Clinical care needs and experiences for patients with spinal cord injury identifying as LGBT

LGBT 脊髓损伤患者的临床护理需求和经验

• 批准号: 10886486
• 负责人: Beatrice Jenny Kiratli
• 金额: --
• 依托单位: VETERANS ADMIN PALO ALTO HEALTH CARE SYS
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-10-01 至 2024-09-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10886486
• 关键词: Address; Age; Area; Attention; Attitude; Awareness; Behavior; Bisexual; Bladder; Body Image; Caring; Chronic; Classification; Clinical; Communities; Complex; Country; Data; Development; Discipline; Discipline of Nursing; Discrimination; Disease; Equity; Ethnic Origin; Exclusion; Face; Female; Fright; Future; Gays; Geographic Locations; Goals; Health; Health Personnel; Health Professional; Health Surveys; Healthcare; Healthcare Systems; Individual; Inpatients; International; Intersex; Interview; Intestines; Knowledge; Lesbian; Lesbian Gay Bisexual; Lesbian Gay Bisexual Transgender; Literature; Mammography; Medical; Mental Depression; Mental Health; Mental Health Services; Methodology; Military Personnel; Mission; Modeling; Nurse Practitioners; Nurses; Operative Surgical Procedures; Outpatients; Participant; Patients; Personal Satisfaction; Persons; Physical Function; Physicians; Pilot Projects; Policies; Population; Prostate; Provider; Psychologist; Psychosocial Assessment and Care; Publishing; Qualitative Research; Quality of Care; Quality of life; Recording of previous events; Rehabilitation therapy; Reporting; Research; Research Methodology; Research Personnel; Resistance; Resources; Risk; Rural; Sampling; Services; Sex Functioning; Sexual and Gender Minorities; Sexuality; Social Workers; Societies; Spinal cord injury; Structure; Suicide; Surgeon; Surveys; System; Testing; Training; Training Programs; Trust; Validation; Veterans; Woman; access disparities; active duty; clinical care; cohort; design; disability; distrust; experience; health care availability; health equity; health equity promotion; health inequalities; health service use; improved; injured; innovation; male; marginalization; medical specialties; member; novel; patient oriented; perceived discrimination; physical conditioning; population based; programs; psychosocial; racial population; recruit; rural setting; screening; service member; sexual trauma; social; social culture; telehealth; transgender; transgender men; transgender women; urban setting

Background: Numerous challenges are faced by individuals in the general community who identify as lesbian, gay, bisexual or transgender (LGBT) when seeking healthcare. The LGTB community reports harassment, disrespect, discrimination and delay in care as well as reduced likelihood to receive needed screening tests. Many LGBT Veterans are resistant to seeking VA healthcare at all based on past discrimination (perceived and real) and an unwelcoming system. For LGTB Veterans with spinal cord injury and disorders (SCI/D), there are likely additional considerations related to sexuality, bowel and bladder care, body image and mental health. Health care providers often lack experience in dealing with the physical and mental health and sociocultural issues related to LGBT identity, especially in the context of delivering SCI specialty care. Therefore, there is a great need for information on the experiences and unmet needs of this population in order to design VA clinical programs to correctly and sensitively address their complex health care needs and promote their wellbeing. Significance/Impact: This pilot project addresses HSR&D priority areas of Access to Care, Health Equity, and Disability/SCI. Our overarching goal is to open the door to improving VA health care for this vulnerable and understudied population. Based on limited clinical experience, awareness of the problems commonly faced by individuals with SCI/D, and extrapolation from published findings from the non-disabled LGBT population, we expect to find significant disparity in access to knowledgeable clinicians who are sensitive to the specific needs of LGBT Veterans who live with SCI/D. Our study will provide essential information from both Veteran and provider perspectives to begin to fill this gap and contribute invaluable data towards developing solutions. Innovation: This project is innovative as there is a dearth of information regarding health care needs of LGBT Veterans with SCI/D. The investigative team includes experts in LGBT health care within and outside VA; VA SCI clinicians; and VA researchers with expertise in SCI/D clinical care and programs, qualitative methodology, and VA program implementation. Evidence of SCI/D and Veteran-specific experiences and barriers as well as VA provider knowledge and attitudes will be novel information not available in the literature. Specific Aims: 1) Elicit the perspectives of LGBT Veterans with SCI/D about their experiences with VA care, and 2) Elicit the experiences of SCI/D providers and their approaches to caring for LGBT Veterans with SCI/D. Methodology: We will apply qualitative methodology to elicit (i) personal perspectives and lived experiences of 25 Veterans and (ii) attitudes and knowledge/awareness of 15 health care professionals whose focus is SCI/D care. We will sample from the 25 VA SCI/D Centers to include different regions of the country, sampling urban and rural settings. We will aim for inclusion across the LGBT spectrum and will over-recruit female participants to include the potentially unique perspectives of women with SCI/D. We will aim to recruit a range of ages as well as SCI chronicity ranging from recently injured to SCI of long duration. We will include all ethnic/racial groups in order to explore potential cultural issues. The VA SCI/D provider cohort will include physicians and surgeons, nurse practitioners, nurses, therapists, psychologists, social workers, and any relevant disciplines. We will conduct semi-structured interviews with open-ended questions and prompts and then perform matrix analysis drawing from existing SCI/D and LGBT literature to identify barriers, attitudes, and experiences of patient and clinician cohorts. We will probe for positive experiences in addition to barriers and unmet needs. We will primarily use the Health Equity Promotion model as the basis for our domains of enquiry overlaid with the theoretical framework of the International Classification of Functioning, Health and Disability. Implementation / Next Steps: Future research may involve validation of our findings via a more comprehensive qualitative study, a population-based survey, analysis of relevant health services utilization, and development of training programs to better meet the needs of this population through implementation of targeted care.

背景：普通社区中的个人面临许多挑战，他们认为是女同性恋， 寻求医疗保健时，同性恋，双性恋或变性者（LGBT）。 LGTB社区报告骚扰， 不尊重，歧视和延迟护理以及降低可能接受所需筛查测试的可能性。 许多LGBT退伍军人都基于过去的歧视（感知到 真实）和一个不受欢迎的系统。对于患有脊髓损伤和疾病的LGTB退伍军人（SCI/D），有 可能与性，肠和膀胱护理，身体形象和心理健康有关的其他考虑因素。 医疗保健提供者通常缺乏处理身心健康和社会文化的经验 与LGBT身份有关的问题，尤其是在提供SCI专业护理的背景下。因此，有一个 非常需要有关该人群的经验和未满足需求的信息，以设计VA临床 旨在正确，敏感地满足其复杂的医疗保健需求并促进其福祉的计划。 意义/影响：该试点项目涉及获得护理，健康公平和的优先领域 残疾/科学。我们的总体目标是为改善这种脆弱的VA医疗保健打开大门 研究的人口。基于有限的临床经验，对通常面临的问题的认识 具有SCI/D的个体，并从非贫困LGBT人群发表的发现中推断出来，我们 期望在访问知识渊博的临床医生方面发现巨大的差异，这些临床医生对特定需求敏感 与Sci/d一起生活的LGBT退伍军人我们的研究将提供资深人士和 提供者的观点开始填补这一空白，并为开发解决方案提供宝贵的数据。 创新：该项目具有创新性，因为缺乏有关LGBT医疗保健需求的信息 带有科幻/d的退伍军人。调查团队包括弗吉尼亚州内外LGBT医疗保健专家； VA 科学临床医生；以及具有科学/D临床护理和计划专业知识的VA研究人员，定性方法论， 和VA计划实施。科学/D的证据和经验丰富的经验和障碍以及 VA提供者的知识和态度将是文献中无法获得的新颖信息。 具体目的：1）通过科学/d引起LGBT退伍军人的观点，以了解他们在VA Care的经历 2）引发科幻提供者的经验及其对LGBT退伍军人的照顾方法。 方法论：我们将采用定性方法来引起（i）个人观点和生活经验 25名退伍军人和（ii）15位卫生保健专业人员的态度和知识/知识，他们的重点是Sci/D 关心。我们将从25个VA SCI/D中心进行采样，以包括该国的不同地区，对Urban进行采样 和农村环境。我们将旨在遍及LGBT频谱，并将过度招募女性参与者 包括科幻女性的潜在独特观点。我们将旨在招募一系列年龄 以及SCI的慢性性，从最近受伤到长时间的SCI。我们将包括所有种族/种族 群体以探索潜在的文化问题。 VA Sci/D提供商队列将包括医生， 外科医生，护士从业人员，护士，治疗师，心理学家，社会工作者和任何相关学科。 我们将使用开放式问题和提示进行半结构化访谈，然后执行矩阵 分析从现有的SCI/D和LGBT文献中绘制，以确定障碍，态度和经验 患者和临床医生队列。除了障碍和未满足的需求外，我们还将探究积极的经验。 我们将主要使用健康公平促进模型作为与我们的询问领域覆盖的基础 国际功能，健康和残疾分类的理论框架。 实施 /下一步：未来的研究可能涉及通过更全面的发现验证我们的发现 定性研究，基于人群的调查，相关卫生服务利用的分析以及发展 通过实施目标护理，可以更好地满足该人群的需求。