Palliative and End-of-Life Care for LGBT+ Cancer Patients: Scoping the Problems and Identifying the Solutions

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.).

Gay, Bisexual, and Queer Men's Attitudes and Understandings of Intimate Partner Violence and Sexual Assault

Gay, bisexual, and queer (GBQ) men experience significant rates of intimate partner violence (IPV) and sexual assault (SA); however, there is limited research into their attitudes and understandings of IPV and SA. This article presents the findings of a 2018 survey of 895 GBQ men currently residing in Australia, focused on their views and experiences of healthy and unhealthy relationships. The survey included quantitative and open-ended qualitative questions. The findings presented in this article are primarily descriptive, with cross-tabulations and t tests to demonstrate significant differences between groups and correlational statistics to outline associations between variables. Qualitative data were coded under broad themes. The study found a considerable proportion of men (three in five) identified that they had experienced an unhealthy or abusive relationship in the past, with minimal disclosure to police or health services. Men with a history of partner abuse or violence were more likely to report binge drinking or drug use and more likely to know a friend who had abused his partner. 40% of the sample had witnessed an incident of relationship violence between GBQ men, and two-thirds intervened in the violence in some way. The findings of this study underscore the need to engage GBQ men in discussions about respectful relationships, address the role of alcohol and drugs in GBQ socialization and relationships, and provide bystander skills for men to intervene in situations of aggression or violence between men in relationships.

Lesbian, Gay, Bisexual, and Transgender Persons Aging in Rural Areas

Older lesbian, gay, bisexual, and transgender (LGBT) persons face many challenges in aging, including coping with life-long discrimination and encountering family and others who are not supportive of their identities and relationships. Members of this population who reside in small towns and rural areas face even more challenges in older adulthood. This article presents a case study of an older woman who is questioning her sexual orientation and discusses her experiences in the context of aging in a rural community. The article also addresses the historical context in which older LGBT people came of age as well as health issues that impact them. In addition, recommendations are offered for improving provider services with LGBT individuals.

Gender identity and sexual orientation in autism spectrum disorder

Clinical impressions indicate that there is an overrepresentation of gender-dysphoria within the autism spectrum disorder. However, little is presently known about the demographics of gender-identity issues in autism spectrum disorder. Based upon what little is known, we hypothesized that there would be an increased prevalence of gender-dysphoria among those with autism spectrum disorder compared to a typically developing population. We surveyed gender-dysphoria with the Gender-Identity/Gender-Dysphoria Questionnaire among 90 males and 219 females with autism spectrum disorder and compared these rates to those of 103 males and 158 females without autism spectrum disorder. When compared to typically developing individuals, autistic individuals reported a higher number of gender-dysphoric traits. Rates of gender-dysphoria in the group with autism spectrum disorder were significantly higher than reported in the wider population. Mediation analysis found that the relationship between autistic traits and sexual orientation was mediated by gender-dysphoric traits. Results suggest that autism spectrum disorder presents a unique experience to the formation and consolidation of gender identity, and for some autistic individuals, their sexual orientation relates to their gender experience. It is important that clinicians working with autism spectrum disorder are aware of the gender-diversity in this population so that the necessary support for healthy socio-sexual functioning and mental well-being is provided.

Armed conflict, homonegativity and forced internal displacement: implications for HIV among Colombian gay, bisexual and transgender individuals

Colombia has endured six decades of civil unrest, population displacement and violence. We examined the relationships between contextual conditions, displacement and HIV among gay, bisexual and transgender individuals in Bogotá, Colombia. A total of 19 key informants provided information about internal displacement of sexual minorities. Life-history interviews were conducted with 42 participants aged 18 to 48 years and included questions about displacement experiences, sexual behaviour, life prior to displacement and participants' economic and social situation in Bogotá. The interplay of a variety of factors - including internal conflict and violence, homonegativity and 'social cleansing', gender and sexual identity and poverty - strongly shaped the varied experiences of displacement. Migration, sexual violence, exchange sex and low rates of HIV testing were risk factors that increased vulnerability for HIV in this displaced sample. Although displacement and HIV in Colombia are major problems, both are understudied.