Experiences of discrimination in healthcare leave some sexual and gender minority (SMG) adults in doubt that their preferences will be considered in end-of-life care, a new study finds.
Investigators surveyed 201 SGM and 402 non-SGM adults, and conducted qualitative interviews with a subset of the SGM group. A validated measure, the Advance Care Planning (ACP) Engagement Survey, was used to capture experiences of discrimination.
Interviewees were asked about advance care planning, including the appointment of medical decision-makers, sharing preferences and general experiences within the healthcare system.
Survey results showed that most SGM participants had already talked to someone about their end-of-life wishes or were planning to do so. But subsequent interviews found that many end-of-life discussions occurred outside the clinical setting in this group. In addition, SGM people who had not had such a discussion were more likely to indicate that they didn’t feel the need to do so or felt discriminated against.
In the interviews, “[m]any described clinical encounters in which acceptance, understanding and support of SGM people was not clearly expressed by clinicians or healthcare organizations,” reported Carey Candrian, PhD, of the University of Colorado School of Medicine and colleagues. “The important connecting factor was a need to be assured that they would be treated safely and respectfully,” the authors wrote.
To encourage more patient-centered care and improved engagement with SGM patients, investigators recommended that health systems support clinician sensitivity training, including guidance on documentation and requirements.
Clinicians can help to determine how medical decision-makers should be involved and in advance care planning processes that use language that gives SGM patients and those who care for them “space to answer in a way that fits them and their circumstances,” they concluded.
Full findings were published in JAMA Network Open.
Related articles:
Long-term care communities lacking LGBTQ inclusive policies, report finds
