Acquaviva K, Woody I, Godfrey D, Javier NM, O’Mahony S, gonzález-rivera C, Maingi S, Candrian C, Rosa WE. Project Respect: experiences of seriously ill LGBTQ+ patients and partners with their health care providers. HEALTH AFFAIRS SCHOLAR 2023; 1:qxad049. [PMID: 38756746 PMCID: PMC10986209 DOI: 10.1093/haschl/qxad049] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Revised: 09/11/2023] [Accepted: 09/22/2023] [Indexed: 05/18/2024]
Abstract
Discrimination against lesbian, gay, bisexual, transgender, and queer (LGBTQ+) persons in health care creates barriers to serious illness care, including patients avoiding or delaying necessary care, providers disrespecting wishes of surrogates, and adverse outcomes for patients and families. A cross-sectional mixed-methods study using an online survey was used to determine the extent to which LGBTQ+ patients and spouses, partners, and widows experienced disrespectful or inadequate care due to sexual orientation or gender identity. A total of 290 LGBTQ+ patients and partners reported high levels of disrespectful and inadequate care, including 35.2% stating their provider was insensitive to them because of their identity; 30% reporting their provider was unaware of LGBTQ+ health needs; 23.1% feeling judged; 20.7% experiencing rudeness; 20.3% stating providers did not use their correct pronouns; and 19.7% reporting their treatment decisions were disregarded. Black and Hispanic patients were 2-4 times more likely than non-Hispanic White patients to report discrimination. This study demonstrated high levels of disrespectful and inadequate care towards patients and partners due to being LGBTQ+, which was especially problematic for Black and Hispanic patients and those living in politically conservative regions. Recommendations include federal and state civil rights laws to prohibit LGBTQ+ discrimination and institutional practices to address discrimination, including cultural sensitivity training for staff.
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Affiliation(s)
- Gary L Stein
- Wurzweiler School of Social Work, Yeshiva University, New York, NY 10033, United States
| | - Cathy Berkman
- Graduate School of Social Service, Fordham University, New York, NY 10023, United States
| | - Kimberly Acquaviva
- University of Virginia School of Nursing, Charlottesville, VA 22903, United States
| | - Imani Woody
- Mary's House for Older Adults, Inc., Washington, DC 20017, United States
| | - David Godfrey
- Commission on Law and Aging, American Bar Association, Washington, DC 20036, United States
| | - Noelle Marie Javier
- Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, NY 10029, United States
| | - Sean O’Mahony
- Department of Internal Medicine, Rush University Medical Center, Chicago, IL 60612, United States
| | | | - Shail Maingi
- Dana-Farber Cancer Institute, South Weymouth, MA 02190, United States
| | - Carey Candrian
- Department of Internal Medicine, University of Colorado School of Medicine, Aurora, CO 80045, United States
| | - William E Rosa
- Department of Psychiatry & Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY 10065, United States
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7
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Peters PN, Havrilesky LJ, Davidson BA. Guidelines for goals of care discussions in patients with gynecologic cancer. Gynecol Oncol 2023; 174:247-252. [PMID: 37243995 DOI: 10.1016/j.ygyno.2023.05.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 05/07/2023] [Accepted: 05/15/2023] [Indexed: 05/29/2023]
Abstract
This article represents a distillation of literature to provide guidance for goals of care discussions with patients who have gynecologic malignancies. As clinicians who provide surgical care, chemotherapy, and targeted therapeutics, gynecologic oncology clinicians are uniquely positioned to form longitudinal relationships with patients that can enable patient-centered decision making. In this review, we describe optimal timing, components, and best practices for goals of care discussions in gynecologic oncology.
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Affiliation(s)
- Pamela N Peters
- Division of Gynecologic Oncology, Department of Obstetrics & Gynecology, Duke University Health System, Durham, NC 27710, United States of America.
| | - Laura J Havrilesky
- Division of Gynecologic Oncology, Department of Obstetrics & Gynecology, Duke University Health System, Durham, NC 27710, United States of America
| | - Brittany A Davidson
- Division of Gynecologic Oncology, Department of Obstetrics & Gynecology, Duke University Health System, Durham, NC 27710, United States of America
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Liantonio J, Tapper CX, Danielewicz M, Spina E, Javier NM. A Call for the Creation of LGBTQ+ Competencies for Hospice and Palliative Medicine (HPM) Fellowship Programs. J Pain Symptom Manage 2023; 65:e381-e385. [PMID: 36563866 DOI: 10.1016/j.jpainsymman.2022.12.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Revised: 12/06/2022] [Accepted: 12/07/2022] [Indexed: 12/25/2022]
Abstract
CONTEXT LGBTQ+ people and their families have unique needs, concerns, and issues when navigating serious illness. OBJECTIVES To develop curricular milestones and an educational framework for hospice and palliative medicine (HPM) fellowship programs to meet the needs of this community. METHODS A working group has developed a plan for the inclusion of LGBTQ+ competencies in HPM fellowship programs, utilizing input from an AAHPM Special Interest Group (SIG) at a national meeting. DISCUSSION Learning to provide culturally competent care is essential for all HPM providers. Our group recommends specific clinical training competencies with plans to pilot them in upcoming academic years. Creating curricular recommendations will help guide fellowship programs education in the care of LGBTQ+ patients with serious illness.
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Affiliation(s)
- John Liantonio
- Sidney Kimmel Medical College, Thomas Jefferson University Hospital (J.L., M.D., E.S.), Philadelphia, Pennsylvania.
| | - Corey X Tapper
- Johns Hopkins University School of Medicine (C.T.), Baltimore, Maryland
| | - Michael Danielewicz
- Sidney Kimmel Medical College, Thomas Jefferson University Hospital (J.L., M.D., E.S.), Philadelphia, Pennsylvania
| | - Elizabeth Spina
- Sidney Kimmel Medical College, Thomas Jefferson University Hospital (J.L., M.D., E.S.), Philadelphia, Pennsylvania
| | - Noelle M Javier
- Icahn School of Medicine at Mount Sinai (N.M.J.), New York, New York
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Schulz-Quach C, Kennedy M, Lyver B. Sexual and gender diversity in cancer care and survivorship. Curr Opin Support Palliat Care 2023; 17:55-69. [PMID: 36656606 DOI: 10.1097/spc.0000000000000628] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
PURPOSE OF THE REVIEW Sexual and gender diverse (SGD) cancer patients possess unique identities and needs that must be considered during their cancer care. This narrative review explores the current literature on sexual and gender diversity in cancer care and survivorship, in addition to providing recommendations encouraged by the current literature. RECENT FINDINGS We performed a literature search for articles published in English between January 2021 and June 2022 in Medline ALL and Embase. Fifty-two studies were included in this review. The many identities encapsulated in 2SLGBTQIA+ (2 Spirited, Lesbian, Gay, Bisexual, Transgender, Queer, Intersexual, Asexual, Agender, Aromantic and all gender identities and sexual orientations that are not listed) communities each have their own unique backgrounds, needs and disparities in cancer care and survivorship. However, we also identified specific protective factors in the cancer experience of SGD patients such as reports of higher resiliency and stronger support networks. Much of the recent research features recommendations on improving cancer care by creating inclusive patient questionnaires, improving in-person and online resources, and educating healthcare providers and patient-facing staff on inclusive care. SUMMARY SGD patients have their own specific challenges during and following their cancer care. As the research continues to grow, we gain a better understanding of the needs of these patients and future steps to take to improve SGD patients' cancer experience.
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Affiliation(s)
- Christian Schulz-Quach
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network
- Centre of Mental Health, University Health Network, Toronto, Ontario, Canada
| | - Margo Kennedy
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network
| | - Brendan Lyver
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network
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Block RG, Sampson A, Gagliardi J, Augusto B, Santiago-Datil W, Schabath MB, Vadaparampil ST, Quinn GP. The LOvE ECHO Training: Developing a Web-Based LGBTQ Cultural Competency Training Module for Oncology Allied Health Professionals. J Adolesc Young Adult Oncol 2022; 11:556-563. [PMID: 35475655 PMCID: PMC9784593 DOI: 10.1089/jayao.2021.0159] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Purpose: This article describes the development of the LGBTQ Oncofertility Education (LOvE-ECHO). The Enriching Communication skills for Health professionals in Oncofertility (ECHO) team created this new education module in response to the needs of oncology allied health professionals to provide inclusive and affirming care to lesbian, gay, bisexual, transgender, and queer (LGBTQ) AYA patients with cancer. The new module is part of the ECHO, a web-based educational training program for oncology allied health professionals to improve communication with AYA about reproductive health. Methods: The development of LOvE-ECHO includes five phases-learner needs assessment, content development and revision, piloting, and finalizing. Results from a survey of past ECHO learners and a comprehensive literature review provided the basis of need for this module and identified the most prominent gaps in knowledge and training. Content development and revision were iterative, including input, feedback, and voices from LQBTA youth and survivors, researchers, reproductive health experts, oncology clinicians, and web developer. Results: The complete LOvE-ECHO module consists of both didactic and interactive lessons. A glossary of terms and narrated PowerPoint establishes a knowledge base and shared vocabulary. Three interactive cases and a plan for action provide learners opportunities to test their new knowledge and transfer it to their practice. Conclusion: The module has received positive feedback to date. It is currently being piloted with new learners who complete a pre-test and post-test, as well as a feedback survey. Analysis of these results will inform revisions to the module.
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Affiliation(s)
| | - Amani Sampson
- Department of Obstetrics and Gynecology, Grossman School of Medicine, New York, New York, USA
| | - Julia Gagliardi
- Department of Obstetrics and Gynecology, Grossman School of Medicine, New York, New York, USA
| | - Bianca Augusto
- Department of Health Outcomes and Behavior, and Equity, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida, USA
| | - Waleska Santiago-Datil
- Department of Health Outcomes and Behavior, and Equity, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida, USA
| | - Matthew B. Schabath
- Department of Cancer Epidemiology, and and Equity, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida, USA
| | - Susan T. Vadaparampil
- Department of Health Outcomes and Behavior, and Equity, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida, USA
- Community Outreach Engagement, and Equity, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida, USA
| | - Gwendolyn P. Quinn
- Department of Obstetrics and Gynecology, Grossman School of Medicine, New York, New York, USA
- Departments of Population Health and Perlmutter Cancer Center, New York, New York, USA
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11
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Chan ASW, Leung LM, Li JSF, Ho JMC, Tam HL, Hsu WL, Iu ANOS, Tang PMK, Yan E. Impacts of psychological wellbeing with HIV/AIDS and cancer among sexual and gender minorities: A systematic review and meta-analysis. Front Public Health 2022; 10:912980. [PMID: 36523575 PMCID: PMC9746694 DOI: 10.3389/fpubh.2022.912980] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Accepted: 10/27/2022] [Indexed: 11/21/2022] Open
Abstract
Background The agony and economic strain of cancer and HIV/AIDS therapies severely impact patients' psychological wellbeing. Meanwhile, sexual minorities experience discrimination and mental illness. LGBT individuals with cancer and HIV/AIDS play two roles. It is important to understand and examine this groups mental wellbeing. Objective The purpose of this study is to synthesize current studies on the impact of HIV/AIDS and cancer on LGBT patients' psychological wellbeing. Methods This research uses a systematic literature review at first and later stage a meta-analysis was run on the same review. In this study, data from Google academic and Web of Science has been used to filter literature. PRISMA 2020 Flow Diagram seeks research on LGBT cancer and HIV/AIDS patients. The above sites yielded 370 related papers, some of which were removed due to age or inaccuracy. Finally, meta-analyses was done on 27 HIV/AIDS and 33 cancer patients's analyse. Results The research included 9,898 LGBT cancer sufferers with AIDS and 14,465 cancer sufferers with HIV/AIDS. Using meta-analysis, we discovered the gap in psychological wellbeing scores between HIV/AIDS LGBT and non-LGBT groups ranged from -10.86 to 15.63. The overall score disparity between the HIV/AIDS LGBT and non-LGBT groups was 1.270 (95% CI = 0.990-1.560, Z = 86.58, P < 0.1). The disparity in psychological wellbeing scores between cancer LGBT group and general group varies from -8.77 to 20.94 in the 34 papers examined in this study. Overall, the psychological wellbeing score disparity between the cancer LGBT subset and the general group was 12.48 (95% CI was 10.05-14.92, Test Z-value was 268.40, P-value was <0.1). Conclusion Inflammation and fibrosis in HIV/AIDS and cancer sufferers adversely affect their psychological wellbeing.
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Affiliation(s)
- Alex Siu Wing Chan
- Department of Applied Social Sciences, Faculty of Health and Social Sciences, The Hong Kong Polytechnic University, Kowloon, Hong Kong SAR, China,*Correspondence: Alex Siu Wing Chan ;
| | - Lok Man Leung
- Department of Applied Social Sciences, Faculty of Health and Social Sciences, The Hong Kong Polytechnic University, Kowloon, Hong Kong SAR, China
| | - Jane Siu Fan Li
- Department of Anatomical and Cellular Pathology, State Key Laboratory of Translational Oncology, The Chinese University of Hong Kong, Hong Kong, Hong Kong SAR, China
| | - Jacqueline Mei Chi Ho
- Faculty of Health and Social Sciences, School of Nursing, Hong Kong Polytechnic University, Kowloon, Hong Kong SAR, China
| | - Hon Lon Tam
- Faculty of Medicine, Nethersole School of Nursing, The Chinese University of Hong Kong, Kowloon, Hong Kong SAR, China
| | - Wing Leung Hsu
- Aceso Medical Centre, Hong Kong, Hong Kong SAR, China,Department of Pharmacy, Health and Well-being, University of Sunderland, Sunderland, United Kingdom
| | - April Nicole On Sang Iu
- Department of Psychology, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, NSW, Australia
| | - Patrick Ming Kuen Tang
- Department of Anatomical and Cellular Pathology, State Key Laboratory of Translational Oncology, The Chinese University of Hong Kong, Hong Kong, Hong Kong SAR, China,Elsie Yan
| | - Elsie Yan
- Department of Applied Social Sciences, Faculty of Health and Social Sciences, The Hong Kong Polytechnic University, Kowloon, Hong Kong SAR, China,Patrick Ming Kuen Tang
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Reich AJ, Perez S, Fleming J, Gazarian P, Manful A, Ladin K, Tjia J, Semco R, Prigerson H, Weissman JS, Candrian C. Advance Care Planning Experiences Among Sexual and Gender Minority People. JAMA Netw Open 2022; 5:e2222993. [PMID: 35857322 PMCID: PMC9301514 DOI: 10.1001/jamanetworkopen.2022.22993] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
IMPORTANCE Advance care planning (ACP) can promote patient-centered end-of-life (EOL) care and is intended to ensure that medical treatments are aligned with patient's values. Sexual and gender minority (SGM) people face greater discrimination in health care settings compared with heterosexual, cisgender people, but it is unknown whether such discrimination occurs in ACP and how it might affect the ACP experiences of SGM people. OBJECTIVES To increase understanding of barriers and facilitators of ACP facing SGM individuals. DESIGN, SETTING, AND PARTICIPANTS This mixed-methods national study of ACP included a telephone survey of self-identified SGM and non-SGM participants in a nationally representative sample drawn from a larger omnibus national panel by SSRS. Qualitative interviews were conducted with a subset of survey participants who identified as SGM. Data were collected from October 2020 to March 2021. EXPOSURES Self-identified SGM. MAIN OUTCOMES AND MEASURES The survey included 4 items from the validated ACP Engagement Survey, adapted to capture experiences of discrimination. Interviews asked about participants' experiences with ACP, including the appointment of medical decision-makers, sharing preferences, and experiences within the health care system more broadly. RESULTS A total of 603 adults participated in the survey, with 201 SGM individuals (mean [SD] age, 45.7 [18.7] years; 101 [50.2%] female; 22 [10.9%] Black, 37 [18.4%] Hispanic, and 140 [69.7%] White individuals) and 402 non-SGM individuals (mean [SD] age, 53.7 [19.2] years; 199 [49.5%] female; 35 [8.7%] Black, 41 [10.2%] Hispanic, and 324 [80.6%] White individuals). Regarding reasons for not completing ACP, SGM respondents, compared with non-SGM respondents, were more likely to say "I don't see the need" (72 [73.5%] vs 131 [57.2%], P = .006) and "I feel discriminated against by others" (12 [12.2%] vs 6 [2.6%], P < .001). Of 25 completed interviews among SGM participants, 3 main themes were identified: how fear and experiences of discrimination affect selection of clinicians and whether to disclose SGM identity; concerns about whether EOL preferences and medical decision-makers would be supported; and a preference to discuss EOL decisions and values outside of clinical settings. CONCLUSIONS AND RELEVANCE This study found that fear of disclosing sexual orientation or gender identity information and discrimination are important barriers to ACP for SGM in clinical settings, but discussions of preferences and values still occur between many SGM people and medical decision-makers. More SGM-specific patient-centered care might better support these discussions within the health care system. Furthermore, health systems can facilitate improved engagement by supporting clinician sensitivity training, including guidance on documentation and requirements.
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Affiliation(s)
- Amanda Jane Reich
- Center for Surgery and Public Health, Brigham and Women’s Hospital, Boston, Massachusetts
| | - Stephen Perez
- Emory University Rollins School of Public Health, Atlanta, Georgia
| | | | | | | | - Keren Ladin
- Department of Occupational Therapy and Community Health, Tufts University, Medford, Massachusetts
| | - Jennifer Tjia
- University of Massachusetts School of Medicine, Worcester
| | | | - Holly Prigerson
- Center for Research on End-of-Life Care, Weill Cornell School of Medicine, New York City, New York
| | - Joel S. Weissman
- Center for Surgery and Public Health, Brigham and Women’s Hospital, Boston, Massachusetts
| | - Carey Candrian
- Division of General Internal Medicine, University of Colorado School of Medicine, Aurora
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13
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Waters AR, Tennant K, Cloyes KG. Cultivating LGBTQ+ Competent Cancer Research: Recommendations from LGBTQ+ Cancer Survivors, Care Partners, and Community Advocates. Semin Oncol Nurs 2021; 37:151227. [PMID: 34753639 DOI: 10.1016/j.soncn.2021.151227] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Revised: 09/28/2021] [Accepted: 09/28/2021] [Indexed: 10/19/2022]
Abstract
OBJECTIVE Sexual and gender minority (SGM) or LGBTQ+ communities were designated as a National Institutes of Health (NIH) disparity population in 2016, yet research exploring SGM cancer disparities is still limited. Thus, we sought the insight of LGBTQ+ cancer survivors, care partners, and community advocates to learn their recommendations for cultivating competent and inclusive cancer research for LGBTQ+ individuals. DATA SOURCES We conducted a focus group with LGBTQ+ survivors and care partners of LGBTQ+ survivors who were 18 years or older (N = 8) and interviews with community advocates who are leaders in LGBTQ+ cancer (N = 8). The focus group and interviews were recorded, transcribed, and qualitatively analyzed using an inductive thematic analysis. CONCLUSION Qualitative analysis elicited an overarching theme of cultivating competent research for LGBTQ+ individuals, including three subthemes: (i) Cisheteronormativity: An inhospitable ecosystem for LGBTQ+ patients, survivors, and care partners, (ii) Study design: Shifting from invasive 'othering' to a sustainable community-driven climate, and (iii) Recruitment and data collection: Ways to cultivate ecosystem health. Cultivating inclusive, competent research with SGM populations is crucial for addressing health disparities and improving cancer survivors' and care partners' health. IMPLICATIONS FOR NURSING PRACTICE Recommendations from LGBTQ+ survivors, care partners, and community advocates ranged from small alterations to systemic changes, highlighting the multifaceted yet feasible process of cultivating LGBTQ+ competent cancer research. The process of cultivating competent research for LGBTQ+ populations will take substantial investment from researchers, providers, and health systems.
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Affiliation(s)
- Austin R Waters
- Cancer Control and Population Sciences Research Program, Huntsman Cancer Institute, Salt Lake City, Utah.
| | - Karrin Tennant
- College of Nursing, University of Utah, Salt Lake City, Utah
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