Communicating with LGBTQ+ persons at end of life: A case‐based analysis of interdisciplinary palliative clinician perspectives

Abstract

ObjectiveLesbian, gay, bisexual, transgender, and queer or questioning (LGBTQ+) persons with serious illness and their families often experience end‐of‐life (EOL) care disparities, such as homophobia and transphobia, disrespect and mistreatment, and exclusion of significant others or life partners. The aim of the study was to explore interdisciplinary clinicians’ communication knowledge and priorities using a case of a gay man at EOL and his same‐sex, cisgender spouse.MethodsInterdisciplinary clinicians (n = 150) who participated in a national 3‐day communication training program, rooted in Adult Learning Theory and supported by the National Cancer Institute, responded to open‐ended questions about a composite case study emphasizing diversity challenges relevant to LGBTQ + communities in the EOL context. A thematic analysis of responses using an iterative, inductive approach was conducted until saturation was reached.ResultsParticipants from nursing (48%), social work (35%) and chaplaincy (17%) responded to the survey. Five themes emerged: 1) provision of patient‐centered care; 2) legal and ethical factors inform care and decision making; 3) considerations of same‐sex spouse or couple context; 4) dynamics and role of family of origin; and 5) elements of inclusive clinical care.ConclusionsLGBTQ + inclusive communication training is essential for all palliative clinicians to deliver culturally safe care. Our findings have implications for identifying unconscious bias, addressing discriminatory care, filling clinician knowledge gaps, and informing educational interventions to support LGBTQ + inclusion. Future research must focus on micro‐ and macro‐level communication issues that shape the quality of palliative and EOL care for patients and chosen family members.

My Partner Is My Family

“…[8][9][10][11] Most health care clinicians were trained with a heteronormative lens, 1,12,13 and there is scant literature documenting how to interact with and support patients using an approach tailored specifically for lesbian, gay, bisexual, transgender, and queer (LGBTQ) patients. 14 Emerging research has illustrated the positive impact LGBTQ awareness and communication training has on patient outcomes [15][16][17][18] ; however, many clinician education programs have yet to incorporate this training in their curricula.…”