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Practice comment

"Ensure you meet the end-of-life needs of LGBT people"

Well planned and delivered end-of-life care is shaped by the patient’s life and personality.

Our new resource on end-of-life care for lesbian, gay, bisexual and transgender (LGBT) people highlights some difficulties that nurses and their colleagues can face.

Experiences of LGBT people can inhibit full, honest discussions with health professionals. This is particularly true of older people who have lived in periods of intolerance and when homosexual acts between consenting men were illegal.

This has implications for how some LGBT people will approach health and social care services, even when they or someone they love is nearing the end of life. There can be complications around confirming next of kin, the extent to which a person has “come out” to family members and the reaction of relatives to sexual orientation and same-sex partners.

Ironically, staff with good intentions who adopt a “we treat everyone the same” attitude can exacerbate problems. This means they could miss the impact of a person’s experiences or their anticipation of discrimination, unintentionally limiting access to end-of-life care.

Many pitfalls can be avoided with an open-minded approach. For example, it is a myth that the next of kin has to be a marriage partner or blood relative (although “nearest relative” definition under the Mental Capacity Act 2005 is more rigid).

Discussions, assessment and care planning should start with open questions around relationships and those closest to patients. The aim is to identify who is important in their personal network - including a partner.

While coordinating care, watch out for signs that coming out to a range of carers and agencies might cause stress to LGBT patients, partners or families.

As a person nears death, be clear about who they wish to be present - and be aware of any potential conflict between the people involved and how that can be managed.

Our resource tells how staff at a hospice responded to tensions between a dying man’s civil partner and his mother, who found it difficult to accept her son’s sexuality. Staff reinforced the role of the civil partner but ensured his mother was respected and her questions answered honestly. They made sure no one felt excluded.

When preparing our guide, we heard moving accounts of unrecognised partners being offered inadequate support and bereavement counselling because the extent of their relationship had been kept hidden. Look out for anyone who might have had an undisclosed close link with the person you have been caring for.

Nursing, like society, has stepped out of the dark ages in responding to the needs of LGBT people. Our guide should help nurses step forward in meeting their needs as their life draws to its end. NT

  • The Route to Success in End of Life Care - Achieving Quality for Lesbian, Gay, Bisexual and Transgender People can be downloaded here.

Claire Henry is director of the National End of Life Care Programme

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Readers' comments (4)

  • I cant see how "Next of kin" meaning relative, can be a myth? The dictionary states kin = "stock; family; relative"! Ofcourse their partner should be considered in the same way but family should be informed, especially if death is near. Old wounds and problems can be healed, at the bedside of a dying person and is a very important time for all concerned. The Hospice, as usual, got it right. Common sense is needed. Set RULES can not meet holistic needs in such cases.

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  • I'm confused now....... surely all those under our care are to be treated with unconditional positive regard? Are we now allowed to differentiate?

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  • Anonymous, I agree! All those under our care are to be treated with unconditional positive regard.

    Sally Carson, the wishes of the patient have to be respected. If a patient has said he/she does not want relatives to be contacted then why should the nurses or doctors 'Know best'. Yes, it is very sad but as a health care professional, you won't know the whole story as to why the patient didn't want family contacting.

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  • Its disgraceful that patients seemingly are being bumped off early on the Liverpool Care Pathway and nurses are allowing this to happen, We have read that patients, relatives and carers are not being consulted. Surely this goes against the UKCC nurses code of ethics. Why has the RCN and Nursing Times been so far silent on this issue, Where is the leadership and guidance? Its a scandal.

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