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Advance Care Planning Experiences Among Sexual and Gender Minority People
IMPORTANCE: Advance care planning (ACP) can promote patient-centered end-of-life (EOL) care and is intended to ensure that medical treatments are aligned with patient’s values. Sexual and gender minority (SGM) people face greater discrimination in health care settings compared with heterosexual, cis...
Autores principales: | , , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
American Medical Association
2022
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9301514/ https://www.ncbi.nlm.nih.gov/pubmed/35857322 http://dx.doi.org/10.1001/jamanetworkopen.2022.22993 |
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author | Reich, Amanda Jane Perez, Stephen Fleming, Julia Gazarian, Priscilla Manful, Adoma Ladin, Keren Tjia, Jennifer Semco, Robert Prigerson, Holly Weissman, Joel S. Candrian, Carey |
author_facet | Reich, Amanda Jane Perez, Stephen Fleming, Julia Gazarian, Priscilla Manful, Adoma Ladin, Keren Tjia, Jennifer Semco, Robert Prigerson, Holly Weissman, Joel S. Candrian, Carey |
author_sort | Reich, Amanda Jane |
collection | PubMed |
description | IMPORTANCE: Advance care planning (ACP) can promote patient-centered end-of-life (EOL) care and is intended to ensure that medical treatments are aligned with patient’s values. Sexual and gender minority (SGM) people face greater discrimination in health care settings compared with heterosexual, cisgender people, but it is unknown whether such discrimination occurs in ACP and how it might affect the ACP experiences of SGM people. OBJECTIVES: To increase understanding of barriers and facilitators of ACP facing SGM individuals. DESIGN, SETTING, AND PARTICIPANTS: This mixed-methods national study of ACP included a telephone survey of self-identified SGM and non-SGM participants in a nationally representative sample drawn from a larger omnibus national panel by SSRS. Qualitative interviews were conducted with a subset of survey participants who identified as SGM. Data were collected from October 2020 to March 2021. EXPOSURES: Self-identified SGM. MAIN OUTCOMES AND MEASURES: The survey included 4 items from the validated ACP Engagement Survey, adapted to capture experiences of discrimination. Interviews asked about participants’ experiences with ACP, including the appointment of medical decision-makers, sharing preferences, and experiences within the health care system more broadly. RESULTS: A total of 603 adults participated in the survey, with 201 SGM individuals (mean [SD] age, 45.7 [18.7] years; 101 [50.2%] female; 22 [10.9%] Black, 37 [18.4%] Hispanic, and 140 [69.7%] White individuals) and 402 non-SGM individuals (mean [SD] age, 53.7 [19.2] years; 199 [49.5%] female; 35 [8.7%] Black, 41 [10.2%] Hispanic, and 324 [80.6%] White individuals). Regarding reasons for not completing ACP, SGM respondents, compared with non-SGM respondents, were more likely to say “I don’t see the need” (72 [73.5%] vs 131 [57.2%], P = .006) and “I feel discriminated against by others” (12 [12.2%] vs 6 [2.6%], P < .001). Of 25 completed interviews among SGM participants, 3 main themes were identified: how fear and experiences of discrimination affect selection of clinicians and whether to disclose SGM identity; concerns about whether EOL preferences and medical decision-makers would be supported; and a preference to discuss EOL decisions and values outside of clinical settings. CONCLUSIONS AND RELEVANCE: This study found that fear of disclosing sexual orientation or gender identity information and discrimination are important barriers to ACP for SGM in clinical settings, but discussions of preferences and values still occur between many SGM people and medical decision-makers. More SGM-specific patient-centered care might better support these discussions within the health care system. Furthermore, health systems can facilitate improved engagement by supporting clinician sensitivity training, including guidance on documentation and requirements. |
format | Online Article Text |
id | pubmed-9301514 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2022 |
publisher | American Medical Association |
record_format | MEDLINE/PubMed |
spelling | pubmed-93015142022-08-11 Advance Care Planning Experiences Among Sexual and Gender Minority People Reich, Amanda Jane Perez, Stephen Fleming, Julia Gazarian, Priscilla Manful, Adoma Ladin, Keren Tjia, Jennifer Semco, Robert Prigerson, Holly Weissman, Joel S. Candrian, Carey JAMA Netw Open Original Investigation IMPORTANCE: Advance care planning (ACP) can promote patient-centered end-of-life (EOL) care and is intended to ensure that medical treatments are aligned with patient’s values. Sexual and gender minority (SGM) people face greater discrimination in health care settings compared with heterosexual, cisgender people, but it is unknown whether such discrimination occurs in ACP and how it might affect the ACP experiences of SGM people. OBJECTIVES: To increase understanding of barriers and facilitators of ACP facing SGM individuals. DESIGN, SETTING, AND PARTICIPANTS: This mixed-methods national study of ACP included a telephone survey of self-identified SGM and non-SGM participants in a nationally representative sample drawn from a larger omnibus national panel by SSRS. Qualitative interviews were conducted with a subset of survey participants who identified as SGM. Data were collected from October 2020 to March 2021. EXPOSURES: Self-identified SGM. MAIN OUTCOMES AND MEASURES: The survey included 4 items from the validated ACP Engagement Survey, adapted to capture experiences of discrimination. Interviews asked about participants’ experiences with ACP, including the appointment of medical decision-makers, sharing preferences, and experiences within the health care system more broadly. RESULTS: A total of 603 adults participated in the survey, with 201 SGM individuals (mean [SD] age, 45.7 [18.7] years; 101 [50.2%] female; 22 [10.9%] Black, 37 [18.4%] Hispanic, and 140 [69.7%] White individuals) and 402 non-SGM individuals (mean [SD] age, 53.7 [19.2] years; 199 [49.5%] female; 35 [8.7%] Black, 41 [10.2%] Hispanic, and 324 [80.6%] White individuals). Regarding reasons for not completing ACP, SGM respondents, compared with non-SGM respondents, were more likely to say “I don’t see the need” (72 [73.5%] vs 131 [57.2%], P = .006) and “I feel discriminated against by others” (12 [12.2%] vs 6 [2.6%], P < .001). Of 25 completed interviews among SGM participants, 3 main themes were identified: how fear and experiences of discrimination affect selection of clinicians and whether to disclose SGM identity; concerns about whether EOL preferences and medical decision-makers would be supported; and a preference to discuss EOL decisions and values outside of clinical settings. CONCLUSIONS AND RELEVANCE: This study found that fear of disclosing sexual orientation or gender identity information and discrimination are important barriers to ACP for SGM in clinical settings, but discussions of preferences and values still occur between many SGM people and medical decision-makers. More SGM-specific patient-centered care might better support these discussions within the health care system. Furthermore, health systems can facilitate improved engagement by supporting clinician sensitivity training, including guidance on documentation and requirements. American Medical Association 2022-07-20 /pmc/articles/PMC9301514/ /pubmed/35857322 http://dx.doi.org/10.1001/jamanetworkopen.2022.22993 Text en Copyright 2022 Reich AJ et al. JAMA Network Open. https://creativecommons.org/licenses/by/4.0/This is an open access article distributed under the terms of the CC-BY License. |
spellingShingle | Original Investigation Reich, Amanda Jane Perez, Stephen Fleming, Julia Gazarian, Priscilla Manful, Adoma Ladin, Keren Tjia, Jennifer Semco, Robert Prigerson, Holly Weissman, Joel S. Candrian, Carey Advance Care Planning Experiences Among Sexual and Gender Minority People |
title | Advance Care Planning Experiences Among Sexual and Gender Minority People |
title_full | Advance Care Planning Experiences Among Sexual and Gender Minority People |
title_fullStr | Advance Care Planning Experiences Among Sexual and Gender Minority People |
title_full_unstemmed | Advance Care Planning Experiences Among Sexual and Gender Minority People |
title_short | Advance Care Planning Experiences Among Sexual and Gender Minority People |
title_sort | advance care planning experiences among sexual and gender minority people |
topic | Original Investigation |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9301514/ https://www.ncbi.nlm.nih.gov/pubmed/35857322 http://dx.doi.org/10.1001/jamanetworkopen.2022.22993 |
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