Licensed from: AdobeStock 316935357
Lesbian, gay, bisexual, transgender, queer and other sexual or gender minority individuals (LGBTQ+) often face discrimination which can impact access to health care, hospice and end of life (EOL) care. Effective hospice and EOL care requires a safe environment in which clients and caregivers can have their individual needs met. The use of language by health care providers plays a large role in establishing a safe environment. Reynaga (2022) and colleagues conducted a study to examine health care providers’ language and their use of cognitive frames to explore their underlying attitudes and beliefs regarding working with LGBTQ+ patients and caregivers.
The authors identified four frames including: pathologizing, homogenizing, normalizing, and individualizing.
Normalizing: The use of terms and examples that frame LGBTQ+ individual as no different from anyone else. This may be well intended but also ignores or erases how LGBTQ+ individuals are treated differently in many sociocultural spaces. Examples: “I don’t think it makes a difference in terms of the care that you provide.” or “We treat everyone equally.”
Homogenizing: The portrayal or description of LGBTQ+ individuals in terms of one or more stereotypical or supposedly intrinsic traits. Additionally, when HCT members use terms and frames that tend to gloss over different subgroups within the LGBTQ+ spectrum. Examples: “It’s just a part of who they are just like you have blonde hair and you know, I wear glasses and I’m gay or I’m not gay or whatever.” or “Gay or transgender, or whatever.”
Pathologizing: The use of terms, metaphors and other references that frame being LGBTQ+ as a disease, condition, abnormality or unhealthy state. Example: “Like I know when people are drinkers or drug addicts, many nurses have a preconceived notion about those patients and about patients who may be, you know, gay or transgender, or whatever.”
Individualizing: When HCT members recognize the variation within LGBTQ+ groups as well as between LGBTQ+ groups and non-LGBTQ+ groups, when providers align themselves with LGBTQ+ groups through bridging or belonging, or when LGBTQ+ identities are historically, socially, and culturally situated in relation to each other and a broader context. Example: “…There’s so much variety—so much individual differences in human nature that it would be impossible to ever be an expert on all of it.”
The individualizing frame lends itself more to person-centered care focused on identifying and accommodating individual needs, which is most aligned with the philosophy of hospice palliative care. In contrast, the normalizing frame represented the opposite viewpoint from the individualizing frame.
Identifying and understanding the discursive biases within the frames used to discuss this population is a vital next step in promoting health equity for the LGBTQ+ population.
The study highlighted the importance of language and supports the need for ongoing education and training regarding the needs of LGBTQ+ patients and families within the context of hospice and EOL care.
Source: Reynaga, M., Bybee, S., Gettens, C., Tay, D. L., Reblin, M., Ellington, L., & Cloyes, K. G. (2022). “We Treat Everyone Equally”: Hospice Care Team Members’ Language Use Regarding Sexual and Gender Minority Patients and Caregivers. American Journal of Hospice and Palliative Medicine®, 10499091221116634.
,
