"We Have a Long Way to Go": Palliative Care Clinicians' Reflections on Inclusive care for LGBTQI+ Older Adult Patients and Care Partners

BACKGROUND AND OBJECTIVES: Prior research with older lesbian, gay, bisexual, transgender, queer, and intersex (LGBTQI+) populations indicates a need for greater documentation of palliative care clinicians' perspectives on communication and clinician knowledge about these patients' needs. LGBTQI+ patients report barriers to their disclosure of sexual orientation and gender identity data, dismissal of chosen care partners, and personal experiences of discrimination in palliative care.

RESEARCH DESIGN AND METHODS: Queer gerontology was applied in this qualitative descriptive study. One-on-one interviews were transcribed, coded, and analyzed using reflexive thematic analysis. Twenty clinicians and associated health care professionals with palliative care training who currently or within the past five years had provided care and/or treatment for older LGBTQI+ patients living with serious illness within Colorado participated in this study.

RESULTS: Three main themes emerged: 1) Limited visibility of LGBTQI+ patients, 2) Asking about sexual orientation and gender identity, and 3) Acknowledging limitations around the current state of care for LGBTQI+ patients and care partners.

DISCUSSION AND IMPLICATIONS: Clinical environments must be inclusive and welcoming to promote a safe space for lesbian, gay, bisexual, transgender, queer, and intersex patients and care partners. Avoiding assumptions around these patients having the same or similar experiences to cisgender, heterosexual patients is critical to making meaningful connections. There is a significant need for lesbian, gay, bisexual, transgender, queer, and intersex-specific culturally relevant training. We recommend improvements in communication, inclusivity, and training/education. Findings indicate several areas to improve trust, equity, and inclusivity.