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

背景：在一般社会中，被认定为女同性恋的个人面临着许多挑战， 同性恋、双性恋或跨性别者（LGBT）在寻求医疗保健时。LGTB社区报告骚扰， 不尊重、歧视和延误护理以及减少接受必要的筛查测试的可能性。 许多LGBT退伍军人基于过去的歧视（感知和 真实的）和一个不受欢迎的系统。对于患有脊髓损伤和疾病（SCI/D）的LGTB退伍军人， 可能的其他考虑因素涉及性、肠道和膀胱护理、身体形象和心理健康。 卫生保健提供者往往缺乏处理身心健康和社会文化问题的经验， 与LGBT身份有关的问题，特别是在提供SCI专业护理的背景下。因此有 非常需要关于该人群的经验和未满足需求的信息，以便设计VA临床 计划，以正确和敏感地解决他们复杂的医疗保健需求，并促进他们的福祉。 意义/影响：该试点项目解决了HSR&D的优先领域，即获得护理，健康公平， 残疾/脊髓损伤。我们的首要目标是打开大门，改善退伍军人事务部的卫生保健，为这一脆弱和 被忽视的人群基于有限的临床经验，认识到常见的问题， SCI/D患者，并从非残疾LGBT人群的已发表研究结果中推断，我们 我希望在获得对特定需求敏感的知识渊博的临床医生方面发现显着的差距 患有SCI/D的LGBT退伍军人我们的研究将提供来自退伍军人和 供应商的观点开始填补这一空白，并为制定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。 有SCI/D的退伍军人调查小组包括弗吉尼亚州内外的LGBT医疗保健专家;弗吉尼亚州 SCI临床医生;以及在SCI/D临床护理和项目，定性方法， VA计划的实施。SCI/D和退伍军人特定经历和障碍的证据，以及 VA提供者的知识和态度将是文献中没有的新信息。 具体目标：1）引出LGBT退伍军人与SCI/D的观点，他们的经验与VA护理， 以及2）汲取SCI/D提供者的经验和他们照顾LGBT退伍军人SCI/D的方法。 方法：我们将采用定性方法来引出（i）个人观点和生活经验， 25名退伍军人和（ii）15名关注SCI/D的医疗保健专业人员的态度和知识/意识 在乎我们将从25个VA SCI/D中心抽样，包括全国不同地区，城市抽样 和乡村环境。我们将致力于包容所有LGBT人群，并将过度招募女性参与者 纳入SCI/D女性患者潜在的独特观点。我们的目标是招募不同年龄的人， 以及从近期受伤到长期持续的SCI的SCI慢性化。我们将包括所有民族/种族 以探讨潜在的文化问题。VA SCI/D提供者队列将包括医生和 外科医生、执业护士、护士、治疗师、心理学家、社会工作者和任何相关学科。 我们将进行半结构化的面试，开放式的问题和提示，然后执行矩阵 从现有的SCI/D和LGBT文献中提取分析，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，我们还将探索积极的经验。 我们将主要使用健康公平促进模型作为我们调查领域的基础， 国际功能、健康和残疾分类的理论框架。 实施/后续步骤：未来的研究可能涉及通过更全面的 定性研究，以人群为基础的调查，相关卫生服务利用的分析， 通过实施有针对性的护理，更好地满足这一人群的需求。

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.