Beyond the Basics: Practical Skills for LGBTQIA+ Affirming Palliative and End-of-Life Care

Key Message: Research demonstrates that LGBTQIA+ individuals experience significant discrimination within palliative and end-of-life care, compromising their dignity and safety when at their most vulnerable. We will highlight clinical and legal strategies to increase affirmation, safety, and inclusion for LGBTQIA+ people, and members of their support networks, when facing a serious illness.

Abstract:

Background:
Research demonstrates that even in the face of serious illness, LBGTQIA+ individuals commonly experience discrimination within hospice and palliative care (HPC) (1,2). While foundational training in caring for LGBTQIA+ individuals remains essential, interprofessional clinicians need additional practical skills to ensure that patients feel affirmed and safe in HPC settings. For example, helping patients document a healthcare proxy and complete a disposition of remains form can be crucial steps in honoring a patient’s preferences for their care and gender identity after death. These additional protections are especially important given the invisibility and vulnerability many LGBTQIA+ individuals experience in healthcare settings.

Approach:
This session will begin by examining key demographic factors within the LGBTQIA+ community that influence access to HPC services. We will present data on advance care planning (ACP), and highlight protections that LGBTQIA+ individuals must consider to honor their priorities for medical care, as well as nuances about post-mortem care (3). The session will also cover inclusive communication strategies—such as asking patients about support networks and intentionally creating safe spaces—to help clinicians affirm diverse family structures and collaborate effectively with interprofessional team members (4,5). Lastly, we will explore the current landscape of bereavement resources and discuss ways to develop more inclusive support programs. The session will include a mix of didactic content, case-based learning, and group dialogue to encourage meaningful discussion among participants. (2,4,5)

Implications:
Since 2020, America’s LGBTQIA+ population has doubled, even as anti-LGBTQIA+ sentiment has sharply increased. In this climate, it is more important than ever for HPC clinicians to understand the unique social and legal challenges faced by LGBTQIA+ individuals and their support networks. Clinicians must be prepared to provide affirming, inclusive care—especially when patients are at their most vulnerable.

References: 1. Stein GL, Berkman C, O'Mahony S, Godfrey D, Javier NM, Maingi S. 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;23(6):817-824. doi: 10.1089/jpm.2019.0542.

2. Acquaviva, KD. LGBTQ-inclusive hospice and palliative care: A practical guide to transforming professional practice. New York: Harrington Park Press, 2017. ​

3. Reich AJ, Perez S, Fleming J, et al. Advance care planning experiences among sexual and gender minority people. JAMA Netw Open 2022;5(7):e2222993. doi:10.1001/jamanetworkopen.2022.22993​

4. Javier NM. Palliative care needs, concerns, and affirmative strategies for the LGBTQ population. Palliat Care Soc Pract. 2021;15:26323524211039234. doi: 10.1177/26323524211039234

5. Rosa WE, Roberts KE, Braybrook D, et al. Palliative and end-of-life care needs, experiences, and preferences of LGBTQ+ individuals with serious illness: A systematic mixed-methods review. Palliat Med 2023;37(4):460-474. doi: 10.1177/02692163221124426.