1
|
Rosa WE, Wakefield D, Scott HM, Braybrook D, Harding R, Bristowe K. Hidden From Sight-From the Closet to the Paywall: A Rapid Evaluation of Restricted and Monetized Access to LGBTQ+ Inclusive Palliative, End-of-Life, and Bereavement Care Research. J Pain Symptom Manage 2024; 68:e183-e189. [PMID: 38942095 DOI: 10.1016/j.jpainsymman.2024.06.016] [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: 02/15/2024] [Revised: 06/11/2024] [Accepted: 06/19/2024] [Indexed: 06/30/2024]
Abstract
INTRODUCTION LGBTQ+ people experience higher burdens of life-limiting illnesses, poorer health outcomes, and multilevel barriers to accessing palliative, end-of-life, and bereavement care. High quality evidence is needed to inform interventions to address these inequities, and inform inclusive practices and policies. Despite global initiatives to improve availability of peer-reviewed journal articles, the minority of research is open access (OA). We aimed to evaluate accessibility of literature related to LGBTQ+ inclusive palliative, end-of-life, and bereavement care. METHODS A rapid review of the evidence regarding LGBTQ+ inclusive palliative, end-of-life, and bereavement care was conducted; OA status of identified articles was assessed. Articles from three published systematic reviews were included (2012, 2016, and 2020). Review articles were updated using the original search and inclusion/exclusion strategies. RESULTS 66 articles related to LGBTQ+ inclusive palliative, end-of-life and bereavement care were identified between 1990-2022. Of these, only 21% (n=14) were OA. Of the OA articles, 79% were published between 2017 and 2022, and 50% were published between 2020-2022, reflecting more recent shifts towards OA publishing. DISCUSSION Health and social care professionals and policy makers rely on access to high quality evidence to inform their work. Failing to make articles related to the needs of LGBTQ+ people and populations OA risks further marginalisation and worsened inequities. Innovative journal policies and funding are needed to enable access, particularly for research that foregrounds the needs of marginalised communities. Where articles are currently behind paywalls, there is a need for accessible summaries or policy briefs to inform inclusive policy and practice.
Collapse
Affiliation(s)
- William E Rosa
- Department of Psychiatry and Behavioral Sciences (W.E.R.), Memorial Sloan Kettering Cancer Center, New York, New York, USA.
| | - Donna Wakefield
- North Tees and Hartlepool NHS Foundation Trust (D.W.), University Hospital of North Tees, Stockton-on-Tees, United Kingdom; Wolfson Palliative Care Research Centre (D.W.), Hull York Medical School, Hull University, Hull, United Kingdom; Population Health Sciences Institute (D.W.), Faculty of Medical Sciences, Newcastle University, Newcastle, United Kingdom
| | - Hannah M Scott
- Florence Nightingale Faculty of Nursing Midwifery and Palliative Care (H.M.S., D.B., R.H., K.B.), Cicely Saunders Institute, King's College London, London, England, United Kingdom
| | - Debbie Braybrook
- Florence Nightingale Faculty of Nursing Midwifery and Palliative Care (H.M.S., D.B., R.H., K.B.), Cicely Saunders Institute, King's College London, London, England, United Kingdom
| | - Richard Harding
- Florence Nightingale Faculty of Nursing Midwifery and Palliative Care (H.M.S., D.B., R.H., K.B.), Cicely Saunders Institute, King's College London, London, England, United Kingdom
| | - Katherine Bristowe
- Florence Nightingale Faculty of Nursing Midwifery and Palliative Care (H.M.S., D.B., R.H., K.B.), Cicely Saunders Institute, King's College London, London, England, United Kingdom
| |
Collapse
|
2
|
Seachrist K, Somers E, Petras L, Didden E, Deci SE, Tomboc P, Kidd KM. Pediatric Palliative Care of a Transgender Adolescent. Pediatrics 2024; 154:e2023064830. [PMID: 38845556 PMCID: PMC11211693 DOI: 10.1542/peds.2023-064830] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Revised: 04/23/2024] [Accepted: 04/23/2024] [Indexed: 06/30/2024] Open
Abstract
A 15-year-old patient with metastatic synovial sarcoma conveyed to his palliative care physician that his dying wish was to start gender-affirming hormone therapy. His medical team was able to identify resources to support both him and his family as they navigated the immense difficulty of a cancer diagnosis and began to understand their child's gender identity. Literature on the care of gender diverse pediatric patients with terminal illness is minimal, but applications from adult literature, and research on supporting gender diverse adolescents more broadly, provided guidance for palliative care, oncology, and gender-affirming care teams. We believe that honoring and supporting the gender identity of adolescents with terminal illness is an essential aspect of end-of-life care. This case report outlines challenges faced by multidisciplinary pediatric team members who provided gender-affirming care for a minor under hospice care and amplifies the need for future research and guidelines pertinent to this patient population.
Collapse
Affiliation(s)
- Katherine Seachrist
- West Virginia University School of Medicine, WVU Medicine Children’s, WVU Medicine, Morgantown, West Viriginia
| | - Emma Somers
- West Virginia University School of Medicine, WVU Medicine Children’s, WVU Medicine, Morgantown, West Viriginia
| | - Laura Petras
- West Virginia University School of Medicine, WVU Medicine Children’s, WVU Medicine, Morgantown, West Viriginia
| | - El Didden
- West Virginia University School of Medicine, WVU Medicine Children’s, WVU Medicine, Morgantown, West Viriginia
| | - Stephen E. Deci
- West Virginia University School of Medicine, WVU Medicine Children’s, WVU Medicine, Morgantown, West Viriginia
| | - Patrick Tomboc
- West Virginia University School of Medicine, WVU Medicine Children’s, WVU Medicine, Morgantown, West Viriginia
| | - Kacie M. Kidd
- West Virginia University School of Medicine, WVU Medicine Children’s, WVU Medicine, Morgantown, West Viriginia
| |
Collapse
|
3
|
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.
Collapse
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
| |
Collapse
|
4
|
van Klinken M, van Leeuwenhoek A. Palliative and End-of-Life Care for LGBT+ Cancer Patients: Scoping the Problems and Identifying the Solutions. Semin Oncol Nurs 2023; 39:151500. [PMID: 37739865 DOI: 10.1016/j.soncn.2023.151500] [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] [Received: 07/03/2023] [Revised: 08/06/2023] [Accepted: 08/23/2023] [Indexed: 09/24/2023]
Abstract
OBJECTIVES People who identify as lesbian, gay, bisexual, and transgender (LGBT+) face inequalities in healthcare and are receiving less palliative and end-of-life care than others with a comparable need. Since the global resolution to improve palliative care made by the World Health Assembly, the World Health Organization, and member states, some progress has been made. However, LGBT+ people are discriminated and marginalized, which leads to suboptimal palliative care. Research on the needs of LGBT+ people and their access to palliative care is limited. Therefore, the aim of this discussion article is to scope unique problems around palliative and end-of-life care for LGBT+ people and identify possible solutions to address these problems with direct links to nursing practice. DATA SOURCES Journal articles and author experience were used for this discussion article. CONCLUSION Oncology nurses need to be educated in communication skills, specific assessment tools, and awareness of the history of LGBT+ people. Increasing knowledge for cancer nurses is pivotal because this affects their views, needs, and perceptions in providing palliative and end-of-life care. IMPLICATIONS FOR NURSING PRACTICE Oncology nurses have a pivotal role in caring for all cancer patients at the end of their life. 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. More research is needed to implement such training in nursing education. ("LGBT+" has been used throughout the article. There are many arguments in favor of using different variations of the acronym, but for purposes of understanding and ease, LGBT+ is the acronym of choice here.).
Collapse
Affiliation(s)
- Merel van Klinken
- Department of Oncological Rehabilitation at Novicare, Haarlem, the Netherlands.
| | | |
Collapse
|
5
|
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.
Collapse
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
| |
Collapse
|
6
|
Hatzikiriakidis K, Ayton D, Skouteris H, Patitsas L, Smith K, Dhulia A, Poon P. A rapid umbrella review of the literature surrounding the provision of patient-centred end-of-life care. Palliat Med 2023; 37:1079-1099. [PMID: 37448148 DOI: 10.1177/02692163231183007] [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: 07/15/2023]
Abstract
BACKGROUND Patients have reported a broad range of unmet needs in their receipt of clinical care at the end of life. Therefore, enhancing the quality of end-of-life care through patient-centred healthcare interactions is warranted. AIM The aim of this rapid umbrella review was to synthesise previous literature reviews that have examined: (1) patient preferences for patient-centred end-of-life care; (2) barriers and enablers to patient-centred end-of-life care; (3) interventions designed to enhance patient-centred end-of-life care; and (4) patient-centred models of end-of-life care. DESIGN A rapid umbrella review was conducted and informed by the Joanna Briggs Institute's methodological guidance for conducting umbrella reviews. DATA SOURCES Three academic databases were searched for relevant literature in May 2022: MEDLINE, PsycINFO and CINAHL Plus. Inclusion criteria encompassed literature reviews that examined the topic of patient-centred care for any adult patients in end-of-life care. RESULTS A total of 92 literature reviews were identified. Findings suggest that there is often a discrepancy between patient preferences and the provision of care. These discrepancies have been associated with a range of barriers at the patient, staff and system levels. Common interventions included education and training for staff which were often met with improved patient outcomes. Patient-centred models of care were underrepresented across the literature. CONCLUSIONS This review highlighted a need for healthcare systems to support staff in providing a patient-centred end of life experience through the development of a co-designed patient-centred model of care, supplemented by professional development and a systematic approach to identifying and documenting patient preferences.
Collapse
Affiliation(s)
- Kostas Hatzikiriakidis
- Health and Social Care Unit, School of Public Health and Preventive Medicine, Monash University, Clayton VIC, Australia
| | - Darshini Ayton
- Health and Social Care Unit, School of Public Health and Preventive Medicine, Monash University, Clayton VIC, Australia
| | - Helen Skouteris
- Health and Social Care Unit, School of Public Health and Preventive Medicine, Monash University, Clayton VIC, Australia
- Warwick Business School, University of Warwick, Coventry, West Midlands, United Kingdom
| | - Luke Patitsas
- Health and Social Care Unit, School of Public Health and Preventive Medicine, Monash University, Clayton VIC, Australia
| | | | | | - Peter Poon
- Monash Health, Clayton, VIC, Australia
- School of Clinical Sciences at Monash Health, Monash University, Clayton, VIC, Australia
| |
Collapse
|
7
|
Timmins L, Pitman A, King M, Gao W, Johnson K, Yu P, Braybrook D, Roach A, Marshall S, Day E, Rose R, Clift P, Almack K, Yi DH, Bristowe K, Harding R. Does the impact of bereavement vary between same and different gender partnerships? A representative national, cross-sectional study. Psychol Med 2023; 53:3849-3857. [PMID: 35620818 PMCID: PMC10317796 DOI: 10.1017/s0033291722000496] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Revised: 01/05/2022] [Accepted: 02/10/2022] [Indexed: 11/05/2022]
Abstract
BACKGROUND Data suggest poorer bereavement outcomes for lesbian, gay and bisexual people, but this has not been estimated in population-based research. This study compared bereavement outcomes for partners of same-gender and different-gender decedents. METHODS In this population-based, cross-sectional survey of people bereaved of a civil partner or spouse 6-10 months previously, we used adjusted logistic and linear regression to investigate outcomes of interest: (1) positive screen on Inventory of Complicated Grief (ICG), (2) positive screen on General Health Questionnaire (GHQ), (3) grief intensity (ICG) and (4) psychiatric symptoms (GHQ-12). RESULTS Among 233 same-gender partners and 329 of different-gender partners, 66.1% [95% confidence interval (CI) 60.0-72.2] and 59.2% [95% CI (53.9-64.6)] respectively screened positive for complicated grief on the ICG, whilst 76.0% [95% CI (70.5-81.5)] and 69.3% [95% CI (64.3-74.3)] respectively screened positive on the GHQ-12. Same-gender bereaved partners were not significantly more likely to screen positive for complicated grief than different-gender partners [adjusted odds ratio (aOR) 1.56, 95% CI (0.98-2.47)], p = 0.059, but same-gender bereaved partners were significantly more likely to screen for psychiatric caseness [aOR 1.67 (1.02, 2.71) p = 0.043]. We similarly found no significant association of partner gender with grief intensity [B = 1.86, 95% CI (-0.91to 4.63), p = 0.188], but significantly greater psychological distress for same-gender partners [B = 1.54, 95% CI (-0.69-2.40), p < 0.001]. CONCLUSIONS Same-gender bereaved partners report significantly more psychological distress. In view of their poorer sub-clinical mental health, clinical and bereavement services should refine screening processes to identify those at risk of poor mental health outcomes.
Collapse
Affiliation(s)
- Liadh Timmins
- Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, Cicely Saunders Institute, King's College London, London, UK
- Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Alexandra Pitman
- Division of Psychiatry, University College London, London, UK
- Camden and Islington NHS Foundation Trust, London, UK
| | - Michael King
- Division of Psychiatry, University College London, London, UK
| | - Wei Gao
- Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, Cicely Saunders Institute, King's College London, London, UK
| | - Katherine Johnson
- Social and Global Studies Centre, Royal Melbourne Institute of Technology, Melbourne, Australia
| | - Peihan Yu
- Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, Cicely Saunders Institute, King's College London, London, UK
| | - Debbie Braybrook
- Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, Cicely Saunders Institute, King's College London, London, UK
| | - Anna Roach
- Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, Cicely Saunders Institute, King's College London, London, UK
| | - Steve Marshall
- Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, Cicely Saunders Institute, King's College London, London, UK
- King's College Hospital, London, UK
| | | | - Ruth Rose
- Patient & Public Involvement, Peacehaven, UK
| | - Paul Clift
- Patient & Public Involvement, London, UK
| | - Kathryn Almack
- School of Health and Social Work, University of Hertfordshire, Hertfordshire, UK
| | - Deok Hee Yi
- Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, Cicely Saunders Institute, King's College London, London, UK
| | - Katherine Bristowe
- Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, Cicely Saunders Institute, King's College London, London, UK
| | - Richard Harding
- Department of Palliative Care Policy & Rehabilitation, King's College London, Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, Cicely Saunders Institute, Bessemer Road, London, UK
| |
Collapse
|
8
|
Hoyt MA, Darabos K, Llave K. Disparities in health-related quality of life among lesbian, gay, and bisexual cancer survivors. J Psychosoc Oncol 2023; 41:661-672. [PMID: 37183953 DOI: 10.1080/07347332.2023.2210548] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
OBJECTIVE This study compared health-related quality of life (HRQOL) among lesbian, gay, and bisexual (LGB) cancer survivors and their heterosexual counterparts in a US population-based sample of cancer survivors. METHODS The study utilized data from the All of Us research program. LGB survivors (n = 885) were matched for age, gender identity, marital status, income, education, and cancer site with heterosexual survivors (n = 885) using 1:1 propensity matching. Physical, mental, and social HRQOL were assessed with items from the Patient-Reported Outcomes Measurement Information System (PROMIS). RESULTS Relative to heterosexuals, LGB cancer survivors reported lower HRQOL in mental and social domains, but not in physical HRQOL. Older age was associated with higher HRQOL across domains. LGB survivors identifying as Black/African American were more likely to experience lower social HRQOL than White survivors. CONCLUSIONS This study highlights several disparities in HRQOL that exist between LGB and heterosexual cancer survivors.
Collapse
Affiliation(s)
- Michael A Hoyt
- Department of Population Health and Disease Prevention, University of California, Irvine, California, USA
| | - Katie Darabos
- Department of Health Behavior, Society, and Policy, Rutgers School of Public Health, Piscataway, New Jersey, USA
| | - Karen Llave
- Department of Population Health and Disease Prevention, University of California, Irvine, California, USA
| |
Collapse
|
9
|
Jackson SS, Patel S, Parker K. Cancer disparities among sexual and gender minority populations. J Natl Med Assoc 2023; 115:S32-S37. [PMID: 37202001 PMCID: PMC10204147 DOI: 10.1016/j.jnma.2023.02.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Accepted: 02/01/2023] [Indexed: 05/20/2023]
Affiliation(s)
- Sarah S Jackson
- National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Shyam Patel
- Sexual & Gender Minority Research Office, National Institutes of Health, Bethesda, MD, USA
| | - Karen Parker
- Sexual & Gender Minority Research Office, National Institutes of Health, Bethesda, MD, USA.
| |
Collapse
|
10
|
Heyworth B. Meeting the health and social care needs of LGBT+ people. Nurs Stand 2023; 38:27-33. [PMID: 36594237 DOI: 10.7748/ns.2023.e12032] [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] [Accepted: 09/26/2022] [Indexed: 01/04/2023]
Abstract
Rapid sociocultural shifts in understanding and acceptance of variations in sexual orientation and gender identity have occurred in recent decades, and UK health and social care providers have a legal obligation to address inclusion, discrimination and equality in policies and services. Despite this, lesbian, gay, bisexual and transgender + (LGBT+) people continue to report inadequate health outcomes and suboptimal experiences of care. This article considers the health ecology in relation to those who identify as LGBT+ and outlines the concept of intersectionality. The author discusses some of the issues experienced by LGBT+ people in relation to various physical and mental health conditions and services. The article aims to encourage nurses to consider what steps they can take to improve care for this group.
Collapse
Affiliation(s)
- Ben Heyworth
- The Christie NHS Foundation Trust, Manchester, England, freelance consultant in LGBT and smoking cessation and LGBT and cancer, and director, Arts for Health, Milton Keynes, England
| |
Collapse
|
11
|
Braybrook D, Bristowe K, Timmins L, Roach A, Day E, Clift P, Rose R, Marshall S, Johnson K, Sleeman KE, Harding R. Communication about sexual orientation and gender between clinicians, LGBT+ people facing serious illness and their significant others: a qualitative interview study of experiences, preferences and recommendations. BMJ Qual Saf 2023; 32:109-120. [PMID: 36657773 PMCID: PMC9887369 DOI: 10.1136/bmjqs-2022-014792] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2022] [Accepted: 06/08/2022] [Indexed: 02/03/2023]
Abstract
BACKGROUND Healthcare organisations have legal and ethical duties to reduce inequalities in access to healthcare services and related outcomes. However, lesbian, gay, bisexual and/or transgender (LGBT+) people continue to experience and anticipate discrimination in health and social care. Skilled communication is vital for quality person-centred care, but there is inconsistent provision of evidence-based clinician education on health needs and experiences of LGBT+ people to support this. This study aimed to identify key stakeholders' experiences, preferences and best practices for communication regarding sexual orientation, gender identity and gender history in order to reduce inequalities in healthcare. METHODS Semistructured qualitative interviews with LGBT+ patients with serious illness, significant others and clinicians, recruited via UK-wide LGBT+ groups, two hospitals and one hospice in England. We analysed the interview data using reflexive thematic analysis. RESULTS 74 stakeholders participated: 34 LGBT+ patients with serious illness, 13 significant others and 27 multiprofessional clinicians. Participants described key communication strategies to promote inclusive practice across three domains: (1) 'Creating positive first impressions and building rapport' were central to relationship building and enacted through routine use of inclusive language, avoiding potentially negative non-verbal signals and echoing terminology used by patients and caregivers; (2) 'Enhancing care by actively exploring and explaining the relevance of sexual orientation and gender identity', participants described the benefits of clinicians initiating these discussions, pursuing topics guided by the patient's response or expressed preferences for disclosure. Active involvement of significant others was encouraged to demonstrate recognition of the relationship; these individual level actions are underpinned by a foundation of (3) 'visible and consistent LGBT+ inclusiveness in care systems'. Although participants expressed hesitance talking about LGBT+ identities with individuals from some sociocultural and religious backgrounds, there was widespread support for institutions to adopt a standardised, LGBT+ inclusive, visibly supportive approach. CONCLUSIONS Person-centred care can be enhanced by incorporating discussions about sexual orientation and gender identity into routine clinical practice. Inclusive language and sensitive exploration of relationships and identities are core activities. Institutions need to support clinicians through provision of adequate training, resources, inclusive monitoring systems, policies and structures. Ten inclusive communication recommendations are made based on the data.
Collapse
Affiliation(s)
- Debbie Braybrook
- Cicely Saunders Institute of Palliative Care, Policy & Rehabilitation, Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, King's College London, London, UK
| | - Katherine Bristowe
- Cicely Saunders Institute of Palliative Care, Policy & Rehabilitation, Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, King's College London, London, UK
| | - Liadh Timmins
- Columbia Spatial Epidemiology Lab, Columbia University Mailman School of Public Health, New York, New York, USA
| | - Anna Roach
- Cicely Saunders Institute of Palliative Care, Policy & Rehabilitation, Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, King's College London, London, UK
| | | | - Paul Clift
- Patient and Public Involvement member, London, UK
| | - Ruth Rose
- Patient and Public Involvement member, Brighton, UK
| | - Steve Marshall
- Cicely Saunders Institute of Palliative Care, Policy & Rehabilitation, Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, King's College London, London, UK,Palliative Care, Cicely Saunders Institute, King's College Hospital NHS Foundation Trust, London, UK
| | - Katherine Johnson
- School of Global, Urban and Social Studies, RMIT University, Melbourne, Victoria, Australia
| | - Katherine E Sleeman
- Cicely Saunders Institute of Palliative Care, Policy & Rehabilitation, Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, King's College London, London, UK
| | - Richard Harding
- Cicely Saunders Institute of Palliative Care, Policy & Rehabilitation, Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, King's College London, London, UK
| |
Collapse
|
12
|
Bristowe K, Timmins L, Braybrook D, Marshall S, Pitman A, Johnson K, Day E, Clift P, Rose R, Yi D, Yu P, Gao W, Roach A, Almack K, King M, Harding R. LGBT+ partner bereavement and appraisal of the Acceptance-Disclosure Model of LGBT+ bereavement: A qualitative interview study. Palliat Med 2023; 37:221-234. [PMID: 36428276 PMCID: PMC9896255 DOI: 10.1177/02692163221138620] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Support from social networks is vital after the death of a partner. Lesbian, gay, bisexual and/or transgender (LGBT+) people can face disenfranchisement and isolation in bereavement. The Acceptance-Disclosure Model (of LGBT+ bereavement) posits that experiences are shaped by the extent to which individuals feel able to disclose their bereavement to others, and whether that loss is acknowledged appropriately. AIM To explore LGBT+ specific experiences of partner bereavement; determine decision-making processes regarding disclosure of relationships/identities; and appraise the Acceptance-Disclosure Model using primary qualitative data. DESIGN Exploratory in-depth qualitative interview study positioned within a social constructivist paradigm. Data were analysed using inductive and deductive reflexive thematic analysis. SETTING/PARTICIPANTS 21 LGBT+ people from across England bereaved of their civil partner/spouse. RESULTS Participants described LGBT+ specific stressors in bereavement: lack of recognition of their loss; inappropriate questioning; unwanted disclosure of gender history; and fears of discrimination when accessing support. Disclosure of LGBT+ identities varied across social networks. Some participants described hiding their identities and bereavement to preserve relationships, and challenging intersections between LGBT+ identities and other aspects of culture or self. These findings provide primary evidence to support the Acceptance-Disclosure Model. CONCLUSIONS LGBT+ people face additional stressors in bereavement. Not all LGBT+ people want to talk directly about their relationships/identities. Sensitive exploration of support needs, aligned with preferences around disclosure of identities, can help foster trust. Five recommendations for inclusive practice are presented. Further research should consider whether the Acceptance-Disclosure Model has utility to explain bereavement experiences for other isolated or disenfranchised groups.
Collapse
Affiliation(s)
- Katherine Bristowe
- Cicely Saunders Institute of Palliative Care, Policy & Rehabilitation, King’s College London, Bessemer Road, London, UK
| | | | - Debbie Braybrook
- Cicely Saunders Institute of Palliative Care, Policy & Rehabilitation, King’s College London, Bessemer Road, London, UK
| | - Steve Marshall
- Cicely Saunders Institute of Palliative Care, Policy & Rehabilitation, King’s College London, Bessemer Road, London, UK
- King’s College Hospital NHS Foundation Trust, Denmark Hill, London, UK
| | - Alexandra Pitman
- Division of Psychiatry, University College London, London, UK
- Camden and Islington NHS Foundation Trust, St. Pancras Hospital, London, UK
| | - Katherine Johnson
- Social and Global Studies Centre, Royal Melbourne Institute of Technology, Melbourne, VIC, Australia
| | | | - Paul Clift
- Patient and Public Involvement, London, UK
| | - Ruth Rose
- Patient and Public Involvement, London, UK
| | - Deokhee Yi
- Cicely Saunders Institute of Palliative Care, Policy & Rehabilitation, King’s College London, Bessemer Road, London, UK
| | - Peihan Yu
- Cicely Saunders Institute of Palliative Care, Policy & Rehabilitation, King’s College London, Bessemer Road, London, UK
| | - Wei Gao
- Cicely Saunders Institute of Palliative Care, Policy & Rehabilitation, King’s College London, Bessemer Road, London, UK
| | - Anna Roach
- Great Ormond Street Institute of Child Health, Faculty of Population Health Sciences, London, UK
| | - Kathryn Almack
- School of Health and Social Work, University of Hertfordshire, Hatfield, Hertfordshire, UK
| | - Michael King
- Division of Psychiatry, University College London, London, UK
| | - Richard Harding
- Cicely Saunders Institute of Palliative Care, Policy & Rehabilitation, King’s College London, Bessemer Road, London, UK
| |
Collapse
|
13
|
Rosa WE, Roberts KE, Braybrook D, Harding R, Godwin K, Mahoney C, Mathew S, Atkinson TM, Banerjee SC, Haviland K, Hughes TL, Walters CB, Parker PA. Palliative and end-of-life care needs, experiences, and preferences of LGBTQ+ individuals with serious illness: A systematic mixed-methods review. Palliat Med 2022; 37:460-474. [PMID: 36475950 PMCID: PMC10171330 DOI: 10.1177/02692163221124426] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Lesbian, gay, bisexual, transgender, and queer/questioning (LGBTQ+) individuals experience discrimination throughout the care continuum, including during serious illness and at end of life. High-quality palliative care requires that health professionals deliver individualized services that reflect the needs, experiences, and preferences of LGBTQ+ persons. AIM To identify and appraise existing evidence related to the needs, experiences, and preferences for palliative and end of life care among LGBTQ+ individuals with serious illness. DESIGN Data-based convergent synthesis design reported per the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. DATA SOURCES PubMed, Embase, Cochrane CENTRAL, PsycINFO, CINAHL, and Scopus from January 1, 2010 to November 6, 2020. RESULTS Of 4875 results captured, 69 articles underwent full-text review and 13 were retained for analysis. Most studies were from North America with trans individuals represented in 10 of 13 studies. Needs (n = 6) included increased social support, institutional safety, economic and legal supports, and advocacy to mitigate health barriers.Experiences (n = 12) were driven by fear and worry associated with discrimination/stigma,providers' hetero-/cisnormative assumptions, homophobia and transphobia, social isolation, and an undignified death. Preferences (n = 6) pertained to inclusion of chosen families in decision-making, disclosure of LGBTQ+ identity based on safety of the clinical environment, and a desire to maintain autonomy. CONCLUSIONS The robustness of the science has improved regarding the needs, experiences, and preferences of trans individuals. Actionable, inclusive policies coupled with sustained and integrated cultural sensitivity training for health workers are mandatory. Interventional research is critical to enhance tailored palliative care for LGBTQ+ people and their chosen families.
Collapse
Affiliation(s)
- William E Rosa
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Kailey E Roberts
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY, USA.,Ferkauf Graduate School of Psychology, Yeshiva University, New York, NY, USA
| | - Debbie Braybrook
- Florence Nightingale Faculty of Nursing Midwifery and Palliative Care, Cicely Saunders Institute, King's College London, London, England, UK
| | - Richard Harding
- Florence Nightingale Faculty of Nursing Midwifery and Palliative Care, Cicely Saunders Institute, King's College London, London, England, UK
| | - Kendra Godwin
- Medical Library, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Cassidy Mahoney
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Shiyon Mathew
- Lienhard School of Nursing, College of Health Professions, Pace University, New York, NY, USA
| | - Thomas M Atkinson
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Smita C Banerjee
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Kelly Haviland
- Advanced Practice Provider Division, Professional Development, Quality and Safety, Memorial Sloan Kettering Cancer Center, New York, NY, USA.,Supportive Care Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Tonda L Hughes
- Center for Sexual and Gender Minority Health Research, Columbia University School of Nursing, New York, NY, USA
| | - Chasity B Walters
- Patient Education & Engagement, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Patricia A Parker
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| |
Collapse
|
14
|
Abstract
Objective: Traditional gender norms and expectations may
disproportionately constrain in-home palliative care received by women. This
scoping review aims to canvass and evaluate the literature on gender disparities
in end of life care and explore relevant themes that could inform future
research and practice. Methods: A systematic search of MEDLINE,
OVID, COCHRANE, and EMBASE was conducted using MeSH terms palliative care,
palliative medicine, terminal care, or hospice care, combined with gender
equity, sex factors, sexism, or gender disparities. Articles were limited to
those in English (2010 to 2021), focusing on end of life care, gender roles,
patients, and caregivers. Results: Of 624 articles identified, 15
met inclusion criteria for critical appraisal using the AMSTAR checklist for
systematic reviews and NICE guidelines for quantitative and qualitative studies.
Most studies were of poor to moderate quality. Thematic analyses identified 6
major themes related to gender disparities: living situation, symptom
experience, care context, care preferences, caregiving, and coping strategies.
Conclusion: Larger scale research of better quality is needed
to fully characterize gender disparities in end of life care and understand how
physicians might mitigate these disparities by building awareness of personal
gender biases, providing support to families, educating them, and initiating
care discussions that overturn traditional and stereotypic gendered
expectations.
Collapse
Affiliation(s)
- Annette D Wong
- Department of Family Medicine, 4257Queen's University, Kingston, Ontario, Canada
| | - Susan P Phillips
- Department of Family Medicine, 4257Queen's University, Kingston, Ontario, Canada
| |
Collapse
|
15
|
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.
Collapse
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
| |
Collapse
|
16
|
Hadler RA, Goldshore M, Rosa WE, Nelson J. "What do I need to know about you?": the Patient Dignity Question, age, and proximity to death among patients with cancer. Support Care Cancer 2022; 30:5175-5186. [PMID: 35246729 PMCID: PMC8896848 DOI: 10.1007/s00520-022-06938-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Accepted: 02/24/2022] [Indexed: 12/24/2022]
Abstract
PURPOSE The Patient Dignity Question (PDQ), "What do I need to know about you as a person to give you the best care possible?" is a validated instrument designed to assess patient priorities and stressors. Administration of the PDQ has been demonstrated to improve patient-provider relationships. The PDQ has been evaluated in multiple settings, but never as a standard component of palliative care consultation. The primary objectives of this study were to determine the feasibility of PDQ screening in palliative care consultation and to characterize responses. The secondary objective was to determine patient and disease factors associated with PDQ response among patients diagnosed with cancer. METHODS PDQ responses were collected from 2015 to 2017, and patient survival data collected through 2018. A codebook was developed to categorize responses using literature review and template analysis; coding was performed until thematic saturation was achieved. We descriptively analyzed thematic distribution among responders and performed multivariable multinomial regression to determine the association between patient characteristics and PDQ response. RESULTS Response to the PDQ was documented in 2053/5002 consultations (41.1%); 1877 patient responses were included in final analysis. A total of 544 (29.5%) patients referenced illness-related concerns, 879 (46.8%) shared personal insights, and 283 (15.1%) cited interpersonal relationships. Younger patients frequently reported illness-related concerns; older respondents (age > 65) often responded with insights into their identity. Patients' responses evaluated less than 1 year before death were more likely to focus upon identity and interpersonal relationships than illness-related concerns. CONCLUSION The PDQ can be used as a means of eliciting values among patients with cancer. Variations in response pattern suggest that approaches to distress may be tailored to age and proximity to death.
Collapse
Affiliation(s)
- R. A. Hadler
- Department of Anesthesia, University of Iowa Carver College of Medicine, 200 Hawkins Dr, Iowa City, IA 52242 USA
| | - M. Goldshore
- Department of Surgery, University of Pennsylvania Health System, 3400 Spruce Street, Philadelphia, PA 19104 USA
| | - W. E. Rosa
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, 641 Lexington Avenue, 7th Fl, New York, NY 10022 USA
| | - J. Nelson
- Division of Supportive Care, Department of Medicine, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065 USA
| |
Collapse
|
17
|
Rosa WE, Banerjee SC, Maingi S. Family caregiver inclusion is not a level playing field: toward equity for the chosen families of sexual and gender minority patients. Palliat Care Soc Pract 2022; 16:26323524221092459. [PMID: 35462621 PMCID: PMC9021511 DOI: 10.1177/26323524221092459] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Affiliation(s)
- William E. Rosa
- Assistant Attending Behavioral Scientist, Department of Psychiatry & Behavioral Sciences, Memorial Sloan Kettering Cancer Center, 641 Lexington Avenue, 7th fl., New York, NY 10022, USA
| | - Smita C. Banerjee
- Department of Psychiatry & Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Shail Maingi
- Dana-Farber, South Shore Hospital, South Weymouth, MA, USA
| |
Collapse
|
18
|
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.
Collapse
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
| |
Collapse
|
19
|
Valenti KG, Janssen LM, Enguidanos S, de Medeiros K. "By the time she got sick it was just kind of too late": A qualitative study on advanced care planning among bereaved lesbian, gay, and bisexual older women. Palliat Med 2022; 36:375-385. [PMID: 34933628 DOI: 10.1177/02692163211065279] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Lesbian, gay, and bisexual (LGB) older women have unmet communication needs around palliative and end-of-life care. Past research has found communication differences for LGB women patients. Consequently, older LGB women may experience healthcare communication barriers around advance care planning. AIM To explore experiences of bereaved LGB older women to understand perspectives regarding advance care planning communication between clinicians, patients, and dyads. DESIGN Guided by queer gerontology as a theoretical framework, this qualitative descriptive study employed individual interviews with purposively recruited participants. Interviews were conducted in person using a semi structured protocol and analyzed using inductive thematic analysis. SETTING/PARTICIPANTS Sixteen LGB women, age 60 years or older from across the United States who had lost a spouse/partner within the past 5 years. RESULTS Four main themes emerged from the transcripts, LGB older women: (1) experience unclear advance care planning communication and end-of-life care support from clinicians, (2) often avoid advance care planning discussions with spouse or partners, (3) lack of knowledge about palliative or end-of-life care, and (4) have more positive experiences when there is consistent communication with spouse or partner and clinicians during a spouse/partner's illness and end-of-life. DISCUSSION While certain experiences and opinions may reflect those of non-LGB older adults, novel advance care planning barriers exist for LGB older women. Greater understanding among clinicians is needed regarding advance care planning conversations with LGB dyads. We recommend four improvements in training, recognition, acceptance, and dyad-based communication interventions.
Collapse
Affiliation(s)
- Korijna G Valenti
- General Internal Medicine, University of Colorado Anschutz School of Medicine, Aurora, CO, USA
| | - Leah M Janssen
- Department of Sociology and Gerontology, Miami University, Oxford, OH, USA
| | - Susan Enguidanos
- Leonard Davis School of Gerontology, University of Southern California, Los Angeles, CA, USA
| | - Kate de Medeiros
- Department of Sociology and Gerontology, Miami University, Oxford, OH, USA
| |
Collapse
|
20
|
Wakefield D, Kane CE, Chidiac C, Braybrook D, Harding R. Why does palliative care need to consider access and care for LGBTQ people? Palliat Med 2021; 35:1730-1732. [PMID: 34696649 DOI: 10.1177/02692163211055011] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Donna Wakefield
- North Tees and Hartlepool NHS Foundation Trust, University Hospital of North Tees, Stockton-On-Tees, UK
| | | | - Claude Chidiac
- Homerton University Hospital NHS Foundation Trust, London, UK
| | - Debbie Braybrook
- Cicely Saunders Institute of Palliative Care and Rehabilitation, Kings College London, London, UK
| | - Richard Harding
- Cicely Saunders Institute of Palliative Care and Rehabilitation, Kings College London, London, UK
| |
Collapse
|
21
|
Chidiac C, Grayson K, Almack K. Development and evaluation of an LGBT+ education programme for palliative care interdisciplinary teams. Palliat Care Soc Pract 2021; 15:26323524211051388. [PMID: 34708209 PMCID: PMC8543653 DOI: 10.1177/26323524211051388] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Accepted: 09/17/2021] [Indexed: 11/16/2022] Open
Abstract
Background: Despite national policy recommendations to enhance healthcare access for LGBT+ (lesbian, gay, bisexual, transgender, and those who do not identify as cisgender heterosexual) people, education on LGBT+ issues and needs is still lacking in health and social care curricula. Most of the available resources are focused on primary care, mental health, and sexual health, with little consideration to broader LGBT+ health issues and needs. The limited available educational programmes pertaining to LGBT+ individuals outside the context of sexual or mental health have mainly focused on cancer care or older adults. Aim: To support palliative care interdisciplinary teams to provide LGBT+ affirmative care for people receiving and needing palliative and end-of-life care. Methods: A 1½-h workshop was developed and evaluated using Kotter’s eight-step process for leading change. Across four hospices, 145 health and social professionals participated in the training. A quasi-experimental non-equivalent groups pre–post-test design was used to measure self-reported levels of knowledge, confidence, and comfort with issues, and needs and terminology related to LGBT+ and palliative care. Results: There was a significant increase in the reported levels of knowledge, confidence, and comfort with issues, needs, and terminology related to LGBT+ and palliative care after attending the training. Most participants reported that they would be interested in further training, that the training is useful for their practice, and that they would recommend it to colleagues. Conclusion: The project illustrates the importance of such programmes and recommends that such educational work is situated alongside wider cultural change to embed LGBT+-inclusive approaches within palliative and end-of-life care services.
Collapse
Affiliation(s)
- Claude Chidiac
- Department of Palliative Care, Homerton University Hospital NHS Foundation Trust, London E9 6SR, UK
| | | | - Kathryn Almack
- School of Health and Social Work, University of Hertfordshire, Hatfield, UK
| |
Collapse
|
22
|
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.
Collapse
Affiliation(s)
- Noelle Marie Javier
- Icahn School of Medicine at Mount Sinai, One Levy Place, 1070, New York, NY 10029, USA
| |
Collapse
|
23
|
Oluyase AO, Higginson IJ, Yi D, Gao W, Evans CJ, Grande G, Todd C, Costantini M, Murtagh FEM, Bajwah S. Hospital-based specialist palliative care compared with usual care for adults with advanced illness and their caregivers: a systematic review. HEALTH SERVICES AND DELIVERY RESEARCH 2021. [DOI: 10.3310/hsdr09120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background
Most deaths still take place in hospital; cost-effective commissioning of end-of-life resources is a priority. This review provides clarity on the effectiveness of hospital-based specialist palliative care.
Objectives
The objectives were to assess the effectiveness and cost-effectiveness of hospital-based specialist palliative care.
Population
Adult patients with advanced illnesses and their unpaid caregivers.
Intervention
Hospital-based specialist palliative care.
Comparators
Inpatient or outpatient hospital care without specialist palliative care input at the point of entry to the study, or community care or hospice care provided outside the hospital setting (usual care).
Primary outcomes
Patient health-related quality of life and symptom burden.
Data sources
Six databases (The Cochrane Library, MEDLINE, EMBASE, Cumulative Index to Nursing and Allied Health Literature, PsycINFO and CareSearch), clinical trial registers, reference lists and systematic reviews were searched to August 2019.
Review methods
Two independent reviewers screened, data extracted and assessed methodological quality. Meta-analysis was carried out using RevMan (The Cochrane Collaboration, The Nordic Cochrane Centre, Copenhagen, Denmark), with separate synthesis of qualitative data.
Results
Forty-two randomised controlled trials involving 7779 participants (6678 patients and 1101 unpaid caregivers) were included. Diagnoses of participants were as follows: cancer, 21 studies; non-cancer, 14 studies; and mixed cancer and non-cancer, seven studies. Hospital-based specialist palliative care was offered in the following models: ward based (one study), inpatient consult (10 studies), outpatient (six studies), hospital at home or hospital outreach (five studies) and multiple settings that included hospital (20 studies). Meta-analyses demonstrated significant improvement favouring hospital-based specialist palliative care over usual care in patient health-related quality of life (10 studies, standardised mean difference 0.26, 95% confidence interval 0.15 to 0.37; I
2 = 3%) and patient satisfaction with care (two studies, standardised mean difference 0.36, 95% confidence interval 0.14 to 0.57; I
2 = 0%), a significant reduction in patient symptom burden (six studies, standardised mean difference –0.26, 95% confidence interval –0.41 to –0.12; I
2 = 0%) and patient depression (eight studies, standardised mean difference –0.22, 95% confidence interval –0.34 to –0.10; I
2 = 0%), and a significant increase in the chances of patients dying in their preferred place (measured by number of patients with home death) (seven studies, odds ratio 1.63, 95% confidence interval 1.23 to 2.16; I
2 = 0%). There were non-significant improvements in pain (four studies, standardised mean difference –0.16, 95% confidence interval –0.33 to 0.01; I
2 = 0%) and patient anxiety (five studies, mean difference –0.63, 95% confidence interval –2.22 to 0.96; I
2 = 76%). Hospital-based specialist palliative care showed no evidence of causing serious harm. The evidence on mortality/survival and cost-effectiveness was inconclusive. Qualitative studies (10 studies, 322 participants) suggested that hospital-based specialist palliative care was beneficial as it ensured personalised and holistic care for patients and their families, while also fostering open communication, shared decision-making and respectful and compassionate care.
Limitation
In almost half of the included randomised controlled trials, there was palliative care involvement in the control group.
Conclusions
Hospital-based specialist palliative care may offer benefits for person-centred outcomes including health-related quality of life, symptom burden, patient depression and satisfaction with care, while also increasing the chances of patients dying in their preferred place (measured by home death) with little evidence of harm.
Future work
More studies are needed of populations with non-malignant diseases, different models of hospital-based specialist palliative care, and cost-effectiveness.
Study registration
This study is registered as PROSPERO CRD42017083205.
Funding
This project was funded by the National Institute for Health Research (NIHR) Health Services and Delivery Research programme and will be published in full in Health Services and Delivery Research; Vol. 9, No. 12. See the NIHR Journals Library website for further project information.
Collapse
Affiliation(s)
- Adejoke O Oluyase
- Cicely Saunders Institute of Palliative Care, Policy & Rehabilitation, King’s College London, London, UK
| | - Irene J Higginson
- Cicely Saunders Institute of Palliative Care, Policy & Rehabilitation, King’s College London, London, UK
| | - Deokhee Yi
- Cicely Saunders Institute of Palliative Care, Policy & Rehabilitation, King’s College London, London, UK
| | - Wei Gao
- Cicely Saunders Institute of Palliative Care, Policy & Rehabilitation, King’s College London, London, UK
| | - Catherine J Evans
- Cicely Saunders Institute of Palliative Care, Policy & Rehabilitation, King’s College London, London, UK
| | - Gunn Grande
- School of Health Sciences, University of Manchester, Manchester, UK
- Manchester Academic Health Science Centre, Manchester, UK
| | - Chris Todd
- School of Health Sciences, University of Manchester, Manchester, UK
- Manchester Academic Health Science Centre, Manchester, UK
- Manchester University NHS Foundation Trust, Manchester, UK
| | - Massimo Costantini
- Palliative Care Unit, Azienda Unità Sanitaria Locale – Istituto di Ricovero e Cura a Carattere Scientifico (USL-IRCCS), Reggio Emilia, Italy
| | - Fliss EM Murtagh
- Cicely Saunders Institute of Palliative Care, Policy & Rehabilitation, King’s College London, London, UK
- Wolfson Palliative Care Research Centre, Hull York Medical School, University of Hull, Hull, UK
| | - Sabrina Bajwah
- Cicely Saunders Institute of Palliative Care, Policy & Rehabilitation, King’s College London, London, UK
| |
Collapse
|
24
|
Webb WA, Mitchell T, Snelling P, Nyatanga B. Life's hard and then you die: the end-of-life priorities of people experiencing homelessness in the UK. Int J Palliat Nurs 2021; 26:120-132. [PMID: 32275478 DOI: 10.12968/ijpn.2020.26.3.120] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
BACKGROUND People experiencing homelessness often die young and without adequate support. In the UK, they fail to access palliative care services and their end-of-life priorities remain poorly understood. AIMS To explore the end-of-life concerns, fears, preferences and priorities of a sample of people experiencing homelessness in the UK. METHODS This is an interpretive phenomenology. Data collected through semi-structured, audio-recorded, face-to-face interviews with 21 homeless participants in the UK were analysed iteratively using thematic analysis. Findings have been interpreted through the lens of Merleau-Ponty's philosophy. RESULTS Eight themes are reported: spiritual concerns; practical concerns; fear of needing care; fear of being forgotten; preference for dying suddenly; preference for being somewhere comfortable where people know me; prioritising autonomy and self-determination; and prioritising authenticity. CONCLUSION A strengths-based, trauma-informed, person-centred, collaborative 'compassionate community' approach to care is recommended for people experiencing homelessness at end of life.
Collapse
Affiliation(s)
- Wendy Ann Webb
- Advanced Clinical Practitioner, University of Worcester, UK
| | | | - Paul Snelling
- Principal Lecturer in Adult Nursing, University of Worcester, UK
| | | |
Collapse
|
25
|
Maingi S, Radix A, Candrian C, Stein GL, Berkman C, O'Mahony S. Improving the Hospice and Palliative Care Experiences of LGBTQ Patients and Their Caregivers. Prim Care 2021; 48:339-349. [PMID: 33985709 DOI: 10.1016/j.pop.2021.02.012] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Primary care providers often express a desire to be more involved with their patients as they transition to hospice care. Given that these providers have a central role in the care of their patients, they have the potential to significantly improve the experiences of lesbian, gay, bisexual, transgender, and queer patients who face serious illnesses. This article discusses the barriers to quality hospice and palliative care experienced by many sexual and gender minorities, as well as specific ways in which primary care physicians can promote equitable end-of-life care.
Collapse
Affiliation(s)
- Shail Maingi
- Department of Medical Oncology, St Peter's Health Partners Cancer Care, 315 South Manning Boulevard, Albany, NY 12208, USA.
| | - Asa Radix
- Callen-Lorde Community Health Center, NYU School of Medicine, 356 West 18th Street, New York, NY 10011, USA
| | - Carey Candrian
- University of Colorado School of Medicine, 12631 East 17th Avenue, Aurora, CO 80045, USA. https://twitter.com/CandrianCarey
| | - Gary L Stein
- Wurzweiler School of Social Work, Yeshiva University, 2495 Amsterdam Avenue, New York, NY 10033, USA
| | - Cathy Berkman
- Graduate School of Social Service, Fordham University, 113 West 60 Street, New York, NY 10023, USA
| | - Sean O'Mahony
- Section of Palliative Medicine, Department of Internal Medicine, Rush Medical College, 1725 West Harrison Street, Suite 955, Chicago, IL 60612, USA
| |
Collapse
|
26
|
Haviland K, Walters CB, Newman S. Barriers to palliative care in sexual and gender minority patients with cancer: A scoping review of the literature. HEALTH & SOCIAL CARE IN THE COMMUNITY 2021; 29:305-318. [PMID: 32767722 PMCID: PMC7867658 DOI: 10.1111/hsc.13126] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/23/2020] [Revised: 04/30/2020] [Accepted: 07/14/2020] [Indexed: 06/02/2023]
Abstract
The Institute of Medicine reports lesbian, gay, bisexual and transgender (LGBT) individuals having the highest rates of tobacco, alcohol and drug use leading to elevated cancer risks. Due to fear of discrimination and lack of healthcare practitioner education, LGBT patients may be more likely to present with advanced stages of cancer resulting in suboptimal palliative care. The purpose of this scoping review is to explore what is known from the existing literature about the barriers to providing culturally competent cancer-related palliative care to LGBT patients. This review will use the five-stage framework for conducting a scoping review developed by Arksey and O'Malley. The PubMed, Scopus, PsychINFO and Cochrane electronic databases were searched resulting in 1,442 citations. Eligibility criteria consisted of all peer-reviewed journal articles in the English language between 2007 and 2020 resulting in 10 manuscripts. Barriers to palliative cancer care for the LGBT include discrimination, criminalisation, persecution, fear, distress, social isolation, disenfranchised grief, bereavement, tacit acknowledgment, homophobia and mistrust of healthcare providers. Limited healthcare-specific knowledge by both providers and patients, poor preparation of legal aspects of advanced care planning and end-of-life care were underprovided to LGBT persons. As a result of these barriers, palliative care is likely to be provided for LGBT patients with cancer in a deficient manner, perpetuating marginalisation and healthcare inequities. Minimal research investigates these barriers and healthcare curriculums do not provide practitioners skills for administering culturally sensitive palliative care to LGBT patients.
Collapse
Affiliation(s)
- Kelly Haviland
- Supportive Care Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | | | - Susan Newman
- College of Nursing, Medical University of South Carolina, Charleston, SC, USA
| |
Collapse
|
27
|
Smith R, Wright T. Older lesbian, gay, bisexual, transgender, queer and intersex peoples' experiences and perceptions of receiving home care services in the community: A systematic review. Int J Nurs Stud 2021; 118:103907. [PMID: 33770516 DOI: 10.1016/j.ijnurstu.2021.103907] [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] [Received: 04/30/2020] [Revised: 09/29/2020] [Accepted: 02/17/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Numbers of older lesbian, gay, bisexual, transgender, queer and intersex (LGBTQI+) people are increasing worldwide in line with the ageing populations of many countries. Most LGBTQI+ people want to remain in their own homes as they age, making it important to understand their experiences and perceptions of receiving home care. This systematic review aimed to examine older (over 60 years) LGBTQI+ people's perceptions and experiences of using formal home care services in the community. METHODS The following six electronic databases were searched from the date of their first records until the first week of March 2020: MEDLINE; PsycINFO; Social Policy and Practice; CINAHL; SSCI; and ASSIA. Hand searches of the reference lists of the included studies and relevant reviews were also conducted. Only peer reviewed research published in English was included. There were no restrictions on study design. Findings were analysed using narrative synthesis. The PROSPERO protocol registration identification number is: CRD42020168443. RESULTS Seven studies involving 169 participants were included in the synthesis. All were qualitative. Most participants were either lesbian women or gay men, with no studies investigating home care for transgender, queer, intersex or other sexual minorities. Fear of accessing home care services due to the perceived threat of homophobia and past negative experiences of discrimination were common. Some concealed any LGBTQI+ materials in their homes to try and hide their sexuality from home care workers. Despite fear of discrimination, lesbian women and gay men reported wanting and expecting the same level of care, dignity and respect as their heterosexual counterparts. Mandatory LGBTQI+ sensitivity training for home care workers was identified for reducing homophobia and increasing the inclusivity of service providers. CONCLUSION Older lesbian women and gay men fear or experience discrimination from home care workers, with some choosing to hide their sexuality causing stress and anxiety. Sensitivity training in the needs of older LGBTQI+ people should be considered by home care service providers as a way of reducing homophobic attitudes which may exist among some home care workers. Due to the paucity of studies and their focus on older lesbian women and gay men, more research is needed to explore the experiences of other sexual minorities receiving home care services who are represented by the LGBTQI+ umbrella term.
Collapse
Affiliation(s)
- Raymond Smith
- Faculty of Medicine, Health and Social Care, Canterbury Christ Church University, North Holmes Road, Canterbury, Kent CT1 1QU, United Kingdom.
| | - Toni Wright
- Faculty of Medicine, Health and Social Care, Canterbury Christ Church University, North Holmes Road, Canterbury, Kent CT1 1QU, United Kingdom
| |
Collapse
|
28
|
The Politics of LGBT+ Health Inequality: Conclusions from a UK Scoping Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18020826. [PMID: 33478019 PMCID: PMC7835774 DOI: 10.3390/ijerph18020826] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Revised: 12/11/2020] [Accepted: 12/16/2020] [Indexed: 11/16/2022]
Abstract
This scoping review of UK evidence aimed to describe what is known about Lesbian, Gay, Bisexual, and Trans (LGBT+) health inequalities in relation to cancer, mental health, and palliative care to inform research, policy and public health interventions. Using a scoping review methodology, we identified studies from database searches, citation tracking, and expert consultation. The in/exclusion criteria was based on the PICOS framework. The data were charted and then summarised to map the theoretical approaches and the main types of evidence and identify knowledge gaps. In total, 279 articles were screened and 83 were included in the final review. We found that there is limited UK research examining LGBT+ health inequality in cancer, mental health and palliative care. We would argue that this thin evidence base is partly due to national policy discussions of LGBT+ health inequality that are framed within a depoliticised ‘it’s getting better’ narrative, and an unwillingness to adequately acknowledge the unjust social and economic relations that produce LGBT+ health inequality. In addition, LGBT+ health inequality is depoliticised by existing public health explanatory theories, models and frameworks that exclude sexual orientation and gender diversity as dimensions of power that interlock with those of socio-economic, race and ethnicity. This is a barrier to developing public health interventions that can successfully tackle LGBT+ health inequality
Collapse
|
29
|
Dickson L, Bunting S, Nanna A, Taylor M, Hein L, Spencer M. Appointment of a Healthcare Power of Attorney Among Older Lesbian, Gay, Bisexual, Transgender, and Queer (LGBTQ) Adults in the Southern United States. Am J Hosp Palliat Care 2020; 38:1291-1298. [PMID: 33291959 DOI: 10.1177/1049909120979787] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND The Lesbian, Gay, Bisexual, Transgender, and Queer (LGBTQ) older adult population may have a heightened need of medical and supportive care while aging. This makes appointment of a healthcare power of attorney (HCPoA) an essential component of end-of-life care to ensure patients' wishes are honored at the end of their lives. The objective of this study was to evaluate the prevalence and preferences for HCPoA appointment among older LGBTQ adults living in the Southern United States. METHODS An online survey was distributed to older LGBTQ adults living in the Southern US regarding appointment of a HCPoA between January-March 2018. PARTICIPANTS The survey was completed by 789 older LGBTQ adults from North Carolina, South Carolina, Georgia, Alabama, Mississippi, Louisiana, and Florida in January-March 2018. RESULTS Overall, 61.6% of respondents had appointed a HCPoA. Respondents with an appointed HCPoA were more likely to be married (aOR = 5.04, p < .001), have larger social networks (aOR = 3.87, p < .001) and be older (aOR = 1.07, p < .001). Gender diverse respondents were less likely to have an appointed HCPoA relative to cisgender respondents (aOR = 0.39, p = .04). Overall, the majority of respondents indicated a spouse or significant other served as their HCPoA (n = 311, 64.5%). CONCLUSIONS Nearly 40% of older LGBTQ adults in the Southern US did not have an appointed HCPoA. Specifically, those who were more socially isolated, single, or who identified as transgender or gender non-binary were less likely to have an appointed HCPoA. These people may benefit from targeted outreach regarding advance care planning.
Collapse
Affiliation(s)
- Lexus Dickson
- School of Medicine, 12322University of South Carolina, Columbia, SC, USA
| | - Samuel Bunting
- Chicago Medical School, 97174Rosalind Franklin University, North Chicago, IL, USA
| | - Alexis Nanna
- College of Arts and Sciences, 2629University of South Carolina, Columbia, SC, USA
| | - Megan Taylor
- College of Arts and Sciences, 2629University of South Carolina, Columbia, SC, USA
| | - Liam Hein
- College of Nursing, 2629University of South Carolina, Columbia, SC, USA
| | - Mindi Spencer
- 49112Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
| |
Collapse
|
30
|
Acknowledging cancer as a family disease: A systematic review of family care in the cancer setting. Eur J Oncol Nurs 2020; 49:101841. [DOI: 10.1016/j.ejon.2020.101841] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Revised: 09/16/2020] [Accepted: 09/25/2020] [Indexed: 02/06/2023]
|
31
|
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
| |
Collapse
|
32
|
Kent EE, Wheldon CW, Smith AW, Srinivasan S, Geiger AM. Care delivery, patient experiences, and health outcomes among sexual and gender minority patients with cancer and survivors: A scoping review. Cancer 2019; 125:4371-4379. [PMID: 31593319 DOI: 10.1002/cncr.32388] [Citation(s) in RCA: 42] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Revised: 05/22/2019] [Accepted: 05/23/2019] [Indexed: 11/07/2022]
Abstract
Sexual and gender minorities (SGMs) face a disproportionate burden of cancer, yet little is known about the experiences and specific needs of these underserved populations in cancer care delivery. The authors conducted a scoping review to characterize the literature on cancer care delivery, health outcomes, and health care experiences for patients with cancer and survivors identifying as SGM. In total, 1176 peer-reviewed citations were identified after a systematic search of the PubMed/Medline, PsycInfo, Cumulative Index of Nursing and Allied Health Literature (CINAHL), and Web of Sciences databases without restriction on publication date. The details captured included study aims, design, population, cancer site, and main findings. Thirty-seven studies published from 1998 to 2017 met the study criteria. Most studies were conducted in the post-treatment survivorship phase of the continuum (n = 30), and breast cancer was the most common cancer site (n = 20). There were only 2 intervention studies. The studies reviewed were classified under the following areas of focus: 1) disclosure of sexual orientation and gender identity, 2) quality of care, 3) psychosocial impact of/ adjustment to cancer, 4) social support, 5) sexual functioning, and 6) health risks/health behavior. Very little research reported an assessment of gender minority status or included a focus on gender minorities (n = 7). This review revealed substantial research gaps given a lack of population-based data and small sample sizes, likely related to the absence of systematic collection of sexual orientation and gender identity information in the cancer care context. Deficient research in this area likely perpetuates health disparities. Further research is needed to identify and remove the barriers to delivering high-quality care to SGM individuals with cancer.
Collapse
Affiliation(s)
- Erin E Kent
- Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, Maryland
- ICF, Inc, Fairfax, Virginia
| | - Christopher W Wheldon
- Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, Maryland
| | - Ashley Wilder Smith
- Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, Maryland
| | - Shobha Srinivasan
- Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, Maryland
| | - Ann M Geiger
- Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, Maryland
| |
Collapse
|
33
|
A Systematic Review of Sexual Minority Women's Experiences of Health Care in the UK. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16173032. [PMID: 31438599 PMCID: PMC6747244 DOI: 10.3390/ijerph16173032] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/23/2019] [Revised: 08/15/2019] [Accepted: 08/17/2019] [Indexed: 11/24/2022]
Abstract
Sexual minority women (SMW) experience worse health and disproportionate behavioural risks to health than heterosexual women. This mixed-methods systematic review evaluated recent studies on health experiences of UK SMW, published 2010–2018. Analysis was through narrative thematic description and synthesis. Identified were 23,103 citations, 26 studies included, of which 22 provided qualitative and nine quantitative results. SMW had worse health experiences that might impact negatively on access, service uptake and health outcomes. Findings highlighted significant barriers facing SMW, including heteronormative assumptions, perceptions and experiences of negative responses to coming out, ignorance and prejudice from healthcare professionals, and barriers to raising concerns or complaints. Little information was available about bisexual and trans women’s issues. Findings highlighted the need for explicit and consistent education for healthcare professionals on SMW issues, and stronger application of non-discrimination policies in clinical settings.
Collapse
|
34
|
Hunt J, Bristowe K, Chidyamatare S, Harding R. 'So isolation comes in, discrimination and you find many people dying quietly without any family support': Accessing palliative care for key populations - an in-depth qualitative study. Palliat Med 2019; 33:685-692. [PMID: 30859906 PMCID: PMC6535799 DOI: 10.1177/0269216319835398] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Ensuring palliative care for all under a new global health policy must include key populations, that is, lesbian, gay, bisexual, transgender and intersex (LGBTI) people, and sex workers. Accessibility and quality of care have not been investigated in lower and middle-income countries where civil rights are the weakest. AIM To examine the accessibility to, and experiences of, palliative care for key populations in Zimbabwe. DESIGN Qualitative study using thematic analysis of in-depth interviews and focus groups. SETTING/PARTICIPANTS A total of 60 key population adults and 12 healthcare providers and representatives of palliative care and key population support organisations were interviewed in four sites (Harare, Bulawayo, Mutare and Masvingo/Beitbridge). RESULTS Participants described unmet needs and barriers to accessing even basic elements of palliative care. Discrimination by healthcare providers was common, exacerbated by the politico-legal-economic environment. Two dominant themes emerged: (a) minimal understanding of, and negligible access to, palliative care significantly increased the risk of painful, undignified deaths and (b) discriminatory beliefs and practices from healthcare providers, family members and the community negatively affected those living with life-limiting illness, and their wishes at the end of life. Enacted stigma from healthcare providers was a potent obstacle to quality care. CONCLUSION Discrimination from healthcare providers and lack of referrals to palliative care services increase the risk of morbidity, mortality and transmission of infectious diseases. Untreated conditions, exclusion from services, and minimal family and social support create unnecessary suffering. Public health programmes addressing other sexually taboo subjects may provide guidance.
Collapse
Affiliation(s)
- Jenny Hunt
- Independent consultant, Harare, Zimbabwe
| | - Katherine Bristowe
- Cicely Saunders Institute of Palliative care, Policy & Rehabilitation, King’s College London, London, UK
| | | | - Richard Harding
- Cicely Saunders Institute of Palliative care, Policy & Rehabilitation, King’s College London, London, UK
| |
Collapse
|
35
|
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]
|
36
|
Meeting the Needs of People Who Identify as Lesbian, Gay, Bisexual, Transgender, and Queer in Palliative Care Settings. J Hosp Palliat Nurs 2019; 21:286-290. [DOI: 10.1097/njh.0000000000000525] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
|
37
|
Abstract
The Department of Veterans Affairs (VA) is likely the largest provider of health care for LGBT persons in US. However, histories of homophobia, stigma, discrimination, and past military policies have all had a lasting impact on the health of LGBT veterans. Effects can be seen across healthcare needs, disparities, access, and utilization for or by LGBT veterans. A case from a VA hospice unit is used to illustrate some challenges and opportunities when providing end-of-life care for an older, lesbian veteran. This veteran had been cared for by her wife who was struggling to meet care needs at home. Over time, it became clear that the wife was emotionally and financially dependent on the veteran, and would be facing many psychosocial and financial challenges when the veteran died. However the wife was reticent to accept referrals for help or services due to past negative experiences with social service agencies related to her sexual orientation. The interdisciplinary team collaborated to care for the veteran's medical needs, and the wife's emotional and psychosocial needs, until after the veteran's death. This case highlights many of the unique needs and challenges that may arise in caring for LGBT veterans and their families at end-of-life.
Collapse
Affiliation(s)
- Kate Lm Hinrichs
- a VA Boston Healthcare System , Boston , MA.,b Harvard Medical School, Department of Psychiatry , Cambridge , MA
| | - Kysa M Christie
- a VA Boston Healthcare System , Boston , MA.,b Harvard Medical School, Department of Psychiatry , Cambridge , MA
| |
Collapse
|
38
|
Lyon ME, Squires L, D'Angelo LJ, Benator D, Scott RK, Greenberg IH, Tanjutco P, Turner MM, Weixel TE, Cheng YI, Wang J. FAmily-CEntered (FACE) Advance Care Planning Among African-American and Non-African-American Adults Living With HIV in Washington, DC: A Randomized Controlled Trial to Increase Documentation and Health Equity. J Pain Symptom Manage 2019; 57:607-616. [PMID: 30472318 PMCID: PMC6382515 DOI: 10.1016/j.jpainsymman.2018.11.014] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Revised: 11/09/2018] [Accepted: 11/14/2018] [Indexed: 12/25/2022]
Abstract
CONTEXT No prospective studies address disease-specific advance care planning (ACP) for adults living with HIV/AIDS. OBJECTIVE To examine the efficacy of FAmily-CEntered (FACE) ACP in increasing ACP and advance directive documentation in the medical record. METHODS Longitudinal, two-arm, randomized controlled trial with intent-to-treat design recruited from five hospital-based outpatient HIV clinics in Washington, DC. Adults living with HIV and their surrogate decision-makers (N = 233 dyads) were randomized to either an intensive facilitated two-session FACE ACP (Next Steps: Respecting Choices goals of care conversation and Five Wishes advance directive) or healthy living control (conversations about developmental/relationship history and nutrition). RESULTS Patients (n = 223) mean age: 51 years, 56% male, 86% African-American. One hundred ninety-nine dyads participated in the intervention. At baseline, only 13% of patients had an advance directive. Three months after intervention, this increased to 59% for the FACE ACP group versus 17% in the control group (P < 0.0001). Controlling for race, the odds of having an advance directive in the medical record in the FACE ACP group was approximately seven times greater than controls (adjusted odds ratio = 6.58, 95% CI: 3.21-13.51, P < 0.0001). Among African-Americans randomized to FACE, 58% had completed/documented advance directives versus 20% of controls (P < 0.0001). CONCLUSIONS The FACE ACP intervention significantly improved ACP completion and advance directive documentation in the medical record among both African-American and non-African-American adults living with HIV in Washington, DC, providing health equity in ACP, which can inform best practices.
Collapse
Affiliation(s)
- Maureen E Lyon
- Division of Adolescent and Young Adult Medicine, Children's National, Center for Translational Science/Children's Research Institute, Washington, DC, USA; George Washington University School of Medicine and Health Sciences, Washington, DC.
| | - Leah Squires
- Washington DC Veterans Affairs Medical Center, Washington, DC
| | - Lawrence J D'Angelo
- Division of Adolescent and Young Adult Medicine, Children's National, Center for Translational Science/Children's Research Institute, Washington, DC, USA; George Washington University School of Medicine and Health Sciences, Washington, DC
| | - Debra Benator
- George Washington University School of Medicine and Health Sciences, Washington, DC; Washington DC Veterans Affairs Medical Center, Washington, DC
| | - Rachel K Scott
- MedStar: Health Research Institute and Washington Hospital Center; George Washington University Milken School of Public Health, Washington, DC, USA
| | - Isabella H Greenberg
- Division of Adolescent and Young Adult Medicine, Children's National, Center for Translational Science/Children's Research Institute, Washington, DC, USA
| | - Patricia Tanjutco
- MedStar: Health Research Institute and Washington Hospital Center; George Washington University Milken School of Public Health, Washington, DC, USA
| | | | - Tara E Weixel
- Office of the Clinical Director, National Human Genome Research Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Yao I Cheng
- Division of Adolescent and Young Adult Medicine, Children's National, Center for Translational Science/Children's Research Institute, Washington, DC, USA
| | - Jichuan Wang
- Division of Adolescent and Young Adult Medicine, Children's National, Center for Translational Science/Children's Research Institute, Washington, DC, USA; George Washington University School of Medicine and Health Sciences, Washington, DC
| |
Collapse
|
39
|
|
40
|
Social Inequalities in Palliative Care for Cancer Patients in the United States: A Structured Review. Semin Oncol Nurs 2018; 34:303-315. [PMID: 30146346 DOI: 10.1016/j.soncn.2018.06.011] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
OBJECTIVES To identify patterns of access to and use or provision of palliative care services in medically underserved and vulnerable groups diagnosed with cancer. DATA SOURCES Google Scholar, PubMed, MEDLINE, and Web of Science were searched to identify peer-reviewed studies that described palliative care in medically underserved or vulnerable populations diagnosed with cancer. CONCLUSION Disparities in both access and referral to palliative care are evident in many underserved groups. There is evidence that some groups received poorer quality of such care. IMPLICATIONS FOR NURSING PRACTICE Achieving health equity in access to and receipt of quality palliative care requires prioritization of this area in clinical practice and in research funding.
Collapse
|
41
|
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.
Collapse
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
| |
Collapse
|
42
|
Harding R. Palliative care as an essential component of the HIV care continuum. Lancet HIV 2018; 5:e524-e530. [PMID: 30025682 DOI: 10.1016/s2352-3018(18)30110-3] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2018] [Revised: 05/11/2018] [Accepted: 05/17/2018] [Indexed: 11/26/2022]
Abstract
Although antiretroviral therapy has reduced mortality among people with HIV, inadequate treatment coverage, ageing, and the increasing incidence of organ failure and malignancies mean that high-quality care should include care at the end of life. This Review summarises the epidemiology of HIV in relation to mortality, and the symptoms and concerns of people with AIDS and those living with HIV who have either related or unrelated advanced comorbidities. In response to the evidence of a need for palliative care, the principles and practice of palliative care are described, and the evidence for its effectiveness and cost-effectiveness is appraised. The core practices of palliative care offer a mechanism to enhance the person-centred nature of HIV care; I identify the gaps in this type of care, and present evidence for effective models of care to address these. I detail the policies that prompt governments and health systems to respond to the palliative care needs of their population. Finally, I conclude this Review with evidence-based recommendations to improve the delivery of, and access to, high-quality HIV care until the end of life, reducing unnecessary suffering while optimising person-centred outcomes.
Collapse
Affiliation(s)
- Richard Harding
- Department of Palliative Care, Policy, and Rehabilitation, Florence Nightingale Faculty of Nursing, Midwifery, and Palliative Care, Cicely Saunders Institute, King's College London, London, UK.
| |
Collapse
|
43
|
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.
Collapse
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
| |
Collapse
|
44
|
Maingi S, Bagabag AE, O'Mahony S. Current Best Practices for Sexual and Gender Minorities in Hospice and Palliative Care Settings. J Pain Symptom Manage 2018; 55:1420-1427. [PMID: 29288882 DOI: 10.1016/j.jpainsymman.2017.12.479] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2017] [Revised: 12/15/2017] [Accepted: 12/18/2017] [Indexed: 11/22/2022]
Abstract
Although several publications document the health care disparities experienced by sexual and gender minorities (SGMs), including lesbian, gay, bisexual, and transgender (LGBT) individuals,1e4 less is known about the experiences and outcomes for SGM families and individuals in hospice and palliative care (HPC) settings. This article provides a brief overview of issues pertaining to SGMs in HPC settings, highlighting gaps in knowledge and research. Current and best practices for SGM individuals and their families in HPC settings are described, as are recommendations for improving the quality of such care.
Collapse
Affiliation(s)
- Shail Maingi
- St. Peter's Health Partners Cancer Care, Troy, New York, USA.
| | | | - Sean O'Mahony
- Rush University Medical Center, Chicago, Illinois, USA
| |
Collapse
|
45
|
Willis P, Almack K, Hafford-Letchfield T, Simpson P, Billings B, Mall N. Turning the Co-Production Corner: Methodological Reflections from an Action Research Project to Promote LGBT Inclusion in Care Homes for Older People. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:ijerph15040695. [PMID: 29642460 PMCID: PMC5923737 DOI: 10.3390/ijerph15040695] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/22/2017] [Revised: 03/19/2018] [Accepted: 03/29/2018] [Indexed: 11/29/2022]
Abstract
Background: Older lesbian, gay, bisexual and trans (LGBT) residents are often invisible in long-term care settings. This article presents findings from a community-based action research project, which attempted to address this invisibility through co-produced research with LGBT community members. Particular Question: What conditions enable co-produced research to emerge in long-term residential care settings for older people? Aims of Project: To analyse outcomes and challenges of action-oriented, co-produced research in the given context. In particular, we explore how co-production as a collaborative approach to action-orientated research can emerge during the research/fieldwork process; and reflect critically on the ethics and effectiveness of this approach in advancing inclusion in context. Methods: The project was implemented across six residential care homes in England. Reflections are based on qualitative evaluation data gathered pre- and post-project, which includes 37 interviews with care home staff, managers and community advisors (two of whom are co-authors). Results and Conclusions: We discuss how the co-production turn emerged during research and evaluate how the politics of this approach helped advance inclusion—itself crucial to well-being. We argue for the value of co-produced research in instigating organizational change in older people’s care environments and of non-didactic storytelling in LGBT awareness-raising amongst staff.
Collapse
Affiliation(s)
- Paul Willis
- School for Policy Studies, University of Bristol, 8 Priory Road, Clifton, BS8 1TZ, UK.
| | - Kathryn Almack
- School of Health and Social Work, University of Hertfordshire, Hatfield, Hertfordshire, AL10 9AB, UK.
| | - Trish Hafford-Letchfield
- Department of Mental Health, Social Work, Interprofessional Learning and Integrative Medicine, School of Health and Education Middlesex University, Ground Floor, Town Hall Annex, The Burroughs, Hendon, London NW4 4BT, UK.
| | - Paul Simpson
- Department of Applied Health and Social Care, Edge Hill University, St Helens Road, Ormskirk, Lancs, L39 4QP, UK.
| | - Barbara Billings
- Department of Mental Health, Social Work, Interprofessional Learning and Integrative Medicine, School of Health and Education Middlesex University, Ground Floor, Town Hall Annex, The Burroughs, Hendon, London NW4 4BT, UK.
| | - Naresh Mall
- Department of Mental Health, Social Work, Interprofessional Learning and Integrative Medicine, School of Health and Education Middlesex University, Ground Floor, Town Hall Annex, The Burroughs, Hendon, London NW4 4BT, UK.
| |
Collapse
|
46
|
Lisy K, Peters MDJ, Schofield P, Jefford M. Experiences and unmet needs of lesbian, gay, and bisexual people with cancer care: A systematic review and meta-synthesis. Psychooncology 2018; 27:1480-1489. [PMID: 29462496 DOI: 10.1002/pon.4674] [Citation(s) in RCA: 73] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2017] [Revised: 02/05/2018] [Accepted: 02/08/2018] [Indexed: 12/12/2022]
Abstract
OBJECTIVES To explore the cancer care experiences and unmet needs of people who identify as a sexual or gender minority. METHODS A qualitative systematic review and meta-synthesis was undertaken based on a registered protocol. Following literature searching and study selection, study quality was examined by using the Critical Appraisal Skill Programme Checklist. Qualitative data were extracted verbatim from included studies and synthesized by using thematic analysis. RESULTS Fifteen studies that included lesbian, gay, and bisexual (LGB) people living with or beyond cancer were included in the review. Studies including gender minorities were not identified. Most of the study participants were sexual minority women with breast cancer or sexual minority men with prostate cancer. Meta-synthesis of 106 individual findings generated 6 overarching themes pertaining to sexual orientation disclosure, experiences and fear of homophobia, positive and negative health-care professional behaviors, heterocentric systems and care, inadequacy of available support groups, and unmet needs for patient-centered care and LGB-specific information. Lesbian, gay, and bisexual people often reported feelings of anxiety, invisibility, isolation, and frustration throughout the cancer care continuum. CONCLUSIONS Analysis of the experiences of LGB people with cancer care shows that LGB people face numerous challenges due to their sexual orientation and receive care that does not adequately address their needs. Training and education of health-care professionals are strongly recommended to address some of these challenges and practice gaps. Culturally appropriate care includes avoiding heterosexual assumptions, use of inclusive language, the provision of tailored information, and involving partners in care.
Collapse
Affiliation(s)
- Karolina Lisy
- Department of Cancer Experiences Research, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia.,Australian Cancer Survivorship Centre, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Micah D J Peters
- School of Nursing and Midwifery, Division of Health Sciences, The University of South Australia, Adelaide, South Australia, Australia
| | - Penelope Schofield
- Department of Cancer Experiences Research, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia.,Department of Psychology, Swinburne University, Melbourne, Victoria, Australia.,Sir Peter MacCallum Department of Oncology, The University of Melbourne, Parkville, Victoria, Australia
| | - Michael Jefford
- Department of Cancer Experiences Research, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia.,Australian Cancer Survivorship Centre, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia.,Sir Peter MacCallum Department of Oncology, The University of Melbourne, Parkville, Victoria, Australia
| |
Collapse
|
47
|
|
48
|
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.
Collapse
|
49
|
Bristowe K, Hodson M, Wee B, Almack K, Johnson K, Daveson BA, Koffman J, McEnhill L, Harding R. Recommendations to reduce inequalities for LGBT people facing advanced illness: ACCESSCare national qualitative interview study. Palliat Med 2018; 32:23-35. [PMID: 28502218 PMCID: PMC5758934 DOI: 10.1177/0269216317705102] [Citation(s) in RCA: 70] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Lesbian, gay, bisexual and/or trans (LGBT) people have higher risk of certain life-limiting illnesses and unmet needs in advanced illness and bereavement. ACCESSCare is the first national study to examine in depth the experiences of LGBT people facing advanced illness. AIM To explore health-care experiences of LGBT people facing advanced illness to elicit views regarding sharing identity (sexual orientation/gender history), accessing services, discrimination/exclusion and best-practice examples. DESIGN Semi-structured in-depth qualitative interviews analysed using thematic analysis. SETTING/PARTICIPANTS In total, 40 LGBT people from across the United Kingdom facing advanced illness: cancer ( n = 21), non-cancer ( n = 16) and both a cancer and a non-cancer conditions ( n = 3). RESULTS In total, five main themes emerged: (1) person-centred care needs that may require additional/different consideration for LGBT people (including different social support structures and additional legal concerns), (2) service level or interactional (created in the consultation) barriers/stressors (including heteronormative assumptions and homophobic/transphobic behaviours), (3) invisible barriers/stressors (including the historical context of pathology/criminalisation, fears and experiences of discrimination) and (4) service level or interactional facilitators (including acknowledging and including partners in critical discussions). These all shape (5) individuals' preferences for disclosing identity. Prior experiences of discrimination or violence, in response to disclosure, were carried into future care interactions and heightened with the frailty of advanced illness. CONCLUSION Despite recent legislative change, experiences of discrimination and exclusion in health care persist for LGBT people. Ten recommendations, for health-care professionals and services/institutions, are made from the data. These are simple, low cost and offer potential gains in access to, and outcomes of, care for LGBT people.
Collapse
Affiliation(s)
- Katherine Bristowe
- King’s College London, Cicely Saunders Institute, Department of Palliative Care, Policy & Rehabilitation, UK
| | | | - Bee Wee
- Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Kathryn Almack
- Nottingham Centre for the Advancement of Research into Supportive, Palliative and End-of-Life Care, The University of Nottingham, Nottingham, UK
| | - Katherine Johnson
- School of Applied Social Science, University of Brighton, Brighton, UK
| | - Barbara A Daveson
- King’s College London, Cicely Saunders Institute, Department of Palliative Care, Policy & Rehabilitation, UK
| | - Jonathan Koffman
- King’s College London, Cicely Saunders Institute, Department of Palliative Care, Policy & Rehabilitation, UK
| | | | - Richard Harding
- King’s College London, Cicely Saunders Institute, Department of Palliative Care, Policy & Rehabilitation, UK
| |
Collapse
|
50
|
Thomeer MB, Donnelly R, Reczek C, Umberson D. Planning for Future Care and the End of Life: A Qualitative Analysis of Gay, Lesbian, and Heterosexual Couples. JOURNAL OF HEALTH AND SOCIAL BEHAVIOR 2017; 58:473-487. [PMID: 29172768 PMCID: PMC5718053 DOI: 10.1177/0022146517735524] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
Two key components of end-of-life planning are (1) informal discussions about future care and other end-of-life preferences and (2) formal planning via living wills and other legal documents. We leverage previous work on the institutional aspects of marriage and on sexual-minority discrimination to theorize why and how heterosexual, gay, and lesbian married couples engage in informal and formal end-of-life planning. We analyze qualitative dyadic in-depth interviews with 45 midlife gay, lesbian, and heterosexual married couples ( N = 90 spouses). Findings suggest that same-sex spouses devote considerable attention to informal planning conversations and formal end-of-life plans, while heterosexual spouses report minimal formal or informal planning. The primary reasons same-sex spouses give for making end-of-life preparations are related to the absence of legal protections and concerns about discrimination from families. These findings raise questions about future end-of-life planning for same- and different-sex couples given a rapidly shifting legal and social landscape.
Collapse
|