Barriers to advance care planning identified for sexual and gender minorities

Discrimination in the health care system is an important barrier to advance care planning for sexual and gender-minority (SGM) people, according to a study published online July 20 in JAMA Network Open.

Amanda Jane Reich, Ph.D., from Brigham and Women's Hospital in Boston, and colleagues examined barriers and facilitators to advance care planning discussions among SGM people. The analysis included survey responses from 201 SGM people and 402 non-SGM people.

The researchers found that compared with non-SGM respondents, SGM respondents were more likely to respond with "I don't see the need" and "I feel discriminated against by others" as reasons for not completing advance care planning. Three main themes were identified from interviews among SGM participants, including how fear and experiences of discrimination affect selection of clinicians and whether to disclose SGM identity; concerns about whether end-of-life preferences and medical decision-makers would be supported; and a preference to discuss end-of-life decisions and values outside of clinical settings.

"More SGM-specific patient-centered care might better support these discussions within the health care system," the authors write. "Furthermore, health systems can facilitate improved engagement by supporting clinician sensitivity training, including guidance on documentation and requirements."