AOSW Navigator (Association of Oncology Social Work)

Book review:
LGBTQ-Inclusive Hospice and Palliative Care, by Kimberly Acquaviva

Not enough inclusive materials have been written and presented about the unique issues LGBTQ face in the health care system, and there are no specific or standard practice guidelines.

This book is written for a variety of practitioners, and specifically focuses on an inclusive approach to working with LGBTQ patients and their significant others in end-of-life care.

Because of its systematic and educational layout, it is equally useful for beginners as well as those well-versed and experienced.

Each chapter starts with clear objectives and key points, discussion questions, chapter activities and helpful tools. A comprehensive glossary with excellent definitions can be found at the end of the book. One would hope it would be put on a mandatory reading list for students.

The author starts off introducing various ways for clinicians to reflect on and explore their own prejudices in nonjudgmental, precisely stated language with concrete tools to improve self-awareness and communication. Throughout the book, she highlights the necessity of a paradigm shift from treating LGBTQ as a special population to inclusion in health care models. Referring to existing models of assessment and interventions, she not only advocates for a language of inclusion, but also lays out concretely how such models would look. As such, her approach is unique and goes beyond the typical cultural competency models and description of specific issues of subpopulations in our profession. She identifies specific gaps in existing models with clear and objective focus on evidence-based practice interventions, and always highlighting compassion in her examples.

What makes this book unique is that it includes a wealth of information about the domains of the various professionals on the team. As such, it would make a useful basis for interdisciplinary discussions in health care, not just in hospice or palliative care. It would be a good book to draw from in team discussions to explore ways to use agreed- upon, objective language when speaking about LGBTQ, sex and gender.

Throughout the text, Acquaviva highlights the importance of a simultaneous shift in attitude, knowledge, skills and policy. She introduces a seven-step process for ensuring inclusive, nonjudgmental care in each interaction. She also introduces a five-dimensional assessment model and incorporates specific clinical examples related to assessment and physical exams, care planning, shared decisionmaking, family dynamics, patient and family education, psychosocial and spiritual care, and ethically and legally informed care; all this with a wealth of concrete stories and sample tools.

The book has a section on how race, ethnicity, religion, language and socioeconomic status interface with gender identity and sexual orientation. For social workers, with their keen insight of how systems affect individuals and groups, this chapter is especially relevant.

What this book does not address much is how the specific clinical challenges and issues for LGBTQ fit into the larger context of our health care system and its inequities; for example, significantly lower rates of breast and cervical screening. What it does very well, however, is offer inspirational stories and evidence-based strategies to develop inclusivity in the clinical setting.

Since so little has been written in our own profession on this topic, to complement this book I recommend:

  • NASW LGBT Practice Session.
  • Rorty, M. (2015). Transgender individuals and families affected by cancer. In Christ, G., Messner, C., & Behar, L., (Eds.), Handbook of Oncology Social Work (pp. 281-287). New York: Oxford University Press.
  • Smolinski, K., & Colon, Y. (2011). Palliative care with lesbian, bisexual and transgender persons. In Altilio, T., & Otis-Green, S. (Eds.), Oxford Textbook of Palliative Social Work (pp. 379-387). New York: Oxford University Press.
  • Smolinski, K., & Goeren, W. (2015). Gay, lesbian and bisexual individuals with diagnosis of cancer. In Christ, G., Messner, C., & Behar, L., (Eds.), Handbook of Oncology Social Work ( pp. 281-287). New York: Oxford University Press.

Reviewed by Roeliena VanZanten, MSW, ACSW