Training Health Care Providers Caring for Seriously Ill LGBTQ+ Persons and Their Partners: Project Respect

Background: Despite improvements in the social, cultural, and legal environment for lesbian, gay, bisexual, transgender, and queer (LGBTQ+) people, backlash in recent years has been severe, with increases in discrimination, harassment, and stigma, including in the provision of health care and palliative care. Objectives: To document disrespectful and discriminatory health care to seriously ill LGBTQ+ patients and partners and identify behaviors that might benefit from provider training to promote respectful and competent care to this population. Design: A cross-sectional mixed-methods study was conducted. Surveys were completed online and took about 15 minutes to complete. Settings/Subjects: LGBTQ+ people with a serious illness or their spouses, partners, and widows were recruited from national and local organizations in the United States that serve LGBTQ+ communities, including health care organizations, hospice and palliative care programs, and LGBTQ+-focused programs. Measurements: Open-ended questions on 11 types of discriminatory care to patients and 5 types of discriminatory care to partners due to sexual orientation or gender identity. Results: Seven areas of concern that are relevant to training health care providers were identified, including provider discomfort, lack of knowledge on health concerns, asking about important relationships, asking about sexual behaviors, psychosocial concerns, institutional responsibilities for training, and relationship between training and good care. Conclusions: Health care organizations and professional education should promote staff training and nondiscrimination policies to ensure that all patients and families are competently treated with equity and compassion, regardless of sexual orientation and gender identity, especially in conservative regions of the United States and when caring for transgender patients and communities of color.