216 - Investigating LGBTQ+ Experiences in Pediatric Care Through Multi-Informant Perspectives

Publication Number: 216.5515

Bridge F. Dorsey, University of Utah, Salt Lake City, UT, United States; Meg Grimshaw, University of Utah School of Medicine, Salt Lake City, UT, United States; Raquel Maynez, University of Utah School of Medicine, Salt Lake City, UT, United States; Austin R. Waters, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States; Sarah Wawrzynski, Nemours Childrens Hospital, Delaware, Wilmington, DE, United States; Laura Hult, University of Utah, Salt Lake City, UT, United States; Katie Gradick, University of Utah Health, Salt Lake City, UT, United States

Background: Discrimination in healthcare has created disparities in care quality and access for LGBTQ+ individuals. Few populations are more vulnerable than children with life-limiting illness, but little is known about palliative providers’ ability to offer inclusive care to LGBTQ+ children and adolescents. This study addresses gaps in understanding pediatric palliative care providers' readiness to deliver LGBTQ+-inclusive care, aiming to identify barriers and educational opportunities at Primary Children’s Hospital (PCH) in Salt Lake City, Utah.

Objective: We used qualitative methods to explore PCH provider practices and perceptions regarding LGBTQ+ inclusivity, with an emphasis those who care for children with life-threatening and life-limiting illnesses.

Design/Methods: Providers and clinical staff caring for children with life-threatening or life-limiting illnesses at PCH were recruited via flyers and departmental announcements for 30–45-minute semi-structured interviews. Interview guides were developed with content experts and piloted with feedback from LGBTQ+ patients and providers. Nineteen interviews were recorded, transcribed, and analyzed using inductive qualitative methods.

Results: Our analysis revealed three primary themes: 1) concerns about inclusivity of the hospital environment, including lack of LGBTQ+ imagery on walls/pamphlets, inability of colleagues to be out at work, and inconsistent collection of pronouns and sexual orientation and gender identity (SOGI) data in the electronic health record (EHR); 2) suboptimal self-assessed knowledge about how to best support LGBTQ+ patients and families, including provider-acknowledged religious or cultural barriers to engagement with LGBTQ+ families, concerns about offending families by asking for pronouns or SOGI data, and lack of awareness of specific hospital or local support resources for LGBTQ+ families; and 3) openness to training and quality improvement in serving LGBTQ+ families, including improved data collection, use of approved scripts, and simulation trainings to improve knowledge and comfort with LGBTQ+ topics.

Conclusion(s): This study fills a literature gap by exploring barriers to inclusive LGBTQ+ care in a pediatric inpatient setting. Key barriers, such as unclear EHR documentation and cultural concerns, highlight the need for better data collection, support systems, and educational initiatives to enhance cultural competency. Addressing these can foster a more inclusive environment for LGBTQ+ pediatric patients and families in palliative care. Future research should include LGBTQ+ patient, family, and provider perspectives across settings.