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Abstract
Background Healthcare organisations have legal and ethical duties to reduce inequalities in access to healthcare services and related outcomes. However, lesbian, gay, bisexual and/or transgender (LGBT+) people continue to experience and anticipate discrimination in health and social care. Skilled communication is vital for quality person-centred care, but there is inconsistent provision of evidence-based clinician education on health needs and experiences of LGBT+ people to support this. This study aimed to identify key stakeholders’ experiences, preferences and best practices for communication regarding sexual orientation, gender identity and gender history in order to reduce inequalities in healthcare.
Methods Semistructured qualitative interviews with LGBT+ patients with serious illness, significant others and clinicians, recruited via UK-wide LGBT+ groups, two hospitals and one hospice in England. We analysed the interview data using reflexive thematic analysis.
Results 74 stakeholders participated: 34 LGBT+ patients with serious illness, 13 significant others and 27 multiprofessional clinicians. Participants described key communication strategies to promote inclusive practice across three domains: (1) ‘Creating positive first impressions and building rapport’ were central to relationship building and enacted through routine use of inclusive language, avoiding potentially negative non-verbal signals and echoing terminology used by patients and caregivers; (2) ‘Enhancing care by actively exploring and explaining the relevance of sexual orientation and gender identity’, participants described the benefits of clinicians initiating these discussions, pursuing topics guided by the patient’s response or expressed preferences for disclosure. Active involvement of significant others was encouraged to demonstrate recognition of the relationship; these individual level actions are underpinned by a foundation of (3) ‘visible and consistent LGBT+ inclusiveness in care systems’. Although participants expressed hesitance talking about LGBT+ identities with individuals from some sociocultural and religious backgrounds, there was widespread support for institutions to adopt a standardised, LGBT+ inclusive, visibly supportive approach.
Conclusions Person-centred care can be enhanced by incorporating discussions about sexual orientation and gender identity into routine clinical practice. Inclusive language and sensitive exploration of relationships and identities are core activities. Institutions need to support clinicians through provision of adequate training, resources, inclusive monitoring systems, policies and structures. Ten inclusive communication recommendations are made based on the data.
- communication
- healthcare quality improvement
- health professions education
- patient-centred care
- qualitative research
Data availability statement
No data are available. To preserve the pseudonymity of the interviewees, the transcribed interviews are not available for sharing.
This is an open access article distributed in accordance with the Creative Commons Attribution 4.0 Unported (CC BY 4.0) license, which permits others to copy, redistribute, remix, transform and build upon this work for any purpose, provided the original work is properly cited, a link to the licence is given, and indication of whether changes were made. See: https://creativecommons.org/licenses/by/4.0/.
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- communication
- healthcare quality improvement
- health professions education
- patient-centred care
- qualitative research
Data availability statement
No data are available. To preserve the pseudonymity of the interviewees, the transcribed interviews are not available for sharing.
Supplementary materials
Supplementary Data
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Footnotes
Twitter @DEBraybrook
Correction notice This article has been updated since it was first published online. The IQ Joint study group has been added to the author list. In addition to this, blinded data in the methods section has been updated with the correct information.
Contributors RH and KB conceived the study, supported by PC, KJ, RR and KES. Study coordination was led by DB and supported by AR and LT. Recruitment was led by DB, KB, SM, KES and LT, and supported by PC, ED and RR. DB conducted the interviews, participated in transcription, reviewed and analysed the transcripts, and wrote the first version of the manuscript. DB conducted data analysis with input from KB and RH, and review by all authors. KB, RH and KES were involved in initial critical review and revision of the manuscript, followed by all authors. All authors read and approved the final version of the manuscript. RH is the guarantor.
Funding This study is funded by the National Institute for Health Research (NIHR) under its Research for Patient Benefit programme (Grant Reference Number PB-PG-0816-20001), and supported by the NIHR Applied Research Collaboration South London (NIHR ARC South London) at King’s College Hospital NHS Foundation Trust. The views expressed are those of the authors and not necessarily those of the NIHR or the Department of Health and Social Care.
Competing interests KB, SM, KJ and RH have received funding from the NIHR for other research work, and DB, KB, PC, RH and LT are members of the EAPC task force on improving palliative and end-of-life care for LGBT+ people.
Provenance and peer review Not commissioned; externally peer reviewed.
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