School of Nursing, 5228University of Wisconsin-Madison, Madison, WI, USA.
Am J Hosp Palliat Care. 2021 Jun;38(6):644-649. doi: 10.1177/1049909121996276. Epub 2021 Feb 15.
LGBTQ+ individuals experience multiple challenges receiving quality care at the end of life, such as lack of confidence in the healthcare system to address their needs and lack of knowledge about advance care planning. Important gaps remain about the needs of LGBTQ+ individuals in the provider-patient relationship and how critical discussions about the end of life occur or do not occur in that relationship. The purpose of this study is to explore patients' narratives of their relationship with their provider and their experiences discussing end-of-life care with their providers, among patients who do and do not identify as LGBTQ+.
Twenty-nine attendants of an event devoted to LGBTQ+ health, 15 of which identified as LGBTQ+, completed an altered version of the CAHPS® Patient Narrative Elicitation Protocol. We used inductive content analysis to qualitatively analyze the data.
Respondents described wanting to be heard, finding safety and trust, and valuing competency in their relationship with their provider. Respondents who identified as LGBTQ+ additionally 1) valued providers who avoided making assumptions, 2) looked for cues of safety to indicate they would be accepted by the provider, and 3) sought providers competent in LGBTQ+ care needs. Few respondents had discussed end-of-life care with their provider, although some assumed that their provider may or may not be able to meet their needs based on aspects of their provider-patient relationship.
Strengthening patient-provider relationships may help improve the care of LGBTQ+ populations, particularly for the end of life.
LGBTQ+ 个体在生命末期接受高质量护理时会遇到多种挑战，例如对医疗保健系统满足其需求的信心不足，以及对预先护理计划的了解不足。在提供者-患者关系中，LGBTQ+ 个体的需求以及关于生命末期的重要讨论如何发生或不发生在这种关系中，仍存在重要差距。本研究的目的是探讨患者与提供者关系的叙述以及与提供者讨论临终关怀的经验，这些患者中有的认同 LGBTQ+，有的不认同。
29 名参加专门讨论 LGBTQ+健康问题活动的与会者完成了 CAHPS®患者叙事引出方案的修改版，其中 15 名参与者认同 LGBTQ+。我们使用归纳内容分析法对数据进行定性分析。
受访者描述了希望被倾听、寻求安全和信任，并重视与提供者的关系中的能力。认同 LGBTQ+的受访者还）重视避免做出假设的提供者，2）寻找安全线索以表明他们将被提供者接受，3）寻求在 LGBTQ+护理需求方面有能力的提供者。尽管一些患者假设他们的提供者可能或可能无法满足他们的需求，因为他们的提供者-患者关系的某些方面，但很少有受访者与他们的提供者讨论过临终关怀。
加强医患关系可能有助于改善 LGBTQ+人群的护理，特别是在生命末期。
