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AHRQ Research Advances Shared Decisionmaking Strategies for Ethnic Minority LGBT Populations
Ensuring that LGBT patients get access to the high-quality care they deserve is a priority for Department of Health and Human Services (HHS) agencies. LGBT individuals face substantial barriers to quality health care, including refusals of care, substandard care, inequitable policies and practices, and exclusion from health outreach or education efforts. These barriers can lead to disparities and increased health risks. Combating these barriers can be accomplished by applying patient-centered care and shared decisionmaking techniques when caring for LBGT populations.
For example, in May 2015, the Centers for Medicare & Medicaid Services issued guidance clarifying that the preventive services available under the Affordable Care Act are available to all, regardless of an individual’s gender identity, sex assigned at birth, or recorded gender. In addition, the Office of Adolescent Health works directly with young LGBT people, helping them fight the stigma and discrimination that can put them at greater risk for negative health outcomes.
Even with these efforts, many in the LGBT community still experience health disparities, especially those that are both LGBT and racial/ethnic minorities. Most clinicians have only a basic level of LGBT cultural competence, and few understand how race and ethnicity further add to the complexities of treating LGBT patients. This often leaves these dual minority patients unable to engage in the high-quality shared decisionnmaking that is essential to patient-centered care.
Thanks to AHRQ-funded research that was published in the March issue of the Journal of General Internal Medicine, clinicians and health care organizations now have tools and resources on how to reduce health and health care disparities experienced by dual LGBT racial/ethnic minority patients through improved shared decisionnmaking.
Findings from this research can guide interventions between patients and clinicians and offer suggestions on how organizations can incorporate shared decisionnmaking that supports LGBT patients. For example, one article proposes a conceptual model for how an ethnic LGBT patient’s multiple, intersecting social identities create added challenges to clear and open communication. A systematic review found that decision aids delivered via personal counseling and multi-media and print materials improved decision quality and patient-doctor communication in a majority of the studies reviewed. A third article identifies drivers, ranging from health information technology to an organization’s physical layout and workflows, which improve clinician-patient interaction and, ultimately, shared decisionnmaking. The articles and editorial include:
- “Development of a Conceptual Framework for Understanding Shared Decision-Making among African-American LBGT Patients and their Clinicians”
- “Use of Decision Aids with Minority Patients: A Systematic Review”
- “A Model of Organizational Context and Shared Decision Making Application to LGBT Racial and Ethnic Minority Patients”
- “Improving Shared Decision Making with LGBT Racial and Ethnic Minority Patients”
Understanding the barriers that prevent dual LGBT racial/ethnic minority patients from effectively communicating with their doctors is key to reducing disparities in quality health care for this population. This research represents some of the work being done by AHRQ and its HHS sister agencies to ensure that high-quality health care is available to all, regardless of gender, race, or ethnicity.