LGBTQ+ Inclusive Palliative Care in the Context of COVID-19: Pragmatic Recommendations for Clinicians

Abstract

As coronavirus disease 2019 (COVID-19) continues to impact the seriously ill and their families on a global scale, considerations given to marginalized groups amid the pandemic are essential to ensure the provision of high-quality and dignified care. Lesbian, gay, bisexual, transgender, gender-nonconforming, and queer/questioning-identified (LGBTQþ) persons are particularly vulnerable to health inequities across settings, including palliative care and at the end of life. There is a crucial gap in the literature pertaining to palliative care for LGBTQþ populations during COVID-19. We aim to fill this gap by providing essential health inequity and social support background pertaining to LGBTQþ persons and practical recommendations for immediate implementation that support inclusive and respectful care for these populations. Using these recommendations is a pragmatic pathway to promote trust, transparency, patient and family engagement, and value concordant care amid the health system strain caused by COVID-19.

Cuidados paliativos no contexto da pandemia de COVID-19: desafios e contribuições

“…Em relação às temáticas, duas categorias sintetizam os principais aspectos abordados nos estudos: "Estratégias para implementação dos cuidados paliativos no enfrentamento da COVID-19" (17)(18)(19)21,23,25,(27)(28)(29)(30)(31)(32)35,36,(38)(39)(40)(41)(42)44) (19; 63,3%) e "Terapêutica paliativista no contexto da pandemia: desafios e contribuições" (16,(19)(20)(21)(22)(23)(24)(25)(26)(27)(28)(29)31,33,34,(36)(37)(38)(39)(40)(41)(43)(44)(45) (24; 80%).…”

“…(18,21,23,25,27,28,30-32,35,39,40,42,44 ou cuidadores. (23,26,34,40,41,(43)(44)(45) Os desafios estiveram relacionados ao acesso dos pacientes aos serviços de saúde, (26,34,36,44) às necessidade de capacitação dos profissionais, (26,27,29,33,36) à sobrecarga de trabalho e à falta de recursos, como retratado na figura 2. (26,36) Alguns estudos estão tanto na primeira quanto na segunda categoria, pois apresentaram informações pertinentes para ambas.…”

“…Reforça-se a ação da equipe de cuidados paliativos em humanizar as práticas destinadas ao paciente e respeitar sua individualidade, assegurando que os indivíduos recebam cuidados de alta qualidade, com respeito à sua forma de ver e viver a vida. (34)…”

Sex and Gender Issues for Individuals With Acquired Brain Injury During COVID-19: A Commentary

“…Previous experience with natural disasters suggests that marginalized groups experience substantially more negative consequences in times of natural disaster, which warrants enhanced support and advocacy. For example, LGBTQ+ individuals are at a disadvantage, both for greater risk of COVID-19 mortality 25 and poorer ABI related treatment, 12 such as “lack of specialized and knowledgeable screening, education, and treatment for reproductive health, sexuality, and sexual performance related issues.” 12 (p377) Although the current COVID-19 pandemic is certain to lead to many unknown and unanticipated outcomes in this and other groups, there are specific areas known to affect women and LGBTQ+ individuals with ABI, namely IPV, social and financial disparities, and technological accessibility. Disparities in these domains can be expected to be exacerbated by the current state of the world and lead to further marginalization, making them critical to highlight as potential intervention targets.…”

LGBTQ care at the time of COVID-19

“…Reluctance to visit healthcare services for fear of discrimination which is higher among LGBTQ community is a definite barrier for proper screening, early diagnosis and prompt treatment for COVID-19. In many cases their palliative/end-of-life care may be compromised amidst systemic inequality, health disparity and marginalization [ 8 ]. Moreover, it has been observed that sexual minority group possesses lower perceived susceptibility to COVID-19, lesser worry about the pandemic and are less likely to undertake hygienic measures than heterosexuals [ 9 ].…”