LGBT Patient Care Research Articles

Enhancing cultural competence in caring for lesbian, gay, bisexual, and transgender patients: An online training program for Taiwanese student nurses and nurses

BackgroundHealth disparities exist among lesbian, gay, bisexual, and transgender (LGBT) populations worldwide. However, student nurses and nurse staff have limited knowledge and skills in providing culturally competent nursing care for LGBT patients in Taiwan. ObjectivesThis paper describes the development, implementation, and evaluation of an online training program for the cultural competence of student nurses and nurses in Taiwan. DesignA one-group pre-/post-test study design. SettingsThe study was conducted in five nursing schools, 10 nursing associations, and 37 long-term care facilities. Two prominent online bulletin boards (PTT Nurse and Dcard Nurse) and one Taiwanese nursing group on Facebook were used to recruit participants. ParticipantsIn total, 301 student nurses and nurses participated in the study and responded to pre- and post-test questionnaires. MethodsAn online training program for culturally competent nursing care was developed and implemented. The pre- and post-test questionnaires contained three sections: (1) demographics, (2) knowledge of LGBT health, and (3) the Sexual Orientation Counselor Competency Scale. Three open-ended questions were included in the post-test questionnaire to evaluate the online training program. ResultsThe online training program significantly improved the participants' knowledge and cultural competence skills. However, their attitudes towards cultural competence did not change after the program was implemented. Regarding qualitative feedback of the online training program, feedback on the strengths and limitations of the program was summarized under three themes: program content, website design, and online modules. ConclusionsThe results suggest the importance of an online training program which may contribute to reducing health disparities among the LGBT population.

Attitudes toward, knowledge of, and beliefs regarding providing care to LGBT patients among student nurses, nurses, and nursing educators: A cross-sectional survey

BackgroundStudies have assessed attitudes toward, knowledge of, and beliefs regarding providing care for lesbian, gay, bisexual, and transgender (LGBT) patients among student nurses, nurses, and nursing educators individually, but few studies have compared these aspects among these groups. ObjectivesTo examine the attitudes toward, knowledge of, and beliefs regarding providing care for LGBT patients among student nurses, nurses, and nursing educators in Taiwan. DesignCross-sectional survey. SettingsThe study was advertised in 8 nursing schools, 14 nursing associations, 209 nursing homes, and 2 online chatrooms in Taiwan. ParticipantsA total of 1150 participants were recruited: 447 student nurses, 475 nurses, and 228 nursing educators. MethodsData were collected between August 2021 and January 2022 through a questionnaire with five sections: demographics, knowledge of LGBT health, the Knowledge about Homosexuality Questionnaire, the Attitude Toward Lesbian and Gay Men Scale, and the Gay Affirmative Practice Scale. ResultsThe results suggest that the participants had limited knowledge of LGBT health. The nursing educators had the lowest scores for knowledge of LGBT health and homosexuality and the most negative attitudes toward lesbians and gay men among the groups; however, they were most likely to report their beliefs regarding providing nursing care to LGBT patients than the other two groups. ConclusionsThe results indicate the importance of providing nursing educators with training courses and resources related to culturally competent care to improve education for nursing students and care for LGBT patients.

Medical students' perceptions of their preparedness to care for LGBT patients in Taiwan: Is medical education keeping up with social progress?

Integrating training on health equity of sexual and gender minorities (SGM) in medical education has been challenging globally despite emphasis on the need for medical students to develop competence to provide adequate care for diverse patient groups. This study elicits Taiwanese medical students' perceptions of their values and preparedness to care for Lesbian, Gay, Bisexual, or Transgender (LGBT) patients using a qualitative approach that considers broader societal changes, and more focused topics such as the provision of relevant training in medical education. Eighty-nine medical students/trainees from two southern Taiwanese medical schools (one public and one private) participated in focus groups (n = 70) and individual interviews (n = 19). Qualitative analysis was conducted using inductive thematic analysis. Participants (i) expressed wide social acceptance and openness toward LGBT individuals, but were unsure of ways to communicate with LGBT patients; (ii) confirmed that stigmatization and biases might be developed during their training; (iii) recognized gender stereotypes could have negative impacts on clinical reasoning; (iv) considered themselves prepared to care for LGBT patients, yet equated non-discriminatory attitudes to preparedness; (v) acknowledged a lack of relevant professional skills; (vi) implicated curriculum did not address LGBT issues systematically and explicitly. This study has identified the insufficiencies of current medical training and inadequate preparedness of medical students/trainees to provide better care for LGBT patients. It provides insights for medical educators to design and implement effective medical curriculum and training, and faculty development programs to equip medical students/trainees with self-awareness and competencies to more readily provide holistic care for SGM, in keeping up with social progress, and promote health equity for a more diverse patient population.

Abstract 3635: A randomized trial to examine the effectiveness of an LGBT cultural sensitivity training for oncologists: The COLORS trial

Abstract Background: Our group developed and piloted the Curriculum for Oncologists on LGBT populations to Optimize Relevance and Skills (COLORS), an interactive web-based LGBT cultural sensitivity training for oncologists. Building on our formative pilot work, in February 2021 we launched a randomized trial to compare the effectiveness of the oncology-specific COLORS training to a general LGBT healthcare cultural sensitivity training. We report here on pre- and post-assessments of this trial. Methods: From the AMA Masterfile we obtained names and mailing addresses for 5,000 practicing oncologists that were randomly selected for equal distributions across the 9 U.S. Census Divisions. From February to May 2021, we mailed FedEx envelopes to these oncologists that included a invitation letter and information to register for the trial. Using REDCap, oncologists registered, completed a pre-training assessment, were randomized and emailed instructions on how to complete their assigned training (COLORS training or a publicly available web-based LGBT comparison training), and then completed a post-training assessment. The pre- and post-training assessments include measures for knowledge, attitudes (Modern Homonegativity Scale [MHS] and Modified Attitudes Toward LGBT Patients Scale [ATLPS-M], and practice behaviors (Gay Affirmative Practice [GAP] Scale) Results: As of October 2021, 224 oncologists were enrolled, 201 completed the pre-training and were randomized, and 138 completed the post-training assessment. Among those randomized to COLORS, there were significant decreases from pre- to post-training (median: 24 [IQR 19-30] vs. 22.5 [16-28.5]; p<0.01), indicating a shift toward more positive attitudes, and no significant difference from pre- to post-training for LGBT comparison training (median: 22.5 [IQR 16-29] vs. 22 [14-27]; p=0.98). Both trainings yielded significant (p<0.01) increases from pre- to post-training for the GAP scale, indicating an increase in LGBT-affirming practice behaviors. However, the delta was higher for COLORS vs. LGBT comparison training (Δ 4 vs. Δ 2, respectively). Likewise, both trainings yielded significant (p<0.01) improvements in knowledge from pre- to post-training. Neither training yielded trainings yielded significant differences from pre- to post-training for ATLPS-M. Conclusion: Results from two prior single-arm trials and now this RCT demonstrate that the COLORS training is effective in improving knowledge, attitudes, and affirming clinical practices related to the care of LGBT patients. This work is generously funded by the Bristol Myers Squibb (BMS) Foundation and BMS Company. Citation Format: Matthew B. Schabath, Jaileene Perez-Morales, Eryk N. Hernandez, Jarred D. Miller, Gwendolyn P. Quinn, Julia Seay. A randomized trial to examine the effectiveness of an LGBT cultural sensitivity training for oncologists: The COLORS trial [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2022; 2022 Apr 8-13. Philadelphia (PA): AACR; Cancer Res 2022;82(12_Suppl):Abstract nr 3635.

Development and assessment of the effectiveness of an LGBT cultural sensitivity training for oncologists: The COLORS training.

11000 Background: Published studies report oncologists have limited knowledge about LGBT health and cancer needs but also report high interest in receiving education regarding the unique health needs of LGBT patients with cancer. As such, our group developed the Curriculum for Oncologists on LGBT populations to Optimize Relevance and Skills (COLORS), an interactive web-based LGBT cultural sensitivity training for oncologists that focused on focused on improving knowledge and communication skill-building. We report here on the results from two single-arm feasibility/acceptability trials and one randomized pragmatic trial (RPT) demonstrating effectiveness of the COLORS training. Methods: The first single-arm trial included 44 oncologists from three cancer centers in Florida and the second single-arm trial included 50 oncology fellows recruited through ASCO. The RPT included 225 oncologists randomly selected for equal distribution across the U.S., and participants were randomly assigned to either the COLORS training or a publicly available, web-based LGBT comparison training. Each of these studies included pre- and post-training assessments of LGBT-related knowledge, attitudes, and affirming practices. The RCT included a 3-month follow-up assessment to gauge retention of LGBT-affirming knowledge, attitudes, and practices over time. Results: Both single arm trials demonstrated that the COLORS training was feasible, acceptable, and results from the pre- and post-training assessments suggested the training improved knowledge, attitudes, and affirming practice behaviors. In the RPT, those randomized to COLORS demonstrated significant improvements in LGBT-related attitudes pre- to post-training (p < 0.01), and no significant changes in attitudes were observed among those randomized to the comparison training (p = 0.98). Both trainings yielded significant (p < 0.01) increases from pre- to post-training in LGBT-affirming practice behaviors. Likewise, both trainings yielded significant (p < 0.01) improvements in knowledge from pre- to post-training. Similar significant findings were observed when we analyzed the 3-month follow-up assessment. Conclusions: Results from the prior single-arm trials and the current RCT demonstrate that the COLORS training is effective in improving oncologist knowledge, attitudes, and affirming clinical practices related to the care of LGBT patients with cancer. Part of this work was funded by the Bristol Myers Squibb (BMS) Foundation and BMS Company.

The Binary Order of Things: A Discursive Study of Nursing Students’ Talk on Providing, and Learning About, LGBT Patient Care

ABSTRACT Against the backdrop of the healthcare inequities and maltreatment facing LGBT patients, recommendations have been made for the inclusion of LGBT health topics in nursing curricula. Based on data collected in focus group discussions with South African nursing students, we complicate the assumption that training focused on health-specific knowledge will effectively reform providers’ prejudicial practices. Findings reveal ambivalence: silence and discrimination versus inclusive humanism. Participants drew on discourses of ignorance, religion, and egalitarian treatment to justify their inadequacy regarding LGBT patients; while doing so, however, they deployed othering discourses in which homophobic and transphobic disregard is rendered acceptable, and “scientifically” supported through binary, deterministic views of sexuality and gender. Such “expert” views accord with Foucault’s notion of “grotesque discourse.” We conclude with a discussion of the findings’ implications for nursing education; we call for the recognition and teaching of binary ideology as a form of discursive violence over LGBT lives.

25014 Interactive didactic session for residents and medical students on dermatologic care for lesbian, gay, bisexual, and transgender patients

Introduction: Despite increasing emphasis on lesbian, gay, bisexual, and transgender (LGBT) health in medical education across specialties, evidence-based training on LGBT patient care in dermatology is lacking. Our study assessed the effectiveness of an interactive didactic session on dermatologic care of LGBT patients in improving participants’ clinical preparedness, attitudinal awareness, and basic knowledge of LGBT patients in a dermatologic setting.

27701 Clinical recommendations to address dermatologic healthcare disparities in HIV-positive lesbian, gay, bisexual, and transgender (LGBT) patients

In the United States, 1.2 million people are living with HIV, with gay and bisexual men and transgender women disproportionately affected by the virus. While efforts are underway to improve the quality of care in lesbian, gay, bisexual, and transgender (LGBT) HIV-positive patients and address healthcare disparities in this population, innate institutional and societal stigmas often halt the progression of clinical reform. As physicians who are responsible for the management of the cutaneous manifestations of HIV and the adverse dermatologic effects of anti-retroviral therapy, dermatologists are in a unique position to treat HIV-positive LGBT patients. In an effort to improve the dermatologic care for HIV-positive LGBT patients, our review highlights a dermatologist’s role in HIV-positive LGBT care, addresses HIV and LGBT-related stigma in healthcare, and discusses three clinical interventions that can be implemented to decrease HIV-associated stigma, promote cultural competence, and improve the therapeutic alliance between HIV+ LGBT patients and dermatologists.

An Assessment of Lesbian, Gay, Bisexual, and Transgender Health Competencies Among Bachelors-Prepared Registered Nurses in Graduate-Level Study.

To assess graduate nursing students' lesbian, gay, bisexual, and transgender (LGBT)-specific health competencies. Using a cross-sectional design, a 13-item multiple response survey, derived from The Joint Commission guidelines and LGBT health competencies proposed by the Association of American Medical Colleges, was administered online to 116 registered nurses enrolled in graduate study. Survey items assessed nurses' knowledge of LGBT health, professionalism, provision of patient care, communication skills, care environment, gaps in learning, and systems-based practice. Descriptive analyses were used to summarize frequencies and proportions of study variables. Respondent nurses' knowledge about health, prevalent conditions, and social factors that influence LGBT health was somewhat limited. Respondents did not rate their knowledge about LGBT health high (µ = 3.11 [1.1], median = 3) and did not feel qualified to educate other colleagues about LGBT health issues (µ = 2.43 [1.26], median = 2). But 58% (n = 65) indicated that they felt comfortable performing prostate exams on transgender female patients (born with male genitalia); 62% (n = 70) felt comfortable doing pap smears for transgender male patients (born with female genitalia). Sixty nurses (52%) stated that they would advocate reforms within existing health care institutions to improve the care of LGBT patients. Cultural competency training was offered in some health care settings and environmental indications of inclusivity were inconsistent. LGBT health competence among graduate nursing students was limited. There is a need to reevaluate LGBT health-related content in nursing curricula as well as robust assessment of competence in LGBT health.

Patient sexual orientation and gender identity disclosure.

In the UK, 2.3% of men and 1.6% of women identify as lesbian, gay or bisexual (LGB). Of the UK population, 1% are estimated to identify as transgender (T). Of the LGB population, 46% do not disclose their sexual orientation to health care professionals (HCPs) and 18% of transgender patients avoid health care altogether. Non-disclosure of sexual orientation and/or gender identity contributes to worse health outcomes for LGBT patients. This study aimed to explore medical students' perceptions of the barriers to health care for LGBT patients and the importance of patient disclosure of sexual orientation or gender identity. Focus groups included medical students across five year-groups from a medical school in the South East of England. Discussions followed a pre-approved topic guide with a primary and co-facilitator present. Focus groups were audio-recorded, transcribed verbatim and the data underwent framework analysis. Forty-five undergraduate medical students participated (40% of whom were non-heterosexual). Most participants believed that the incorrect use of pronouns and discrimination would be a cause for non-disclosure of gender identity and sexual orientation to HCPs. Several participants thought it was more important to know a patient's gender identity than sexual orientation. Many participants felt that collecting sexual orientation information on healthcare registration forms is acceptable. More education regarding LGBT health needs and ways to encourage patient disclosure of sexual orientation or gender identity should be included in the undergraduate medical school curricula to increase the competency of future doctors when interacting with LGBT patients.

Culturally Competent Care for LGBT Patients in Dermatology Clinics

Lesbian, gay, bisexual, and transgender (LGBT) patients face unique health disparities.1 Routine collection of sexual orientation and gender identity (SOGI) data can optimize patient-provider interactions.2 Gender-neutral bathrooms promote inclusivity for LGBT patients.3 There is limited data on the extent to which dermatology practices make use of such features to deliver culturally competent care to LGBT patients.

Caring for transgender cancer patients: Shortcomings of medical education.

11002 Background: Caring for transgender patients requires specific knowledge and skills. Medical schools spend less than 5 hours on average training for treatment of LGBT patients (Obedin-Maliver, JAMA, 306 (9), 971). This paper assesses the knowledge on the topic and skills of postgraduate Oncology students from Universidad del Salvador at the Observational Standard Clinical Examination (OSCE) 2019 (JCO 34 (15), Abstract e18150, 2017). Methods: At one of the stations of OSCE 2019, students had thirty minutes to complete a clinical record of a simulated transman patient with ovarian cancer stage IIIC. Based on the real case of Robert Eads, actors were trained with the documentary on his life “Southern Comfort”. Students were assessed on: A) knowledge of the transman condition, B) use of preferred gender pronoun by the patient, C) discontinuation of testosterone treatment, D) recommendation of genetic study, E) treatment of ovarian cancer according to NCCN guidelines, F) moral discomfort with LGBT patient care. All interviews were filmed or recorded by an observer. All films, recordings and clinical records were reviewed to rate the students' performance. Results: A total of 25 postgraduate Oncology students took the OSCE 2019. Assessment: A) 5/25 (20%) lacked knowledge of the transman condition, B) 3/25 (12%) did not use the patient's preferred gender pronoun, C) 17/25 (68%) discontinued testosterone, D) 23/25 (92%) requested genetic study, E) all students treated ovarian cancer according to NCCN guidelines, F) none expressed moral discomfort with LGBT patient care. Conclusions: 1) It is feasible to assess the knowledge and skills required for treatment of transgender patients in Oncology. 2) We found shortcomings of student's medical training regarding transgender patients: one in five did not understand the patient's condition, three did not use the patient´s preferred gender pronoun during the interview and more than half suspended the necessary hormone therapy for their condition. 3) This emphasizes the need to deepen our medical and communication skills in order to assist the transgender population and should be included in future ASCO-ASH milestones for specialty accreditation.

Culturally Competent Care of LGBT Patients: The NP Experience

Culturally Competent Care of LGBT Patients: The NP Experience

Cultural competency and microaggressions in the provision of care to LGBT patients in rural and appalachian Tennessee

PurposeLack of provider training in lesbian, gay, bisexual, and transgender (LGBT) cultural competence may diminish healthcare access. Culturally competent providers may enact microaggressions when providing LGBT patient care, especially in sociopolitically conservative areas. Our study examined LGBT cultural competence and microaggressions among healthcare providers in rural Tennessee. MethodsProviders (n = 85) completed a self-report survey on LGBT cultural competence. Post-survey, we invited respondents to provide an interview to contextualize quantitative findings and identify barriers to LGBT patient care (n = 6). ResultsMost quantitative respondents disagreed that they preferred not to care for LGBT patients (85.9%) or that they would refuse care to LGBT patients (92.9%). Only half felt competent to provide LGBT patient care (54.1%). Fewer oncology than primary care providers felt competent treating LGBT patients, and more physicians than nurses reported their training did not adequately address LGBT issues. Qualitatively, interviewees reported serving patients “equally”, yet described discomfort with LGBT patients and LGBT microaggressions in clinical practice. Principal conclusionsWhile many providers felt competent to provide LGBT patient care, they described behaviors and attitudes that may contribute to LGBT healthcare inequities. Practice ImplicationsProvider training must address how microaggressions negatively influence patient-provider interactions and LGBT patient care.

Incorporating LGBT Health in an Undergraduate Medical Education Curriculum Through the Construct of Social Determinants of Health.

The AAMC has provided a resource to medical schools for implementing curricular change in lesbian, gay, bisexual, and transgender (LGBT) health education. However, studies have identified that many health professionals who do not feel comfortable in their ability to provide quality care for LGBT patients do not perform complete sexual histories routinely and/or harbor bias towards these patients or their sexual practices. This situation underscores the continued need for further education on this topic. Based on a needs assessment survey of medical students and faculty, we developed a 1-hour didactic lecture to provide instruction on how social determinants of health impact the care of LGBT patients. Students were not required to have any prerequisite knowledge for the session. A content expert in LGBT health taught the lecture using Microsoft PowerPoint in a traditional medical school lecture hall. The lecture was given to 180 third-year medical students. A total of 63 students (35%) responded to the retrospective pre- and postlecture survey. After the didactic lecture, students reported a statistically significant change in their knowledge of the lecture objectives. The didactic lecture was able to increase students' knowledge of how social determinants impact the health of LGBT patients. The lecture can be incorporated into a longitudinal curriculum on LGBT health. Additional work and research are needed on increasing comfort in faculty teaching.

Encouraging patients to disclose their lesbian, gay, bisexual, or transgender (LGBT) status: oncology health care providers' perspectives.

A compelling touted strategy for reducing discrimination towards lesbian, gay, bisexual, and transgender (LGBT) patients is improving communicative competence of health care providers (HCPs); however, evidence base for describing communication practices between HCPs and LGBT patients is scarce. The purpose of this study was to qualitatively examine HCP experiences and perspectives as they relate to patient sexual orientation and gender identity (SOGI) disclosure, perceived communication and structural/administrative challenges in interactions with LGBT patients, and suggestions for improving care of LGBT patients. The sample consisted of 1,253 HCPs, who provided open-ended responses to an online cross-sectional survey conducted at a Comprehensive Cancer Center in the Northeastern United States. The open-ended responses were inductively and deductively coded for key themes and sub-themes. The results demonstrated an array of useful communication strategies employed by oncology HCPs to encourage LGBT patients' SOGI disclosure (direct questions regarding sexual orientation, use of the term "partner," and using correct pronouns), communication and structural/administrative challenges faced by HCPs in providing care (HCP own fears and biases, transgender patient care, insurance issues, and procedural challenges for LGBT patients), and suggested recommendations from oncology HCPs to improve their care delivery for LGBT patients (more provider-based training, improving awareness of LGBT-friendly resources, establishing trusting relationships, and not assuming sexuality or gender identity). These findings have implications for developing and evaluating training programs to improve LGBT sensitivity and communication among HCPs, and encourage SOGI disclosure in an open and judgment-free health care environment.

The Education and Practice Environment for Medical Radiation Science Professionals Caring for Lesbian, Gay, Bisexual, and Transgender Patients: An Analysis of a #MedRadJClub Tweet Chat

IntroductionThe medical radiation sciences' (MRS) MedRadJournalClub attracts a global group of participants to monthly sessions to discuss selected journal articles. The September 2017 session explored the experiences of MRS professionals working with lesbian, gay, bisexual, and transgender (LGBT) patients. The aim of the chat was to establish staff educational preparation, how participants’ organizations approached the issue, and what participants would do differently at work or at home in relation to this patient population after the chat. MethodData were extracted using the Twitter advanced search function with #MedRadJClub from the 19th to 23rd September 2017. The data were reviewed and categorized for themes. Tweets related to shared LGBT resources were captured, verified, and counted separately. Results44 participants took part in the September Twitter chat. After data cleaning, 127 tweets were included for analysis with a further 16 tweets sharing LGBT resources. Almost all of the participants disclosed that they had no undergraduate education or workplace training in the care of LGBT patients. Workplaces of a limited few participants had specific approaches to improve experiences for this patient population. Many participants were eager to advocate for changes in their workplaces after the Twitter chat. ConclusionThere is still work to be carried out to educate MRS professionals to enhance their LGBT patients’ experience and improve workplaces. Positive changes in education and a more inclusive clinical environment will ultimately improve care for LGBT patients.

Comprehensive Internal Medicine Residency Curriculum on Primary Care of Patients Who Identify as LGBT.

Graduate medical education curricula that provide training on LGBT healthcare are limited. The purpose of this study was to create and evaluate an LGBT curriculum for internal medicine (IM) residents. The implicit association test (IAT) measuring implicit bias toward gay individuals was administered as part of a needs assessment. The curriculum was developed by a multidisciplinary team, with objectives derived from the Association of American Medical Colleges' curricular recommendations and the Fenway Guide to Lesbian, Gay, Bisexual, and Transgender Health. Surveys assessed residents' perceptions of the importance of primary care for LGBT patients, and their knowledge of and confidence in providing primary care to LGBT patients. Faculty also rated the usability of the curricular materials. The IAT showed a slight preference for straight people compared with gay people, with an average "D score" of 0.27 ± 0.42. The importance of receiving education about the primary care of LGB patients was rated as high across the pre- to postsurveys. Knowledge improved with participation in the curriculum (average overall score: 42% pre- vs. 66% postsurvey, p < 0.0001). Participants' confidence in their ability to provide information to LGBT patients about resources for community engagement and to implement gender-neutral practices in their clinics increased significantly (p < 0.05). This curriculum pilot demonstrated an improvement in IM residents' knowledge of and confidence in providing care to LGBT patients. Our results suggest that curricular materials can be developed by experts in LGBT health and utilized effectively by nonexpert faculty to increase residents' knowledge and confidence regarding LGBT healthcare.

Enhancing Lesbian, Gay, Bisexual, and Transgender Cultural Competence in a Midwestern Primary Care Clinic Setting.

The process of initiating lesbian, gay, bisexual, and transgender (LGBT) cultural competencies and educational interventions developed to increase staff knowledge on LGBT culture and health issues is discussed, including a computer-based module and panel discussion. The module intervention showed a statistically significant increase (p = .033) of staff LGBT knowledge from pretest to posttest scores. An evaluation after the panel discussion showed that 72% of staff indicated they were more prepared for LGBT patient care.

A Guide for Palliative Medicine Clinicians Taking Care of Lesbian, Gay, Bisexual, and Transgender Patients Using a Whole Person Care Approach (SA516)

•Understand the impact of spiritual and existential distress in LGBT patients with chronic medical illnesses.•Access tools and resources to support LGBT patients and families facing life threatening illnesses and uncertain legal protection state-by-state.•Assess the unique needs of transgender patients who are receiving care from faith-based organizations. In 2011, the Institute of Medicine report on the Health of Lesbian, Gay, Bisexual, and Transgender (LGBT) People cited lack of legal protections and lack of social support as significant barriers to the quality of palliative care. LGBT patients have achieved expanded rights and access to health care. State health policy and legislation varies widely across the country and many states offer little legal protection to LGBT patients. LGBT patients living with chronic illnesses experience higher rates of depression and anxiety and more likely to have lower rates of satisfaction with care that they receive from health care providers (Kamen C 2015). Healthcare providers receive little training on caring for LGBT patients and often are unaware of educational and patient support resources for LGBT patients. While LGBT patients and their families are reported to have higher preferences for advance care planning, palliative care, and hospice many palliative care and hospice organizations lack policies and educational resources in regard to care of LGBT patients and families. Our transdisciplinary team of co-presenters includes representatives from medicine, advance practice nursing, social work and chaplaincy. The presenters will use case-based teaching to highlight the role of chaplaincy in assessing LGBT specific spiritual and existential distress. We will address the role of chaplaincy in promoting psychological well-being in LGBT patients by chaplain led Dignity Therapy. We will address the role of social workers to proactively promote formalized surrogate decision makers of LGBT patients’ preference, psychosocial well-being and resources to address variability in state protection for LGBT patients. We will address the role of hospice and palliative medicine teams in caring for transgender patients with advanced illnesses who are receiving care from faith-based and long-term care organizations. We will present resources for providers to educate their teams on caring and advocating for LGBT patients. •Resources to Improve The Quality Of Hospice And Palliative Care For Sexual And Gender Minority Patients And Families•Center of Excellence For Transgender Health - http://transhealth.ucsf.edu/•Hospice Foundation of America LGBT Resources- https://hospicefoundation.org/End-of-Life-Support-and-Resources/Coping-with-Terminal-Illness/How-to-Choose/LGBT-Resources•Lambda Legal Tools for Life and Financial Planning- http://www.lambdalegal.org/publications/take-the-power•LGBT best and promising practices for cancer care for LGBT patients and families throughout the cancer continuum- http://www.lgbthealthlink.org/Cancer-Best-Practices•LGBT Hospice and Palliative Care Network – https://lgbthpm.org/resources/•National Resources Center on LGBT Aging - http://LGBTagingcenter.org/resources•Services and Advocacy for Gay, Lesbian, Bisexual & Transgender Elders- http://sageusa.care/ Institute of Medicine: The Health of Lesbian, Gay, Bisexual, and Transgender People Building a Foundation for Better Understanding. Washington, DC: National Academy of Science, 2011. Kamen C, Mustian KM, Dozier A, Bowen DJ, Li Y. Disparities in psychological distress impacting lesbian, gay, bisexual and transgender cancer survivors. Psychooncology 2015 24(11):1384-91.