What About Us? Inclusive Hospice and Palliative Care for Transgender and Gender Diverse People

Key Message: This session highlights three complex cases of transgender and gender diverse patients experiencing barriers and challenges to high quality hospice and palliative care and how interprofessional collaboration can mitigate these gaps in care through provider education, advocacy around safe discharge practices, and leveraging of resources to meet their needs.

Abstract: Comprising less than 1% of the US population, Transgender and Gender Diverse people (TGD) have endured a long history of marginalization, oppression, and stigmatization.(1) They have experienced and continues to face high levels of physical and mental health distress compared to the general population. (2) They encounter significant barriers and challenges to accessing high quality medical care, including hospice and palliative care. A 2020 study showed that more than two thirds of hospice and palliative care providers felt that TGD patients were more likely to experience discrimination and that a third of them observed outright discrimination towards TGD patients.(3) A more focused study specifically on TGD patients in 2024 revealed that disrespectful and discriminatory care towards them consisted of misgendering, ridicule, ignorance of appropriate medical care etc. resulting in mistrust towards healthcare providers.(4) This presentation will describe, illustrate, and reflect upon three complex cases of TGD patients residing in New York City who have experienced significant challenges around transitions in care and appropriate access to hospice services upon hospital discharge, discontinuation of hormone replacement therapy (HRT) at the end-of-life (EOL), misgendering, lack of provider training in TGD medical care, and a lack of psychosocial and regulatory support for inclusive and affirming hospice and palliative care among others. We will review the holistic, compassionate, and multidimensional strategies taken through the integration of a medical, biopsychosocial, cultural, and existential/spiritual framework to ensure that this vulnerable community receives the appropriate, timely, and optimal care they need at the EOL. Specific strategies utilized included partnerships with hospice agencies and primary care providers, innovative approaches to discharge planning, interprofessional collaboration, and provider education on the basics of gender-affirming therapies.

References: 1. Clark KD, Lunn MR, Sevelius JM et al. Relationships between structural stigma, society stigma, and minority stress among gender minority people. Sci Rep. 2025 Jan;15(1):2996. doi: 10.1038/s41598-024-85013-8
2. Liu M, Patel VR, Reisner SL. Health Status and Mental Health of Transgender and Gender Diverse Adults. JAMA Intern Med. 2024 June;184(8):984-986. doi:10.1001/jamainternmed.2024.2544
3. Stein GL, Berkman CO, O’Mahony S et al. Experiences of Lesbian, Gay, Bisexual, and Transgender Patients and Families in Hospice and Palliative Care: Perspectives of the Palliative care Team. J Palliat Med. 2020 June;23(6):817-824. doi: 10.1089/jpm.2019.0542. Epub 2020 Jan 9.
4. Berkman C, Stein GL, Javier NM et al. Disrespectful and Inadequate Palliative Care to Transgender Persons. Palliat Support Care. 2024 Feb;22(1):3-9. doi: 10.1017/S1478951523001104.