Creating a Culturally Competent Clinical Environment for LGBT Patients

Wilkerson, J. Michael; Rybicki, Sarah L; Barber, Cheryl; Smolenski, Derek J.

doi:10.1080/10538720.2011.589254

Cited by 92 publications

(93 citation statements)

References 22 publications

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“…28,31,32 Minority patients may require additional time or sensitivity to build trust if they are not receiving care as frequently or have had prior negative experiences. 39 Organizations can streamline SDM by preparing patients before the encounter or by finding other ways to distribute SDM across the visit. 1,57,58…”

Section: Patient Flow Through the Clinic / Timingmentioning

confidence: 99%

“…59 Team-based care spreads ○ Maintain a community advisory board ○ Survey or interview patients about their health care experiences and needs -Participate in provider referral programs through LGBT organizations 33,39 -Advertise clinics in media and events serving LGBT and racial/ethnic minority LGBT communities 14,33 (continued on next page)…”

Section: Patient Flow Through the Care Team / Team Compositionmentioning

confidence: 99%

“…18,45 Organizations must also ensure that their entire staff is committed to building and maintaining a positive reputation in these communities. 39 …”

Section: Staff Diversity and Concordancementioning

confidence: 99%

“…Patients are more likely to seek care and disclose sexual orientation or gender identity to their health providers in a safe environment. 16,39,96 Organizations should display these visuals only if paired with other deeper efforts to create a welcoming environment. 14,96 Dual-minority patients may require welcoming visuals beyond traditional LGBT signage to feel safe, since some dualminority patients may feel excluded from majority LGBT social and health spaces ( Table 2).…”

Section: Physical Environment: Welcoming Visual Cuesmentioning

confidence: 99%

“…42,43 For most minority patients, cultural tailoring goes beyond language 107 and literacy; 108 for example, LGBT-specific educational materials can help LGBT patients discuss their options and preferences with clinicians. 33,39 Materials should acknowledge the intersection of minority identities by depicting and incorporating multiple facets of diversity (e.g., sexual orientation, race, ethnicity, age, gender).…”

Section: Decision Aids and Educational Materialsmentioning

confidence: 99%

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A Model of Organizational Context and Shared Decision Making: Application to LGBT Racial and Ethnic Minority Patients

et al. 2016

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Shared decision making (SDM) occurs when patients and clinicians work together to reach care decisions that are both medically sound and responsive to patients' preferences and values. SDM is an important tenet of patient-centered care that can improve patient outcomes. Patients with multiple minority identities, such as sexual orientation and race/ethnicity, are at particular risk for poor SDM. Among these dualminority patients, added challenges to clear and open communication include cultural barriers, distrust, and a health care provider's lack of awareness of the patient's minority sexual orientation or gender identity. However, organizational factors like a culture of inclusion and private space throughout the visit can improve SDM with lesbian, gay, bisexual, and transgender (BLGBT^) racial/ethnic minority patients who have faced stigma and discrimination. Most models of shared decision making focus on the patient-provider interaction, but the health care organization's context is also critical. Context-an organization's structure and operations-can strongly influence the ability and willingness of patients and clinicians to engage in shared decision making. SDM is most likely to be optimal if organizations transform their contexts and patients and providers improve their communication. Thus, we propose a conceptual model that suggests ways in which organizations can shape their contextual structure and operations to support SDM. The model contains six drivers: workflows, health information technology, organizational structure and culture, resources and clinic environment, training and education, and incentives and disincentives. These drivers work through four mechanisms to impact care: continuity and coordination, the ease of SDM, knowledge and skills, and attitudes and beliefs. These mechanisms can activate clinicians and patients to engage in high-quality SDM. We provide examples of how specific contextual changes could make SDM more effective for LGBT racial/ethnic minority populations, focusing especially on transformations that would establish a safe environment, build trust, and decrease stigma.

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Section: Patient Flow Through the Clinic / Timingmentioning

confidence: 99%

Section: Patient Flow Through the Care Team / Team Compositionmentioning

confidence: 99%

“…18,45 Organizations must also ensure that their entire staff is committed to building and maintaining a positive reputation in these communities. 39 …”

Section: Staff Diversity and Concordancementioning

confidence: 99%

Section: Physical Environment: Welcoming Visual Cuesmentioning

confidence: 99%

Section: Decision Aids and Educational Materialsmentioning

confidence: 99%

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A Model of Organizational Context and Shared Decision Making: Application to LGBT Racial and Ethnic Minority Patients

et al. 2016

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Assessment of Perspectives on Health Care System Efforts to Mitigate Perceived Risks Among Immigrants in the United States

et al. 2020

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IMPORTANCE Increases in the enforcement of immigration policies, deportations, and rhetoric critical of immigration during and after the 2016 US presidential election have been associated with a decrease in health-seeking behaviors and an increase in adverse health outcomes among immigrants. Efforts to address the health care needs of immigrants after the 2016 presidential election have centered on individual-level patient-practitioner strategies or federal-and state-level policy changes. However, these approaches have not captured the role of health care systems and the range of health care facilities encompassed within them.OBJECTIVE To characterize policies and actions implemented by health care facilities to address immigration status-related stressors. DESIGN, SETTING, AND PARTICIPANTSThis exploratory qualitative study involved semistructured interviews in a purposive sample of health care facilities across 5 states (California, Texas, New York, Florida, and Illinois) with the largest populations of individuals with undocumented immigration status. Data from media sources and informational interviews with local immigration advocacy leaders were used to identify health care facilities that had implemented welcoming policies and strategies. Stakeholders, including administrators, frontline clinicians involved in policy implementation, and senior executive leaders, were interviewed. Interviews were conducted between May 1 and August 9, 2018, and were recorded, transcribed, and coded using constant comparative analysis. Data analysis was performed from MAIN OUTCOMES AND MEASURES Stakeholder perspectives on the range, scope and content of policies and actions implemented to address immigration-related stressors at health care facilities.RESULTS A total of 38 in-depth interviews were conducted spanning 25 health care facilities in 5 states; these facilities included 13 federally qualified health centers, 7 academic or private hospitals, and 5 public institutions. Interviewees described policies and actions that mitigated one or more of the following perceived risks: (1) risk of exposure to immigration enforcement personnel at or near facilities, (2) risk of immigration status-related information disclosure, (3) risk associated with patient-level stressors, (4) risk associated with practitioner-level stressors, and (5) coordination of risk mitigation. Most personnel at health care facilities emphasized that their policies and actions fit within a larger mission and history of addressing the social needs of diverse patients and mitigating risks for patients. CONCLUSIONS AND RELEVANCEHealth care facilities can implement both active and reactive measures to address perceived immigration-associated risks among patients and practitioners.Population health and immigration policies are at the forefront of current policy debates. An (continued) Abstract (continued) understanding of the ways in which health care facilities can serve to mitigate perceived risks among their patients and employees can be one step toward ...

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Clinical Issues—September 2022

Seeman¹

2022

AORN Journal

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THIS MONTH Providing inclusive care to patients in the lesbian, gay, bisexual, transgender, and queer or questioning community Key words: unisex restroom, patient privacy, inclusivity, “Safe Zone,” LGBTQ community. Preventing trips over power cords Key words: power cords, pathway, Bluetooth, wireless technology, falls. Reducing discomfort of personnel standing for prolonged procedures Key words: prolonged standing, antifatigue mats, sit‐stand stools, microbreaks, ergonomics. Using a clear adhesive dressing as a sterile drape patch Key words: adhesive dressing, patch, instructions for use (IFU), sterile drapes, contamination.

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Creating a Culturally Competent Clinical Environment for LGBT Patients

Cited by 92 publications

References 22 publications

A Model of Organizational Context and Shared Decision Making: Application to LGBT Racial and Ethnic Minority Patients

A Model of Organizational Context and Shared Decision Making: Application to LGBT Racial and Ethnic Minority Patients

Assessment of Perspectives on Health Care System Efforts to Mitigate Perceived Risks Among Immigrants in the United States

Clinical Issues—September 2022

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