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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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Tapper CX. Geriatric Palliative Care: Providing Excellent Care to Lesbian, Gay, Bisexual, Transgender, Queer Older Adults. Clin Geriatr Med 2023; 39:359-368. [PMID: 37385688 DOI: 10.1016/j.cger.2023.04.001] [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: 07/01/2023]
Abstract
LGBTQ+ patients encounter discrimination and bias in health care settings. They experience worse health outcomes than their cisgender and heterosexual counterparts. There are numerous ways to provide equitable and comprehensive palliative care to seriously ill LGBTQ+ individuals. These strategies include communication techniques, encouragement to complete advance directives, implicit bias training, and interdisciplinary collaboration.
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Affiliation(s)
- Corey X Tapper
- Department of Medicine, Johns Hopkins University School of Medicine, 1830 East Monument Street, Suite 8021, Baltimore, MD 21205, USA.
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Dube D, Sussman T, Brotman S, de Vries B, Gutman G. Advance Care Planning among Older Gay Men Living with HIV in Montreal, Canada: Challenges to Thinking and Talking about Future Care. JOURNAL OF HOMOSEXUALITY 2022; 69:756-772. [PMID: 33433307 DOI: 10.1080/00918369.2020.1855029] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
This qualitative study employed a cross sectional focus group design to explore how older gay men living with HIV, experience, perceive, and engage with advance care planning (ACP). Seven gay men 50+, residing in Montreal, Canada, participated in a focus group that was audio-recorded, transcribed, and thematically analyzed. Findings suggested that social isolation, preoccupations with day-to-day living, and managing disclosures related to sexual orientation and HIV status created barriers to these men's capacities to think about let alone talk about future care. These findings challenge current conceptualizations of ACP, which position reflection as an individual process that precedes allocating a decision-maker and communicating care preferences. Analyses further revealed that relational connections helped create a space where ACP could occur for participants. Hence, improving the uptake of ACP amongst older gay men with HIV may require interventions that embed such discussions into broader programs aimed at building support and community.
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Affiliation(s)
- Denis Dube
- School of Social Work, McGill University, Montreal, Quebec, Canada
| | - Tamara Sussman
- School of Social Work, McGill University, Montreal, Quebec, Canada
| | - Shari Brotman
- School of Social Work, McGill University, Montreal, Quebec, Canada
| | - Brian de Vries
- Department of Gerontology, San Francisco State University, San Francisco, California, USA
| | - Gloria Gutman
- Department of Gerontology, Simon Fraser University, Vancouver, British Columbia, Canada
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Makita M, Bahena A, Almack K. The role of sexual orientation, age, living arrangements and self-rated health in planning for end-of-life care for lesbian, gay and bisexual (LGB) older people in the UK. SEXUALITIES 2022; 25:99-116. [PMID: 35177950 PMCID: PMC8841625 DOI: 10.1177/1363460720932381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
This article reports on findings from the quantitative phase of a two-year research project designed to explore end-of-life care experiences and needs of lesbian, gay, bisexual and transgender people. We draw on a subset of the sample (N = 180/237) to analyse the relationship between advance care planning, sexual orientation, living arrangements and self-rated health. The results contribute to a growing body of evidence on how sexual minorities approach and make decisions on advance care planning. A greater understanding of such patterns could help inform the way healthcare professionals engage in conversations about end-of-life care planning with older LGB people.
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Dhawan N, Ovalle AA, Yeh JC. The role of hospice and palliative care in supporting and fostering trust among the LGBTQ+ population. Palliat Care Soc Pract 2021; 15:26323524211042637. [PMID: 34617018 PMCID: PMC8488409 DOI: 10.1177/26323524211042637] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Affiliation(s)
- Natasha Dhawan
- Department of Hematology and Oncology, Dartmouth-Hitchcock Medical Center, 1 Medical Center Drive, Lebanon, NH 03756, USA
| | - Anais A Ovalle
- Department of Leadership Preventative Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA
| | - Jonathan C Yeh
- Section of Palliative Care, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA
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Javier NM. Palliative care needs, concerns, and affirmative strategies for the LGBTQ population. Palliat Care Soc Pract 2021; 15:26323524211039234. [PMID: 34527948 PMCID: PMC8436312 DOI: 10.1177/26323524211039234] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Accepted: 07/23/2021] [Indexed: 11/16/2022] Open
Abstract
The Lesbian, Gay, Bisexual, Transgender, and Queer/Questioning population, also known as sexual and gender minorities, are an incredibly marginalized and vulnerable population that have been disproportionately affected by the provision, delivery, and optimal access to high-quality medical care including palliative, hospice, and end-of-life care. The long-standing and unique experiences shaped by positive and negative historical events have led to a better understanding of significant barriers and gaps in equitable healthcare for this population. The intersection of both internal and external stressors as well as minority identities in the context of discriminatory political and societal infrastructures have resulted in variable health outcomes that continues to be plagued by economic barriers, oppressive legislative policies, and undesirable societal practices. It could not be more urgent and timely to call upon the government and healthcare systems at large to execute reforms in policies and regulations, engage in cultural competency training, and promote cultural shifts in beliefs, attitudes, and practices that will ultimately recognize, prioritize, and address the needs of this population. After all, health care access is a universal right regardless of personal, social, political, and economic determinants of comprehensive medical care.
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Affiliation(s)
- Noelle Marie Javier
- Icahn School of Medicine at Mount Sinai, One Levy Place, 1070, New York, NY 10029, USA
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Pecanac KE, Hill MV, Borkowski E. "It Made Me Feel Like I Didn't Know My Own Body": Patient-Provider Relationships, LGBTQ+ Identity, and End-of-Life Discussions. Am J Hosp Palliat Care 2021; 38:644-649. [PMID: 33583189 DOI: 10.1177/1049909121996276] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
PURPOSE LGBTQ+ individuals experience multiple challenges receiving quality care at the end of life, such as lack of confidence in the healthcare system to address their needs and lack of knowledge about advance care planning. Important gaps remain about the needs of LGBTQ+ individuals in the provider-patient relationship and how critical discussions about the end of life occur or do not occur in that relationship. The purpose of this study is to explore patients' narratives of their relationship with their provider and their experiences discussing end-of-life care with their providers, among patients who do and do not identify as LGBTQ+. METHODS Twenty-nine attendants of an event devoted to LGBTQ+ health, 15 of which identified as LGBTQ+, completed an altered version of the CAHPS® Patient Narrative Elicitation Protocol. We used inductive content analysis to qualitatively analyze the data. RESULTS Respondents described wanting to be heard, finding safety and trust, and valuing competency in their relationship with their provider. Respondents who identified as LGBTQ+ additionally 1) valued providers who avoided making assumptions, 2) looked for cues of safety to indicate they would be accepted by the provider, and 3) sought providers competent in LGBTQ+ care needs. Few respondents had discussed end-of-life care with their provider, although some assumed that their provider may or may not be able to meet their needs based on aspects of their provider-patient relationship. CONCLUSIONS Strengthening patient-provider relationships may help improve the care of LGBTQ+ populations, particularly for the end of life.
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Affiliation(s)
- Kristen E Pecanac
- School of Nursing, 5228University of Wisconsin-Madison, Madison, WI, USA
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Valenti KG, Jen S, Parajuli J, Arbogast A, Jacobsen AL, Kunkel S. Experiences of Palliative and End-of-Life Care among Older LGBTQ Women: A Review of Current Literature. J Palliat Med 2020; 23:1532-1539. [DOI: 10.1089/jpm.2019.0639] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Affiliation(s)
- Korijna G. Valenti
- Department of Sociology and Gerontology, Miami University, Oxford, Ohio, USA
| | - Sarah Jen
- School of Social Work, University of Kansas, Lawrence, Kansas, USA
| | - Jyotsana Parajuli
- College of Nursing, Pennsylvania State University, University Park, Pennsylvania, USA
| | - Annabelle Arbogast
- Department of Sociology and Gerontology, Miami University, Oxford, Ohio, USA
| | | | - Suzanne Kunkel
- Department of Sociology and Gerontology, Miami University, Oxford, Ohio, USA
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Stein GL, Berkman C, O'Mahony S, Godfrey D, Javier NM, Maingi S. Experiences of Lesbian, Gay, Bisexual, and Transgender Patients and Families in Hospice and Palliative Care: Perspectives of the Palliative Care Team. J Palliat Med 2020; 23:817-824. [DOI: 10.1089/jpm.2019.0542] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Gary L. Stein
- Wurzweiler School of Social Work, Yeshiva University, New York, New York, USA
| | - Cathy Berkman
- Graduate School of Social Service, Fordham University, New York, New York, USA
| | - Sean O'Mahony
- Department of Internal Medicine, Rush University Medical Center, Chicago, Illinois, USA
| | - David Godfrey
- Commission on Law and Aging, American Bar Association, Washington, DC, USA
| | - Noelle Marie Javier
- Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Shail Maingi
- Department of Medical Oncology, St. Peter's Health Partners, Troy, New York, USA
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Ayhan CHB, Bilgin H, Uluman OT, Sukut O, Yilmaz S, Buzlu S. A Systematic Review of the Discrimination Against Sexual and Gender Minority in Health Care Settings. INTERNATIONAL JOURNAL OF HEALTH SERVICES 2019; 50:44-61. [DOI: 10.1177/0020731419885093] [Citation(s) in RCA: 82] [Impact Index Per Article: 16.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The present systematic review aimed to determine discrimination experiences of sexual and gender minority (SGM) individuals and attitudes toward SGM among health care staff in health care settings. Following PRISMA guidelines, the review was conducted in 3 databases (PubMed, Cochrane Library, Science Direct) using keywords of sexual and gender minority, including “gay,” “lesbian,” “bisexual,” “transgender,” “LGB,” “LGBT,” “health care discrimination,” “stigma,” “homophobia,” “transphobia,” and “attitudes of healthcare professionals” from May to September 2016. Predetermined inclusion criteria were selected. Thirty quantitative studies were eligible for inclusion in this review. Discriminative behaviors experienced by SGM individuals were stigma, denial or refusal of health care, and verbal or physical abuse. Knowledge and educational levels, beliefs, and religion of health care providers affected their attitudes toward SGM patients and their homophobia level. These findings revealed that health care providers needed more education about SGM issues, and SGM-friendly policies should be created for improving health care for SGM individuals.
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Affiliation(s)
- Cemile Hurrem Balik Ayhan
- Department of Psychiatric and Mental Health Nursing, Istanbul University – Cerrahpasa Florence Nightingale Faculty of Nursing, Istanbul, Turkey
| | - Hülya Bilgin
- Department of Psychiatric and Mental Health Nursing, Istanbul University – Cerrahpasa Florence Nightingale Faculty of Nursing, Istanbul, Turkey
| | - Ozgu Tekin Uluman
- Department of Psychiatric and Mental Health Nursing, Health Science Faculty, Kafkas University, Kars, Turkey
| | - Ozge Sukut
- Department of Psychiatric and Mental Health Nursing, Istanbul University – Cerrahpasa Florence Nightingale Faculty of Nursing, Istanbul, Turkey
| | - Sevil Yilmaz
- Department of Psychiatric and Mental Health Nursing, Istanbul University – Cerrahpasa Florence Nightingale Faculty of Nursing, Istanbul, Turkey
| | - Sevim Buzlu
- Department of Psychiatric and Mental Health Nursing, Istanbul University – Cerrahpasa Florence Nightingale Faculty of Nursing, Istanbul, Turkey
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11
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Seelman KL, Lewinson T, Engleman L, Allen A. Motivations for advance care and end-of-life planning among lesbian, gay, and bisexual older adults. QUALITATIVE SOCIAL WORK : QSW : RESEARCH AND PRACTICE 2019; 18:1002-1016. [PMID: 33343234 PMCID: PMC7747803 DOI: 10.1177/1473325018792396] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Lesbian, gay, and bisexual (LGB) 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 LGB 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 LGB 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 LGB older adults and for social work education, as well as implications for future research.
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12
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Javier NM, Oswald AG. Health for the Lesbian, Gay, Bisexual, Transgender, and Queer (LGBTQ) Older Adults. CURRENT GERIATRICS REPORTS 2019. [DOI: 10.1007/s13670-019-0282-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Nguyen AL, Seal D, Bruce O, Dalton M, Palmer A, Pardini M, Quiroga B, Ryu J, Soliman S, Welty JC, Younus I. Caregiving preferences and advance care planning among older adults living with HIV. AIDS Care 2018; 31:243-249. [PMID: 30146895 DOI: 10.1080/09540121.2018.1515472] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
With the increase in the US of the number of older adults living with HIV, more research is needed to understand the caregiving and advance care planning needs of this population. This descriptive study examined the relationship between social support and caregiving preferences and advance care planning. Older adults living with HIV were recruited from clinics in Los Angeles, CA and New Orleans, LA to complete cross-sectional surveys (n = 154). Logistic regression analyses were modeled to determine the characteristics associated with 1) preference for formal short-term term care, 2) preference for formal long-term care, 3) having at least one contact for emergency care, 4) having an advance directive or living will, and 5) having a healthcare proxy or agent. The mean age was 56.8 years. The majority of participants indicated a preference for informal support for both short-term (73.4%) and long-term care (66.2%), 13.2% had no one they could call for emergency care, 26.0% had an advance directive/living will, and 30.5% had a healthcare proxy/agent. In adjusted models, greater social support was associated with preference for informal short-term care and with having at least one emergency contact. Findings suggest that older adults living with HIV prefer informal sources of support for their caregiving needs despite having small social networks and individuals with limited social networks are particularly vulnerable due to lack of access to caregivers in sudden or unexpected health situations.
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Affiliation(s)
- Annie L Nguyen
- a Department of Family Medicine, Keck School of Medicine , University of Southern California , Los Angeles , CA , USA
| | - David Seal
- b Department of Global Community Health and Behavioral Sciences, School of Public Health and Tropical Medicine , Tulane University , New Orleans , LA , USA
| | - Omar Bruce
- a Department of Family Medicine, Keck School of Medicine , University of Southern California , Los Angeles , CA , USA
| | - Margarida Dalton
- b Department of Global Community Health and Behavioral Sciences, School of Public Health and Tropical Medicine , Tulane University , New Orleans , LA , USA
| | - Allison Palmer
- b Department of Global Community Health and Behavioral Sciences, School of Public Health and Tropical Medicine , Tulane University , New Orleans , LA , USA
| | - Marissa Pardini
- b Department of Global Community Health and Behavioral Sciences, School of Public Health and Tropical Medicine , Tulane University , New Orleans , LA , USA
| | - Bailey Quiroga
- b Department of Global Community Health and Behavioral Sciences, School of Public Health and Tropical Medicine , Tulane University , New Orleans , LA , USA
| | - Jenica Ryu
- a Department of Family Medicine, Keck School of Medicine , University of Southern California , Los Angeles , CA , USA
| | - Sarah Soliman
- a Department of Family Medicine, Keck School of Medicine , University of Southern California , Los Angeles , CA , USA
| | - James C Welty
- b Department of Global Community Health and Behavioral Sciences, School of Public Health and Tropical Medicine , Tulane University , New Orleans , LA , USA
| | - Imamah Younus
- a Department of Family Medicine, Keck School of Medicine , University of Southern California , Los Angeles , CA , USA
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Cartwright C, White B, Willmott L, Parker M, Williams G. Australian doctors' knowledge of and compliance with the law relating to end-of-life decisions: implications for LGBTI patients. CULTURE, HEALTH & SEXUALITY 2018; 20:845-857. [PMID: 29067876 DOI: 10.1080/13691058.2017.1385854] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
In most developed countries, competent patients have the legal right to refuse any medical treatment; Advance Care Planning mechanisms extend this right to non-competent patients. However, some groups, including lesbian, gay, bisexual, transgender and intersex (LGBTI) people, risk their wishes not being respected if they lose capacity, more than others. Little is known about medical practitioners' knowledge of, or attitudes to, the law in this area, especially in relation to LGBTI people, or how the law influences their decision-making. An Australian postal survey explored knowledge and attitudes of medical specialists to legal issues relating to withdrawing/ withholding life-sustaining treatment from adults without capacity. One scenario (the focus of this paper) asked which of four plausible substitute decision-makers, including a same-sex partner, had the legal authority to make such decisions. The overall response rate was 32% (867/2702). Less than one-third of respondents correctly identified the same-sex partner as the legally authorised decision-maker. LGBTI people face multiple obstacles to having their end-of-life wishes respected. Where healthcare providers are also ignorant of the partner's legal right to make such decisions, the problem is compounded. Improved legal education for clinicians and promotion of educational resources for members of the LGBTI community is needed.
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Affiliation(s)
- Colleen Cartwright
- a ASLaRC Aged Services Unit , Southern Cross University , Bilinga, Gold Coast , Queensland , Australia
| | - Ben White
- b Faculty of Law, Australian Centre for Health Law Research , Queensland University of Technology , Brisbane , Queensland , Australia
| | - Lindy Willmott
- b Faculty of Law, Australian Centre for Health Law Research , Queensland University of Technology , Brisbane , Queensland , Australia
| | - Malcolm Parker
- c Mayne Medical School , The University of Queensland , Brisbane , Queensland , Australia
| | - Gail Williams
- d School of Public Health , The University of Queensland , Brisbane , Queensland , Australia
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Marsack J, Stephenson R. Barriers to End-of-Life Care for LGBT Persons in the Absence of Legal Marriage or Adequate Legal Documentation. LGBT Health 2018; 5:273-283. [PMID: 29920158 DOI: 10.1089/lgbt.2016.0182] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
End-of-life care has attracted increased attention in recent years due to increases in both the number and mean age of the world's population; however, the experiences of LGBT persons during end-of-life care remain understudied. Given the health disparities and barriers to care experienced throughout the life course of LGBT persons, the frequent involvement of legal spouses in end-of-life care, and the recency of marriage equality, it can be surmised that LGBT persons might experience significantly different barriers to their desired end-of-life care compared to their heterosexual and cisgender counterparts. This article aims to synthesize what is known about these barriers, particularly in the absence of legal marriage or protective legal documentation. Of two hundred and twelve articles reviewed, twenty-three were included for analysis. Common barriers that emerged were discriminatory laws (e.g., prohibitions against same-sex marriage) and policies, lack of decision-making capacity, lack of knowledge regarding patient wishes, lack of visitation rights, challenges from biological next of kin, and discrimination and psychological distress. Recommendations for future research are provided based on gaps that were identified. These include increased research on transgender persons and bisexual persons, and on providers of end-of-life care. In addition, the recommendations take into account that important legislative and policy changes occurred after the period in which the studies reviewed here were published. The impact of those changes cannot be reported in this study and should be determined by future studies. This synthesis provides the contextual understanding necessary for research and improvement in this vastly understudied area.
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Affiliation(s)
- Jessica Marsack
- Department of Health Behavior and Biological Sciences, School of Nursing, University of Michigan, and The Center for Sexuality and Health Disparities, University of Michigan , Ann Arbor, Michigan
| | - Rob Stephenson
- Department of Health Behavior and Biological Sciences, School of Nursing, University of Michigan, and The Center for Sexuality and Health Disparities, University of Michigan , Ann Arbor, Michigan
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Cloyes KG, Hull W, Davis A. Palliative and End-of-Life Care for Lesbian, Gay, Bisexual, and Transgender (LGBT) Cancer Patients and Their Caregivers. Semin Oncol Nurs 2018; 34:60-71. [PMID: 29306523 PMCID: PMC5863535 DOI: 10.1016/j.soncn.2017.12.003] [Citation(s) in RCA: 46] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
OBJECTIVE To identify the unique needs of lesbian, gay, bisexual, and transgender (LGBT) cancer patients and caregivers, and review recommendations supporting more effective and inclusive palliative and end-of-life care. DATA SOURCES Published research and clinical guidelines. CONCLUSION Transitions in care raise particular challenges for LGBT patients, including provider communication, perceptions of safety and acceptance, and assessing and respecting patients' definitions of family and spirituality. IMPLICATIONS FOR NURSING PRACTICE LGBT patients and their caregivers need competent nurses to support them, especially during transitions. Implementing LGBT-inclusive education, training, and practice will improve outcomes for LGBT cancer patients and their caregivers - and potentially all patients.
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Hughes M, Cartwright C. Lesbian, gay, bisexual and transgender people's attitudes to end-of-life decision-making and advance care planning. Australas J Ageing 2016; 34 Suppl 2:39-43. [PMID: 26525446 DOI: 10.1111/ajag.12268] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
AIM To examine lesbian, gay, bisexual and transgender (LGBT) people's attitudes to advance care planning (ACP) options and alternative decision-making at the end of life. METHOD Three hundred and five LGBT people completed an online or paper-based questionnaire, comprising fixed-choice questions and open-ended questions. RESULTS Most respondents, particularly those identifying as female or transgender, preferred a partner to be their alternative decision-maker at the end of life should the need arise. Fifty-two per cent of respondents had spoken to this person about their wishes. Regarding legal options enabling end-of-life decision-making, 29% had an enduring power of attorney, 18% an enduring guardian and 12% an advance care directive. CONCLUSION Despite the significance of ACP for promoting the rights of LGBT people at the end of life, the take-up of these options was nearly as low as for the general population. The potential for targeted strategies to increase the take-up of ACP is identified.
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Affiliation(s)
- Mark Hughes
- School of Arts and Social Sciences, Southern Cross University, Bilinga, Queensland, Australia
| | - Colleen Cartwright
- School of Health and Human Sciences, Southern Cross University, Bilinga, Queensland, Australia
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Carabez R, Scott M. ‘Nurses don't deal with these issues’: nurses’ role in advance care planning for lesbian, gay, bisexual and transgender patients. J Clin Nurs 2016; 25:3707-3715. [DOI: 10.1111/jocn.13336] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/11/2016] [Indexed: 11/30/2022]
Affiliation(s)
- Rebecca Carabez
- School of Nursing; San Francisco State University; San Francisco CA USA
| | - Megan Scott
- School of Nursing; San Francisco State University; San Francisco CA USA
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21
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Andreassen P, Neergaard MA, Brogaard T, Skorstengaard MH, Jensen AB. The diverse impact of advance care planning: a long-term follow-up study on patients' and relatives' experiences. BMJ Support Palliat Care 2015; 7:335-340. [PMID: 26424073 DOI: 10.1136/bmjspcare-2015-000886] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2015] [Revised: 06/24/2015] [Accepted: 09/16/2015] [Indexed: 11/03/2022]
Abstract
BACKGROUND Advance care planning (ACP) is a process of discussing and recording patients' preferences for future care, aiming to guide healthcare decisions at the end of life (EOL). AIM To explore nuances in the long-term impact of ACP by studying patient and relative experiences. DESIGN A qualitative follow-up interview study. Interviews were recorded, transcribed and analysed using thematic synthesis. SETTING/PARTICIPANTS 3 patients with a life-limiting disease (lung or heart disease), affiliated with a major Danish hospital, and 7 relatives were interviewed 1 year after participating in an ACP discussion. RESULTS The experiences were diverse. Some patients and relatives felt 'relieved', 'more secure' and more in control due to ACP. To some, ACP had led to open communication rather than 'beating around the bush', and to spending more quality time together. However, others perceived ACP as irrelevant. Some stated that the patient's wishes had not been met regardless of ACP. Others felt that EOL questions cannot be realistically considered until 'you're in the middle of it', because many factors are involved. In one case, participating in ACP led to a patient-relative conflict, resulting in EOL issues being 'tucked away'. CONCLUSIONS The study reveals great diversity in patient and relative experiences of ACP. The study challenges previous research which mainly emphasises ACP as a valuable tool to optimise EOL care. This study stresses the importance of awareness of the highly individual nature of preferences and needs of patients and relatives regarding information, involvement and communication about EOL care.
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Affiliation(s)
| | | | - Trine Brogaard
- Department of Public Health, Aarhus University Hospital, Aarhus C, Denmark
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Arthur DP. Social Work Practice with LGBT Elders at End of Life: Developing Practice Evaluation and Clinical Skills Through a Cultural Perspective. JOURNAL OF SOCIAL WORK IN END-OF-LIFE & PALLIATIVE CARE 2015; 11:178-201. [PMID: 26380926 DOI: 10.1080/15524256.2015.1074141] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
This article focuses on culturally sensitive clinical issues related to best practices with lesbian, gay, bisexual, transgender (LGBT) elder patients at end-of-life (EOL) at key points in the therapeutic relationship. Vital concepts, including practice evaluation and clinical skills, are presented through a cultural and oncology lens. There is a paucity of LGBT research and literature as well as a shortfall of MSW graduate school education specific to social work palliative and end-of-life care (PELC) practice with LGBT elders. The content of this article is designed to be adapted and used as an educational tool for institutions, agencies, graduate programs, medical professions, social work, and students. Learning the unique elements of LGBT cultural history and their implications on EOL care can improve social work practice. This article provides an examination from assessment and engagement basics to advance care planning incorporating specific LGBT EOL issues.
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Affiliation(s)
- Darren P Arthur
- a Beth Israel Comprehensive Cancer Center-East Campus , Mount Sinai Beth Israel Hospital , New York , New York , USA
- b New York University Silver School of Social Work , New York , New York , USA
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Hughes M, Cartwright C. LGBT people's knowledge of and preparedness to discuss end-of-life care planning options. HEALTH & SOCIAL CARE IN THE COMMUNITY 2014; 22:545-552. [PMID: 24935483 DOI: 10.1111/hsc.12113] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 04/08/2014] [Indexed: 06/03/2023]
Abstract
Despite the devastating impact of HIV/AIDS, end-of-life care planning among lesbian, gay, bisexual and transgender (LGBT) communities is relatively under-researched, especially in Australia. This paper reports findings of a survey of 305 LGBT people living in New South Wales, which examined their knowledge of and attitudes towards end-of-life care. The focus of this paper is their preparedness to discuss with healthcare providers any end-of-life care plans. The results highlight that while the majority of respondents were aware of three of the four key end-of-life care planning options available in New South Wales--enduring powers of attorney, enduring guardians and person responsible (only a minority had heard of advance healthcare directives)--a much smaller number of people had actually taken up these options. Only a minority of respondents were able to identify correctly who had the legal right to make treatment decisions for a person who is unconscious following a car accident. A small proportion of people had discussed end-of-life care options with general practitioners or another main healthcare provider, and only in very few cases were these issues raised by the practitioners themselves. Those most likely to not feel comfortable discussing these issues with practitioners included younger people, those not fully open about their sexuality to family members, and transgender people and others who do not define their gender as male or female. The paper highlights the importance of education strategies to raise awareness of the end-of-life care planning options among LGBT people, as well as strategies for increasing health providers' preparedness to discuss these issues with LGBT patients.
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Affiliation(s)
- Mark Hughes
- School of Arts and Social Sciences, Southern Cross University, Gold Coast, Queensland, Australia
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24
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Jenkins CL, Edmundson A, Averett P, Yoon I. Older lesbians and bereavement: experiencing the loss of a partner. JOURNAL OF GERONTOLOGICAL SOCIAL WORK 2014; 57:273-287. [PMID: 24798053 DOI: 10.1080/01634372.2013.850583] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/26/2013] [Accepted: 09/27/2013] [Indexed: 06/03/2023]
Abstract
There is very little research focused on older bereaved lesbians. This study is a response to the lack of knowledge about the issues for older lesbians who lose a partner. We examined bereavement issues for 55 older lesbians. The study asked participants to describe their concerns and experiences after losing a partner. Qualitative analysis identified several themes that ran throughout, including disenfranchised grief, the loneliness of isolation, and the frustration of relentless battles. These findings indicate the need for social workers to educate themselves and others about the particular needs facing this vulnerable group of older women.
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Affiliation(s)
- Carol L Jenkins
- a School of Social Work , East Carolina University , Greenville , North Carolina , USA
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25
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Brennan-Ing M, Seidel L, Larson B, Karpiak SE. Social care networks and older LGBT adults: challenges for the future. JOURNAL OF HOMOSEXUALITY 2014; 61:21-52. [PMID: 24313252 DOI: 10.1080/00918369.2013.835235] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Research on service needs among older adults rarely addresses the special circumstances of lesbian, gay, bisexual, and transgender (LGBT) individuals, such as their reliance on friend-centered social networks or the experience of discrimination from service providers. Limited data suggests that older LGBT adults underutilize health and social services that are important in maintaining independence and quality of life. This study explored the social care networks of this population using a mixed-methods approach. Data were obtained from 210 LGBT older adults. The average age was 60 years, and 71% were men, 24% were women, and 5% were transgender or intersex. One-third was Black, and 62% were Caucasian. Quantitative assessments found high levels of morbidity and friend-centered support networks. Need for and use of services was frequently reported. Content analysis revealed unmet needs for basic supports, including housing, economic supports, and help with entitlements. Limited opportunities for socialization were strongly expressed, particularly among older lesbians. Implications for senior programs and policies are discussed.
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Affiliation(s)
- Mark Brennan-Ing
- a AIDS Community Research Initiative of America (ACRIA), ACRIA Center on HIV & Aging , New York , New York , USA
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26
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Lawton A, White J, Fromme EK. End-of-life and advance care planning considerations for lesbian, gay, bisexual, and transgender patients #275. J Palliat Med 2013; 17:106-8. [PMID: 24351127 DOI: 10.1089/jpm.2013.9457] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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28
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Garfield CF, Isacco A, Sahker E. Religion and Spirituality as Important Components of Men’s Health and Wellness. Am J Lifestyle Med 2012. [DOI: 10.1177/1559827612444530] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Men’s health has been receiving increased attention in health care research and practice because of associated negative outcomes and men’s reluctance to seek help. Religion or religiosity, defined as involvement in an organized, structured community focused on moral code, and spirituality, defined as the subjective, mystical, and holistic interpretation of personal beliefs and behaviors, have been associated with positive health outcomes. Specifically, religion and spirituality mediate an increase in positive health outcomes and a decrease in risk factors through social and existential well-being. However, men seem to be less religious and spiritual compared with women, a potential problem as men may be missing an important pathway to health and wellness. This state-of-the-art review examines the intersections of religion, spirituality, and health and focuses on how religion and spirituality relate specifically to men’s health and health behaviors. Subsequently, 4 health problems with religious and spiritual implications are examined that have been identified in the literature as pertinent to men’s health: (a) prostate cancer screening and coping, (b) HIV/AIDS prevention and coping, (c) addictions, and (d) palliative care. Finally, suggestions are offered for clinicians to incorporate an understanding of religion and spirituality into their patient encounters.
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Affiliation(s)
- Craig F. Garfield
- Departments of Pediatrics and Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, Illinois (CFG)
- Counseling Psychology Program, Chatham University, Pittsburgh, Pennsylvania (AI, ES)
| | - Anthony Isacco
- Departments of Pediatrics and Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, Illinois (CFG)
- Counseling Psychology Program, Chatham University, Pittsburgh, Pennsylvania (AI, ES)
| | - Ethan Sahker
- Departments of Pediatrics and Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, Illinois (CFG)
- Counseling Psychology Program, Chatham University, Pittsburgh, Pennsylvania (AI, ES)
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29
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Harding R, Epiphaniou E, Chidgey-Clark J. Needs, Experiences, and Preferences of Sexual Minorities for End-of-Life Care and Palliative Care: A Systematic Review. J Palliat Med 2012; 15:602-11. [DOI: 10.1089/jpm.2011.0279] [Citation(s) in RCA: 77] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Richard Harding
- King’s College London, Cicely Saunders Institute, Department of Palliative Care, Policy & Rehabilitation, London, United Kingdom
| | - Eleni Epiphaniou
- King’s College London, Cicely Saunders Institute, Department of Palliative Care, Policy & Rehabilitation, London, United Kingdom
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30
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Cartwright C, Hughes M, Lienert T. End-of-life care for gay, lesbian, bisexual and transgender people. CULTURE, HEALTH & SEXUALITY 2012; 14:537-548. [PMID: 22468824 DOI: 10.1080/13691058.2012.673639] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
There is little understanding in Australia of the special issues faced by gay, lesbian, bisexual and transgender people in end-of-life care and advance care planning. This exploratory study aimed to achieve an initial understanding of these issues to inform the development of a larger study involving gay, lesbian, bisexual and transgender service users. Consultations were carried out with 19 service providers and 6 gay, lesbian, bisexual and transgender community members in the Northern Rivers and metropolitan Sydney areas of New South Wales, Australia. Participants reported barriers to health care service access due to discrimination, inappropriate care and lack of knowledge among both consumers and health care workers of legal rights at the end of life. While advance care planning can assist with improving end-of-life care, respondents reported a number of obstacles. These included a lack of knowledge and absence of perceived need and the additional obstacle of social isolation, leading to difficulties identifying alternative decision-makers. The study highlighted the need for education for gay, lesbian, bisexual and transgender people and health and aged care providers on existing legal provisions to prevent discrimination in end-of-life care.
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Affiliation(s)
- Colleen Cartwright
- ASLaRC Aged Services Unit, School of Health and Human Sciences, Southern Cross University, Tweed Heads, Australia
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31
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Rawlings D. End-of-life care considerations for gay, lesbian, bisexual, and transgender individuals. Int J Palliat Nurs 2012; 18:29-34. [DOI: 10.12968/ijpn.2012.18.1.29] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Deb Rawlings
- Palliative & Supportive Services, Flinders University, Flinders University Health Sciences Building, Repatriation General Hospital, Daws Road, Daw Park, Adelaide, South Australia 5041, Australia
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32
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Pereira SM, Fradique E, Fialho R, Cerqueira M, Pereira A, Sampaio F. Advance directives: Portuguese Palliative Care Professionals' views. Int J Palliat Nurs 2011; 17:373-80. [DOI: 10.12968/ijpn.2011.17.8.373] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Sandra M. Pereira
- Azores University, Nursing School of Angra do Heroísmo, Canada dos Melancólicos, 9700-878 Angra do Heroísmo, Portugal
| | | | - Renata Fialho
- North Lisbon Hospital Centre, Saint Mary Hospital, Portugal
| | | | | | - Florbela Sampaio
- Health School, Polythecnic Institute of Viana do Castelo, Portugal
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Abstract
The spiritual dimensions of surgical palliative care encompass recognition of mortality (physician and patient); knowledge of moral and ethical dilemmas of medical decision making; respect for each individual and for all belief systems; responsibility to remain physically and psychologically present for the patient and family; and knowledge of when chaplains, palliative care professionals, or social workers should be consulted. Certain aspects of surgical palliative care distinguish it from palliative care in other medical disciplines such as the 2 definitions (palliative procedure and palliative care), treating a disproportionate share of patients who suffer unforeseen tragic events, and the surgical system.
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Affiliation(s)
- Margaret J Tarpley
- Department of Surgery, Vanderbilt University, Nashville, TN 37232-2730, USA.
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34
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Abstract
Considerable controversy surrounds the issue of care at the end of life (EOL) for older adults. Technological advances and the legal, ethical, clinical, religious, cultural, personal, and fiscal considerations in the provision of artificial hydration and nutrition support to older adults near death are presented in this comprehensive review.
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Affiliation(s)
- Roschelle A Heuberger
- Department of Human Environmental Studies, Central Michigan University, Mt. Pleasant, Michigan 48859, USA.
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35
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Abstract
The needs and desires of lesbians and gay men with cancer at the end of their lives are not fundamentally different from any other dying individual's needs. There are, however, significant legal restrictions and societal attitudes that can negatively affect the dying experiences of lesbians and gay men. Lesbians and gay men face many challenges at the end of their lives, including issues of disclosure in the healthcare setting, discrimination, misconceptions, legal and financial barriers and the disenfranchised grief of surviving same-sex partners. Oncology social workers can play a prominent role in advocating for these individuals to allow for dignity and support in spite of these barriers and provide effective interventions to help in assisting lesbians and gaymen with healthcare decision-making and end-of-life care planning.
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36
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Selwyn PA. Palliative care for patient with human immunodeficiency virus/acquired immune deficiency syndrome. J Palliat Med 2006; 8:1248-68. [PMID: 16351539 DOI: 10.1089/jpm.2005.8.1248] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Peter A Selwyn
- Department of Family and Social Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York 10467, USA.
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37
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Stein GL, Sherman PA. Promoting Effective Social Work Policy in End-of-Life and Palliative Care. J Palliat Med 2005; 8:1271-81. [PMID: 16351541 DOI: 10.1089/jpm.2005.8.1271] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Policy developments in the health care arena in general, and in end-of-life and palliative care in particular, strongly influence the practice environment for the delivery of hospice and palliative care services and the diverse roles of social work practitioners. This article analyzes policy developments in two crucial areas-ethics and law and disenfranchisement and health disparities. It focuses on the recent social work literature and other key sources and provides recommendations to promote the roles of social workers in ethics consultation, public policy, and advocacy and to integrate better the perspectives and concerns of diverse communities into palliative care practice, education, and policy.
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Affiliation(s)
- Gary L Stein
- New Jersey Health Decisions, Verona, New Jersey 07044, USA.
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Gwyther LP, Altilio T, Blacker S, Christ G, Csikai EL, Hooyman N, Kramer B, Linton J, Raymer M, Howe J. Social work competencies in palliative and end-of-life care. JOURNAL OF SOCIAL WORK IN END-OF-LIFE & PALLIATIVE CARE 2005; 1:87-120. [PMID: 17387058 DOI: 10.1300/j457v01n01_06] [Citation(s) in RCA: 72] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
Abstract
Social workers from clinical, academic, and research settings met in 2002 for a national Social Work Leadership Summit on Palliative and End-of-Life Care. Participants placed the highest priority on the development and broad dissemination of a summary document of the state-of-the-art practice of social work in palliative and end-of-life care. Nine Summit participants reviewed the literature and constructed this detailed description of the knowledge, skills, and values that are requisite for the unique, essential, and appropriate role of social work. This comprehensive statement delineates individual, family, group, team, community, and organizational interventions that extend across settings, cultures, and populations and encompasses advocacy, education, training, clinical practice, community organization, administration, supervision, policy, and research. This document is intended to guide preparation and credentialing of professional social workers, to assist interdisciplinary colleagues in their collaboration with social workers, and to provide the background for the testing of quality indicators and "best practice" social work interventions.
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Affiliation(s)
- Lisa P Gwyther
- Duke University Institute on Care at the End of Life, Duke University Medical Center, Durham, NC 27710, USA
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Abstract
There is very little research literature that addresses sexuality at the end of life. Although end-of-life care has become a priority for nursing education, the issue of end-of-life sexuality is not included in the curriculum. Nurses are frequently in a position to establish relationships with couples that encourage a frank discussion and information sharing. As patient advocates, nurses can address end-of-life sexuality issues by taking a sexual history and implementing a general intervention model, such as the PLISSIT. Couples need to be reassured that if they have enjoyed a close sexual relationship, sexual intimacy may continue to be part of their relationship, even at the end of life.
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Shankle MD, Maxwell CA, Katzman ES, Landers S. An Invisible Population: Older Lesbian, Gay, Bisexual, and Transgender Individuals. ACTA ACUST UNITED AC 2003. [DOI: 10.1081/crp-120021079] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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