COMMENTARY

Palliative Care for Gender and Sexual Minorities

Betty R. Ferrell, PhD, RN

Disclosures

August 24, 2018

Unmet Opportunities in Palliative Care

Palliative care provides holistic care to patients with serious illnesses. However, as with all other specialties in healthcare, palliative care has not fully served sexual and gender minorities (SGMs). A recent article[1] looked at the status of palliative care for lesbian, gay, bisexual, and transgender people with serious illnesses and considered unmet opportunities to improve the care that these patients receive.

In their discussion of palliative care for SGMs, Maingi and colleagues[1] outlined the significant barriers to care for this population identified by the Institute of Medicine,[2] including the lack of education and research on SGM health needs, the lack of cultural competency on the part of healthcare providers, and the absence of legal protections for patients.

Best practices have been offered by key groups, including the American Society of Clinical Oncology.[3,4] These recommendations are summarized into categories of clinical practice, research, education, healthcare, and organizations/payers. The recommendations include many suggestions that can be integrated into current practice as well as the direction for some strategies that require further development and evaluation.

Clinical best practices include:

  • Asking patients about sexual orientation and gender identity, and respecting decisions to disclose or not disclose this to others;

  • Respecting patient wishes in regard to relationships with families of origin and families of choice;

  • Discussing and addressing patient wishes in regard to care decisions such as hormone therapy discontinuation;

  • Addressing mental health issues, suicide risk, and psychosocial distress;

  • Ensuring that standards for pain and symptom management are met; and

  • Addressing financial planning, burial rights, visitation, surrogate decision-making, child custody, and other legal issues.

Best practices in research, education, healthcare organizations, and payers are also offered in the article, as is a table of key resources and websites to support this work.

Viewpoint

This topic is of critical importance given that SGMs have higher rates of chronic illnesses as well as higher rates of mortality from those illnesses.[5] SGMs also experience higher rates of physical illnesses, such as cancer and HIV/AIDS, and more mental health conditions, including anxiety, depression, and substance use.

A key message in this article is that people from SGM groups deserve high-quality, respectful care in all phases of healthcare, but this is of special importance during serious illness and at the end of life.[6,7]

This article is particularly commendable because it moves beyond the discussion of barriers and weaknesses in care to formulating best practices in palliative and end-of-life care for SGMs. The palliative care community began this dialogue in the 1980s by demonstrating compassionate care at the height of the AIDS epidemic. In 2018 and beyond, palliative care has a continuing opportunity to model the best care for this group of patients and families.

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