Innovation, collaboration key to fighting racial disparities for LGBT patients

Trust is essential in providing equal access to care and improving outcomes
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Lesbian, gay, bisexual and transgender (LGBT) patients of color face significant health outcome disparities compared to their white counterparts. A team at the University of Chicago has dedicated itself to easing these inequities and finding ways to establish trust between these patients and their healthcare providers, enabling them to work together to ensure the patients' health and improve their long-term outcomes, according to the university's Science Life magazine.

For example, the Your Voice! Your Health! program, funded by the Agency for Healthcare Research and Quality, aims to improve access and education for LGBT patients of color. The team's goal is to use a multi-layered approach to make the healthcare system work for people whose identities place them at the intersection of marginalized groups. 

"Racial/ethnic, sexual orientation, and gender identity minority status are all marginalized social identities, so they act in concert to further marginalize people who are trying to navigate the healthcare system," Monica Peek, M.D., of University of Chicago Medicine, told the magazine. "One of the things that we're trying to understand better is how people make choices about healthcare when they are standing at the intersection of multiple social groups that have historically experienced societal discrimination and disparities in healthcare delivery," 

The idea of "intersectionality" lies at the heart of the Chicago project, the notion each person's identity is composed of multiple levels of social categorization, all of which affect that person's experience of society and the healthcare system. 

The team published three papers about their findings in the National Journal of Internal Medicine.

The first paper discussed the importance of establishing trust between healthcare providers and patients from marginalized groups, whereas the second paper dealt with "decision aids," or educational interventions such as one-on-one counseling, self-guided materials or multimedia tools.

When the team began to study this topic, they were stunned by the paucity of research into the issue of creating decision aids for ethnic and minority patients. Out of 600 extant decision aid programs, only 16 were aimed at ethnic minorities. Most of those--73 percent--were dedicated to cancer screening.

"There are a lot of opportunities for decision aids to be tested and used in these double minority groups, because they have a lot of issues that could be really helped by using tools that facilitate conversations with their doctors," said Aviva Nathan, lead author of the second paper.

The third paper discussed how healthcare providers and institutions can work across department lines and at multiple levels to create an environment that is welcoming to LGBT patients of color and their needs. 

It focused on six key areas where hospitals and healthcare institutions can make strides to establish parity between the treatment of straight and LGBT patients of all races: workflows, health information technology, organizational structure and culture, resources and clinic environment, training and education, and incentives and disincentives.

Studies have shown that even well-meaning straight healthcare providers can be unconsciously biased against LGBT patients. Health reform efforts like the Affordable Care Act have reduced some of the disparities experienced by LGBT patients, but much work remains to be done. Culturally competent doctors can be few and far between, leading some transgender patients to form their own information networks regarding "trans-friendly" doctors.

To learn more:
- here's the article
- read the first, second and third papers
- visit the Your Voice! Your Health! website

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