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Consultant Editor Brian Nyatanga Editor Sean Boyle Group Classified Manager Daniel Doherty Circulation Director Sally Boettcher Associate Publisher, Medical Education Tracy Cowan Production Manager Kyri Apostolou Publishing Director Andrew Iafrati Managing Director Anthony Kerr Chief Executive Officer Ben Allen Editorial enquiries: Sales enquiries: Editorial Board AUSTRALIA Donna Drew Clinical Nurse Consultant in Paediatric Oncology and Palliative Care, Sydney Children’s Hospital Jason Mills University of the Sunshine Coast, Queensland Jane Phillips Professor of Palliative Nursing and Director of the Centre for Cardiovascular and Chronic Care, University of Technology, Sydney BELARUS Anna Garchakova Director, Belarusian Children’s Hospice BELGIUM Tine De Vlieger General Coordinator for Palliative Care, University of Antwerp IRELAND Julie Ling CEO of the European Association for Palliative Care, Our Lady’s Hospice, Dublin ITALY Valentina Biagioli Research Fellow in Nursing and Allied Health Professional Development, Continuing Education and Research, Bambino Gesù Children’s Hospital, Rome, and Lecturer, Sapienza University of Rome NORTHERN IRELAND Sonja McIlfatrick Professor of Nursing, University of Ulster SWITZERLAND Philip Larkin Kristian Gerhard Jebsen Chair of Nursing Palliative Care, Professer, Centre hospitalier universitaire vaudois, University of Lausanne

UGANDA Julia Downing Honorary Professor in Palliative Care, Makerere University, Kampala UNITED KINGDOM Bridget Johnston Professor and Florence Nightingale Foundation Chair of Clinical Nursing Practice Research, University of Glasgow and NHS Greater Glasgow and Clyde Daniel Kelly RCN Chair of Nursing Research, Cardiff University Diane Laverty Nurse Consultant in Palliative Care, St Joseph’s Hospice, London Carole Mula Macmillan Nurse Consultant in Palliative Care and Professional Lead Nurse for Division of Clinical Support Services, Christie NHS Foundation Trust, Manchester Brian Nyatanga Senior Lecturer, University of Worcester Dion Smyth Lecturer-Practitioner in Cancer and Palliative Care, Birmingham City University Anna-Marie Stevens Nurse Consultant in Symptom Control and Palliative Care, Royal Marsden NHS Foundation Trust, London UNITED STATES Jennifer Baird Harvard-Wide Pediatric Health Services Research Fellow, Division of Medicine Critical Care, Boston Children’s Hospital Patricia Berry Professor and Director of Hartford Center of Gerontological Nursing Excellence, Oregon Health and Science University

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International Journal of Palliative Nursing is indexed on Medline, CINAHL, and the British Nursing Index. © MA Healthcare Ltd, 2022. All rights reserved. No part of the International Journal of Palliative Nursing may be reproduced, stored in a retrieval system, or transmitted in any form or by any means electronic, mechanical, photocopying, recording, or otherwise without prior written permission of the Publishing Director. The views expressed do not necessarily represent those of the editor or International Journal of Palliative Nursing. Advertisements in the journal do not imply endorsement of the products or services advertised. Please read our privacy policy, by visiting privacypolicy. This will explain how we process, use and safeguard your data. ISSN 1479-5248 Printed by Pensord Press, Blackwood, NP12 2YA


Equality, diversity and inclusion: a focus on

LGBTQ+ people

The values of equality, diversity and inclusion (EDI) should be well integrated across the healthcare profession. Healthcare providers should accept their universal applicability and do their best to ensure their patients and those around them feel respected, satisfied and valued. Although many people struggle with issues of access, this editorial will focus on those who identify as lesbian, gay, bisexual, transgender or otherwise not as cisgendered or heterosexual (LGBTQ+).

A legacy of discrimination This community was criminalised in England until 1967 (Drescher, 2015), while homosexuality was only declassified as a mental illness by the World Health Organization following its removal from the second edition of the 1973 Diagnostic and Statistical Manual of Mental Health (DSM-2) (Drescher, 2015). It is important for palliative care services to always revisit the legal and cultural status of LGBTQ+ communities around the world, since these positive gains are not felt globally, and many countries still criminalise homosexuality today.

Even in places where LGBTQ+ people have official legal equality, more needs to be done to shift attitudes favourably. This situation can be compared to that facing ethnic minority groups living in the US today, many of whom live with systemic oppression, discrimination and unequal treatment in society despite the end of legal segregation with the 1960s Civil Rights Act. The point here is that it takes a long time for attitudes to shift and practices to change, particularly where governments and influential organisations like healthcare providers, law enforcement and sports bodies fail to introduce policies and develop cultures that ensure EDI. LGBTQ+ communities face issues of stigma and other discriminatory practices, despite legal gains and considerable social change. Evidence from Stonewell and YouGov (2015) reported that, between 2010 and 2013, one in six LGBTQ+ people globally experienced homophobic hate crime. Indeed, it can also be argued that this number may be far higher, as some crimes may not be reported, as victims may risk violence and discrimination, as well as potentially being forced into conversion therapy and/ or imprisonment. Cumulatively, the evidence demonstrates that LGBTQ+ peoples’ concerns should be taken more seriously

Why focus on LGBTQ+ communities? The UK Office for National Statistics’ 2019 figures demonstrate that the number of people aged 65 years and above identifying as LGBTQ+ has significantly increased to over half a million (684 000), compared to the 2015 consensus. This means the demand for palliative care services throughout the LGBTQ+ community are likely to increase. Evidence from the National LGBT survey (Government Equalities Office, 2017) showed that LGBTQ+ people continue to face significant barriers to full participation in public life—this is highly likely to also apply to healthcare and palliative care settings. It should be considered that LGBTQ+ people have a higher risk of some serious illness, in some cases likely because they are more likely to engage in risky behaviours, such as smoking and substance misuse (Stonewall, 2015), which may be attributed to stresses from homophobia, biphobia, transphobia, stigma and discrimination. LGBTQ+-affirmative care should first recognise that LGBTQ+ people are not a homogenous group and have differing needs. Therefore, it is important to recognise past experiences and how they may influence the present, understand spiritual and religious preferences and consider

International Journal of Palliative Nursing September 2022, Vol 28, No 9


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