Structural Barriers to Well-grounded Advance Care Planning for the Seriously Ill: a Qualitative Study of Clinicians’ and Administrators’ Experiences During a Pragmatic Trial

Purpose For sexual and gender minority (SGM) individuals who identify as lesbian, gay, bisexual, transgender, queer, or any other sexual orientation or gender identity (LGBTQ+), the quality of palliative care can depend upon how clinicians view and communicate with this historically minoritized group. Prior literature has demonstrated that SGM patients access care at lower rates, and palliative care clinicians have suggested that SGM patients are more likely to experience discrimination than heterosexual patients. This study examined palliative care clinicians’ perspectives and experiences regarding patient communication, care settings, the built environment, and inclusive care for SGM older adults with serious illness. Methods The health disparities research framework informed a descriptive qualitative analysis of interview data with palliative care professionals (N = 20) across diverse healthcare settings within Colorado regarding their experiences and beliefs about communication and the care of SGM patients. Results Three main themes emerged: (1) Limited sexual orientation and gender identity (SOGI) data collection; (2) Organizational and environmental inclusivity, and the “neutral” space viewed as safe; (3) Missing training platforms regarding SGM patients and a lack of opportunity to identify and discuss SGM patient needs. Conclusion Study findings illuminated the following barriers to providing SGM-inclusive care: perspectives around (1) limitations and preferences regarding collection of SOGI data, (2) organizational and environmental inclusivity, and (3) education and training regarding cultural humility and communication with SGM patients. Findings indicate the need for multidimensional research to better understand and address SGM health disparities and promote equitable care.

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Structural Barriers to Well-grounded Advance Care Planning for the Seriously Ill: a Qualitative Study of Clinicians’ and Administrators’ Experiences During a Pragmatic Trial

Cited by 4 publications

References 31 publications

A Systematic Review of Non–Seriously Ill Community-Dwelling Asians’ Views on Advance Care Planning

A Systematic Review of Non–Seriously Ill Community-Dwelling Asians’ Views on Advance Care Planning

Content Analysis of Serious Illness Conversation Documentation: Structured vs. Free-Text Information

Palliative Care Professionals’ Perceptions of Communication With Sexual and Gender Minority Patients

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