Queering Palliative Care: Validation of a Thematic Framework for Understanding Queer-Affirming Palliative Care Education

Dr Craig Geoff Howes & Dr JoAn Stanek

Boolean Search Terms

General search terms

(Queer* OR LGBT* OR lesbian* OR gay* OR bisexual* OR transgender* OR intersex OR msm OR wsw) AND (Palliat* OR death OR dying OR terminal) AND (Healthcare worker* OR doctor* OR nurse* OR social worker* OR profession*) AND (Educat* OR curriculum OR train* OR teach*)

Expanded search terms:

PubMed:

(“Sexual and Gender Minorities”[Mesh] OR Queer* OR LGBT* OR lesbian* OR gay OR bisexual* OR transgender* OR intersex OR MSM OR WSW) AND (“Health Personnel”[Mesh] OR Healthcare worker* OR doctor* OR nurse* OR social worker* OR profession*) AND (“Education”[Mesh] OR Educat* OR curriculum OR train* OR teach*) AND (“Palliative Care”[Mesh] OR Palliat* OR death OR dying OR terminal)

EMBASE:

(‘sexual and gender minority’/exp OR ‘queer*’ OR ‘lgbt*’ OR ‘lesbian*’ OR ‘gay’ OR ‘bisexual*’ OR ‘transgender*’ OR ‘intersex’ OR ‘msm’ OR ‘wsw’) AND (‘health care personnel’/exp OR ‘healthcare worker*’ OR ‘doctor*’ OR ‘nurse*’ OR ‘social worker*’ OR ‘profession*’) AND (‘education’/exp OR ‘educat*’ OR ‘curriculum’ OR ‘train*’ OR ‘teach*’) AND (‘palliative therapy’/exp OR ‘palliat*’ OR ‘death’ OR ‘dying’ OR ‘terminal’) AND [embase]/lim NOT ([embase]/lim AND [medline]/lim)

Scopus:

( TITLE-ABS ( queer* OR lgbt* OR lesbian* OR gay OR bisexual* OR transgender* OR intersex OR msm OR wsw ) ) AND ( TITLE-ABS ( “Healthcare worker*” OR doctor* OR nurse* OR “social worker*” OR profession* ) ) AND ( TITLE-ABS ( educat* OR curriculum OR train* OR teach* ) ) AND ( TITLE-ABS ( palliat* OR death OR dying OR terminal ) )

CINAHL (EBSCOhost):

(MH “Sexual and Gender Minorities+” OR Queer* OR LGBT* OR lesbian* OR gay OR bisexual* OR transgender* OR intersex OR MSM OR WSW) AND (MH “Health Personnel+” OR Healthcare worker* OR doctor* OR nurse* OR social worker* OR profession*) AND (MH “Education+” OR Educat* OR curriculum OR train* OR teach*) AND (MH “Palliative Care” OR Palliat* OR death OR dying OR terminal)

PsycInfo (EBSCOhost):

(DE “Sexual Minority Groups” OR Queer* OR LGBT* OR lesbian* OR gay OR bisexual* OR transgender* OR intersex OR MSM OR WSW) AND (DE “Health Personnel” OR DE “Allied Health Personnel” OR DE “Clinicians” OR DE “Direct Care Workers” OR DE “Medical Personnel” OR DE “Mental Health Personnel” OR Healthcare worker* OR doctor* OR nurse* OR social worker* OR profession*) AND (DE “Education” OR DE “Academic Achievement” OR DE “Academic Environment” OR DE “Academic Specialization” OR DE “Academic Support” OR DE “Adult Education” OR DE “Affective Education” OR DE “Bilingual Education” OR DE “Client Education” OR DE “Coeducation” OR DE “Compensatory Education” OR DE “Computer Assisted Instruction” OR DE “Consumer Education” OR DE “Counselor Education” OR DE “Culturally Responsive Education” OR DE “Curriculum” OR DE “Death Education” OR DE “Distance Education” OR DE “Early Childhood Education” OR DE “Educational Access” OR DE “Educational Degrees” OR DE “Educational Placement” OR DE “Educational Program Accreditation” OR DE “Educational Programs” OR DE “Educational Quality” OR DE “Educational Reform” OR DE “Educational Standards” OR DE “Elementary Education” OR DE “Environmental Education” OR DE “Family Life Education” OR DE “Gifted Education” OR DE “Grade Level” OR DE “High School Education” OR DE “Higher Education” OR DE “Homework” OR DE “Inclusive Education” OR DE “Instructional Media” OR DE “Middle School Education” OR DE “Multicultural Education” OR DE “Nontraditional Education” OR DE “Nursing Education” OR DE “Paraprofessional Education” OR DE “Preschool Education” OR DE “Private School Education” OR DE “Public School Education” OR DE “Religious Education” OR DE “Remedial Education” OR DE “Same Sex Education” OR DE “School Attendance” OR DE “School Choice” OR DE “School Enrollment” OR DE “School Graduation” OR DE “School Readiness” OR DE “School Retention” OR DE “School Transition” OR DE “Secondary Education” OR DE “Social Work Education” OR DE “Special Education” OR DE “STEM” OR DE “Student Admission Criteria” OR DE “Student Records” OR DE “Teaching” OR DE “Vocational Education” OR Educat* OR curriculum OR train* OR teach*) AND (DE “Palliative Care” OR DE “Assisted Suicide” OR DE “Euthanasia” OR Palliat* OR death OR dying OR terminal)

Literature Selection:

Criteria for inclusion

Population:
Healthcare workers and allied professionals practicing in palliative care and end-of-life care published from any country

Intervention:
Any published manuscript with education interventions or education focussed content concerning LGBTQIA+ health
Education interventions or educational content, including any dedicated publication designed to improve the knowledge, comfort and clinical skills concerning LGBTQIA+ health of any length or medium

Outcomes:
Any outcomes including qualitative and quantitative outcomes as well as mixed methodologies

Timespan:
Material published between January 2005 and January 2025

Language:
English language or quality English translation

Criteria for exclusion

Education interventions not focussed on improving the clinical practice of dedicated
queer-affirming palliative care. i.e. A larger curriculum that contains content relating to queer affirming palliative care but not directly concerning QAPC

Literature containing education recommendations without practical applications

Studies focussing on education regarding HIV/AIDS and sexually transmitted infections (STI) that are associated with queerness but which do not include specific palliative care content This content, while important may confound results, especially concerning stigma

Paper	Year published	Quality appraisal	Methods	Country of research
Chidiac, C   First steps: Health and social care professionals beginning to address the palliative and end of life care needs of people with diverse gender identities and sexual orientations in Lebanon	2022	MMERSQI: 45/100   Poor quality as a result of partial information reported or missing. This study is a replication of Chidiac et al.  (2021). Presumably, similar design processes occurred. However, unclear qualitative design processes and outcomes. Incomplete evaluation measure reporting	Development of 1½-hour workshop – adaption of existing workshop.(Chidiac et al., 2021)  Evaluation with pre- and post-intervention self-report questionnaires	Lebanon – Beirut
Chidiac et al.   Development and evaluation of an LGBT+ education programme for palliative care interdisciplinary teams	2021	MMERSQI: 55/100   Satisfactory in most respects. Scores poorly on MMERSQI because of difficult to measure, opinion-based outcomes with high risk of bias.	Development of 1½- hour workshop using Kotter’s eight-stage process for change. Evaluation with pre- and post-intervention questionnaires. Some basic statistical analysis	UK Hospices – London and Essex
Reygan et al.   A pilot training programme for health and social care professionals providing oncological and palliative care to lesbian, gay and bisexual patients in Ireland	2013	MMERSQI: 43/100   Low quality due to study design concerns, especially regarding mixed-methodology. Data analysis not rigorous despite large cohort. Qualitative data not well assimilated into analysis	Development of 50 min training module. Pre- and post-test questionnaire and limited qualitative interviews	Ireland
Stanek, J   Implementation of an Education Module-Creating a Safe Space for LGBTQ Population in a Hospice Setting: a Quality Improvement Project	2023	MMERSQI: 40/100   Scores poorly due to limited reported methods. This is because this quality improvement project was published only as an abstract. Further data was requested from the author who provided more in-depth results	Development of 1-hour continuing nursing education module	USA

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Quality Appraisal Instruments

MMERSQI

Modified Medical Education Research Study Quality Instrument: Tool to appraise the methodological quality of medical education studies. Score /100