Question

1. Culturally competent care in the perinatal field

In order to provide competent care to the LBGTQ population, it is important to identify your own attitudes. After thinking about your attitudes, please address the following question:

1. Are there special needs of this community when assisting these clients to maintain health and engage in preventative care?
2. List how you would use provide patient-centered care to this population.

Answer 1

For the purpose of this document, patients include also their families, carers and extended support
groups. These individuals bring complementary knowledge in their interactions with the health services.
They have their own experience of health and ill-health, the knowhow in caring for themselves and their
dependants, the knowledge of their interactions with the context and of how it affects them in their
health, care choices and actions, the knowledge of their life and health goals, their values and
preferences. These constitute inputs that shape the way care is delivered and the final health outcomes.
The term patient is used in this paper as a person entitled to holistic support to promoting health,
preventing diseases, managing health conditions and improving health and wellbeing. However, it is
acknowledged that the term is frequently used to define a person receiving or registered to receive
medical treatment with a negative connotation due to its association with passive reception of care
rather than with pro-active self-management. The word patient is vastly used by health providers, policy
makers and patients’ organisations.
Other related terms utilized are user or client. These terms highlight people’s right to care but somehow
disregard the intrinsic co-productive role of patients at the interface with services and the asymmetries
of information. On the other hand, the term citizen refers to a legally recognised subject or national of a
state, either native or naturalised. The concept is related to entitlements like the right to healthcare, to
adequate emergency response to major public health threats and to the development of public health
policies as in food regulation or tobacco control. The use of this term, however, excludes a high
numbers of migrants that may suffer a heavy burden of health inequalities.
Four key strategies have been identified for engaging patients, their families and carers:
1. Self-managing health and health conditions. This involves support for developing knowledge,
skills and confidence to manage one’s own health (self-care), caring for a specific health
condition and recovering from an episode of ill health.
2. Shared decision making that involves supports patients in taking decisions about their health, in
considering options including the choice of taking no action, in pondering risks and benefits and
in analysing how the available options suit their values and preferences.
3. Peer-to-peer actions support patients in providing and receiving help from others in similar
conditions, based on mutual and shared understanding.
4. Support to families and carers. This seeks to develop knowledge, skills and actions to enabling
people to care for themselves and for others.
Patient-centered care is an important goal in the delivery of healthcare. However, many patients do not engage in preventive medical care. In this pilot study, we conducted twenty in depth, semi-structured qualitative interviews at the University of Illinois at Chicago Health Sciences campus in a four month time frame. Many patients were underserved and underinsured, and we wanted to understand their experiences in the healthcare system. Using content analysis, several themes emerged from the interview data. Participants discussed the need for empathy and rapport with their providers. They identified provider behaviors that fostered a positive clinical relationship, including step-by step explanations of procedures, attention to body language and clinic atmosphere, and appropriate time management. Participants identified cost as the most common barrier to engaging in preventive care and discussed children and social support as motivating factors. A long-term relationship with a provider was an important motivator for preventive care, suggesting that the therapeutic alliance was essential to many patients. Conversely, many participants discussed a sense of dehumanization in the healthcare system, reporting that their life circumstances were overlooked, or that they were judged based on insurance status or ethnicity. We discuss implications for provider training and healthcare delivery, including the importance of patient-centered medical homes.

Patient-centered care has become an important goal in healthcare delivery. The Institute of Medicine defines patient-centered care as “providing care that is respectful of and responsive to individual patient preferences, needs, and values, and ensuring that patient values guide all clinical decisions.” The Kalamazoo Consensus Statement emphasizes that a strong alliance between the patient and provider is essential in all phases of treatment. For this relationship to be successful, providers must understand both the patient’s subjective experience of his or her illness and the patient’s own health-related values and goals. The provider should also involve the patient in collaborative decision making, and not simply provide directive instruction.
- A systemic review of communication studies that involved neutral observers of healthcare encounters (using either direct observation or video/audio tape analysis) found the following providers behaviors were associated with increased patient satisfaction and, in some cases, greater adherence to treatment recommendations: empathy, courtesy, friendliness, reassurance, support, encouragement of patient questions, providing explanations, and giving positive reinforcement. Overall, patient-centered care has been associated with higher levels of patient satisfaction, improved health outcomes and lower healthcare costs, the three key elements of the “Triple Aim” for optimal healthcare services.