Objectives
- 1.Identify 2-4 reasons provided by HCT providers, including those representing different roles (e.g. RNs, aides, social workers, chaplains), for their beliefs regarding best care and communication practices with LGBTQ+ patients and family caregivers.
- 2.Analyze how HCT members' experience and assumptions may influence care and communication practices while working with LGBTQ+ patients and caregivers, including potential effects on quality of care.
Background
Little research examines hospice care team members’ (HCT) experience and opinions about serving LGBTQ+ patients and caregivers.
Research Objectives
We examined HCT members’ perceptions regarding 1) awareness of LGBTQ+ patients and caregivers; 2) particular needs of these groups; 3) best care and communication practices; and 4) need for education and training.
Methods
We conducted six focus groups with HCT members (n = 48) in three U.S. states; data were audio-recorded, transcribed, and imported into NVivo (12 and R) for coding. Data segments were topically coded until acceptable intercoder reliability was achieved (κ = 0.95); data coded within topics were then aggregated and descriptively summarized.
Results
Participants were largely white (89.8%), non-Hispanic (89.6%), female (87.5%), heterosexual (79.2%), religious (68.8%), averaged 49.2 years old (range = 26-72), had ≥ 5 years of college (39.6%), had worked in their position 6.6 years (SD = 6.26, range 0.25-30), and had no hospice or palliative care training outside their employer (70.8%). Participants were less comfortable with gender diversity than lesbian or gay orientation; most reported no experience with transgender patients or caregivers. Awareness of patients’ or caregivers’ orientation came via disclosure or contextual cues as this information was not collected on intake. Most viewed this knowledge as irrelevant to care, or as something people would share if important to them. Universality of death, the “Golden Rule,” and hospice professionals treating everyone the same were provided as reasons why LGBTQ+ individuals did not have particular care or communication needs. LGBTQ+ HCT participants often countered this by citing historical discrimination and its particular impact on older adults.
Conclusion
Many HCT members seemed unaware of issues impacting the end-of-life experience of LGBTQ+ groups.
Implications for Research, Policy, or Practice
Competency education focused on cultural, historical context and communication competencies would support more inclusive care.
Article info
Identification
Copyright
© 2021 Published by Elsevier Inc.
