Create a Safe Space for LGBTQ+ Patients and Staff

The quarterly educational session of the DFW Palliative Medicine Interest Group hosted Noelle Marie Javier, M.D., associate professor with the Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine, Mount Sinai, NY. On May 25, 2022, Dr. Javier presented “The Rainbow Connection: Creating a safe space for LGBTQ+ patients and staff.”

She shared her knowledge of the epidemiologic landscape and health disparities affecting the LGBTQ+ population, along with concepts surrounding better cultural understanding and practical methods to help improve communication and clinical care strategies. For example, Gallup showed a marked increase in Americans identifying themselves as LGBT – expanding from 3.5% in 2012 to 7.1% in 2021. Approximately one in five Gen-Z adults consider themselves part of the LGBTQ+ demographic. About 1 million Americans identified as transgender in 2016.

Sexual and gender minorities have officially been designated as a “health disparity” population, citing a variety of barriers leading to disproportionate care:

• Structural barriers

• Financial constraints

• Lack of provider education and training

• History of stigma and oppression

• Scant research

• Gaps in policies and regulations

• Invisibility detransitioning

She cited recent research documenting disrespectful and discriminatory treatment of LGBTQ+ patients and families in hospice and palliative care settings. Although legislation may not provide protection for this population, we can look for appropriate guidance from the AMA Code of Medical Ethics and other leading health care provider organizations.

Some tips for building inclusive and affirmative care practices include:

• Creating a welcoming environment by displaying LGBT-friendly symbols or publications in the facility and including gender-neutral restrooms.

• Start by sharing some of your own personal history before asking about your patient’s social history.

• Normalize the respectful collection of SOGI (Sexual Orientation and Gender Identity) data during registration. Adapt forms to be inclusive, such as offering pronouns or labeling family contacts as spouse/partner rather than husband/wife.

• Offer resources and referral programs (support groups, LGBTQ+ activities, community advisory groups)

• Be aware of your biases. Encourage cultural competency and unconscious bias training for staff.

• Lived experiences matter! Initiate open dialogue about life circumstances and LISTEN to each person’s story. Include chosen families in the discussions.

• Be sensitive to the history of stigma, trauma, mental health issues, past surgeries or medications. Always ensure privacy and confidentiality.

• Practice the Dignity Question: “What do I need to know about you as a person to give you the best care possible?”