New research highlights the need for LGBT patientsparticularly those with intersecting minority identitiesto be collaborative with their health providers in making medical decisions.
LGBT patients experience numerous health disparities, and are frequently more reticent to access care, due to a lack of understanding of LGBT issues among health providers, among other issues. That problem is frequently compounded when the patient is of one or more minority identities, according to the research, which was published March 17 in the Journal of General Internal Medicine.
"A critical part of improving care for LGBT people of color is improving communication back and forth between patients and providers, so the papers provide a framework that both sides bring to the patient encounter," said co-author Marshall Chin, MD, associate chief and director of research in general medicine at University of Chicago Medicine. "…The whole crux of the project is to improve decision-making between patients and clinicians. Since values and preferences are elicited and respected, options are given to patients, and decisions are made jointly. It becomes crucial to understand each patient's values and where they are coming from."
Chin explained a number of cultural barriers that might impede communication between LGBT patients with intersecting identities and their providers.
"What's shared is a general sense that LGBTQ folks are 'different,'" he said. "But other issues can includein the Asian-American community, for examplethe concept of filial piety, the duty of the son or daughter to the parents or the wider family, and having children and the continuation of bloodlines. That brings additional elements of guilt to an LGBT person. Another example in Asian-American or Hispanic communities, is undocumented statusthat provides an additional pressure on the ability to have open communication."
Becoming aware of additional pressures such as these make providers more inclined to create safe spaces in which patients feel safe to fully disclose their issues. "I like to start with open-ended questions, getting people to tell me their story, for example, and [explain] what's important in their lives," Chin noted. "Oftentimes, you just follow their lead."
Chin said that the provider's institution can contribute to the process by a number of means, such as ensuring privacy by providing enough space between intake and waiting areas, and training intake personnel in cultural competency on LGBT individuals as well as persons of color. Having records or paperwork include prompts reminding personnel to ask about potential conditions or treatments was another example.
"A patient should have an empowered mindset," he added. "Though when someone is sick is when they often feel the least powerful. But increasingly, clinicians are being trained that there is a value in shared decision-making and patient-empowerment, so we are encouraging people to speak up. A clinician knows that they can't take care of a patient unless they have all the information they need for tailored, individualized care that best their needs, purposes and values."