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

背景：普通社区中自认为是女同性恋的人面临着许多挑战， 同性恋、双性恋或变性人(LGBT)寻求医疗保健。LGTB社区报告称受到骚扰， 不尊重、歧视和护理延误，以及接受必要的筛查测试的可能性降低。 许多LGBT退伍军人基于过去的歧视(感知和 雷亚尔)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，有 可能还有关于性、肠道和膀胱护理、身体形象和心理健康的其他考虑因素。 卫生保健提供者在处理身心健康和社会文化方面往往缺乏经验 与LGBT身份相关的问题，特别是在提供SCI专科护理的背景下。因此，有一个 非常需要关于这一人群的经验和未得到满足的需求的信息，以便设计VA临床 计划，以正确和敏感地满足他们复杂的医疗保健需求，并促进他们的福祉。 意义/影响：该试点项目涉及获得医疗保健、医疗公平和高铁研发的优先领域 残疾/脊髓损伤。我们的首要目标是为这些弱势群体打开改善退伍军人保健服务的大门 未被充分研究的人群。基于有限的临床经验，认识到 患有SCI/D的个体，并从发表的非残疾LGBT人群的研究结果中推断，我们 预计在接触对特定需求敏感的有知识的临床医生方面存在显著差异 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 提供商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：这个项目是创新的，因为缺乏关于LGBT医疗保健需求的信息 患有SCI/D的退伍军人。调查小组包括弗吉尼亚州内外LGBT医疗保健方面的专家 SCI临床医生；以及在SCI/D临床护理和项目、定性方法学方面有专长的VA研究人员， 以及退伍军人事务部项目的实施。SCI/D和退伍军人特定经验和障碍的证据以及 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)激发患有SCI/D的LGBT退伍军人对他们在VA护理方面的经验的看法， 2)引出SCI/D提供者的经验和他们照顾患有SCI/D的LGBT退伍军人的方法。 方法：我们将应用定性的方法来获得(I)个人的观点和生活经验 25名退伍军人和(2)15名以SCI/D为重点的卫生保健专业人员的态度和知识/意识 关心。我们将从25个退伍军人事务部SCI/D中心进行抽样，以包括国家的不同地区，抽样城市 和乡村环境。我们将致力于纳入所有LGBT群体，并将超额招募女性参与者 包括SCI/D女性的潜在独特视角。我们的目标是招募一系列年龄段的人作为 脊髓损伤的慢性化程度从近期损伤到长期损伤不等。我们将包括所有族裔/种族 小组，以探索潜在的文化问题。退伍军人管理局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。 我们将进行带有开放式问题和提示的半结构化面试，然后执行矩阵 分析现有的SCI/D和LGBT文献，以确定障碍、态度和经验 患者和临床医生队列。除了障碍和未得到满足的需求外，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的调查领域的基础， 《国际功能、健康和残疾分类》的理论框架。 实施/下一步：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，相关卫生服务利用和发展的分析 培训方案，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.