Healthcare stereotype threat (HCST), defined as “the threat of being reduced to group stereotypes within healthcare encounters,” may occur when social identities negatively impact healthcare experiences. The aim of this study was to examine the association between advance care planning (ACP) activities and HCST related to sexual orientation and race. Data from an online survey (N = 281) asked Black and White sexual minority (SM) adults ages 50+ about their ACP activities and perceptions of HCST. Higher scores of HCST-sexual orientation were associated with having had ACP discussions and higher scores of HCST-race were associated with having ACP discussions, having completed a living will, and having designated a healthcare proxy. Past experiences of HCST or concerns about experiencing HCST may be a motivating factor for older SM adults to engage in ACP, highlighting how prior and/or current healthcare experiences can potentially impact how SM individuals plan for end-of-life.
AARP & National Alliance for Caregiving. (2020). Caregiving in the United States 2020. AARP.
2.
AbdouC. M.FingerhutA. W. (2014). Stereotype threat among black and white women in health care settings. Cultural Diversity and Ethnic Minority Psychology, 20(3), 316–323. https://doi.org/10.1037/a0036946
3.
AbdouC. M.FingerhutA. W.JacksonJ. S.WheatonF. (2016). Healthcare stereotype threat in older adults in the health and retirement study. American Journal of Preventive Medicine, 50(2), 191–198. https://doi.org/10.1016/j.amepre.2015.07.034
4.
AndersenR. M. (1995). Revisiting the behavioral model and access to medical care: Does it matter?Journal of Health and Social Behavior, 36(1), 1–10. https://doi.org/10.2307/2137284
5.
BaileyD.CalasantiT.CroweA.di LoritoC.HoganP.de VriesB. (2022). Equal but different! Improving care for older LGBT+ adults. Age and Ageing, 51(6), afac142. https://doi.org/10.1093/ageing/afac142
6.
BischoffK. E.SudoreR.MiaoY.BoscardinW. J.SmithA. K. (2013). Advance care planning and the quality of end-of-life care in older adults. Journal of the American Geriatrics Society, 61(2), 209–214. https://doi.org/10.1111/jgs.12105
7.
BowlegL.HuangJ.BrooksK.BlackA.BurkholderG. (2003). Triple jeopardy and beyond: Multiple minority stress and resilience among black lesbians. Journal of Lesbian Studies, 7(4), 87–108. https://doi.org/10.1300/J155v07n04_06
8.
CareyF. R.LeardMannC. A.LehavotK.JacobsonI. G.KolajaC. A.StanderV. A.RullR. P.Millennium Cohort StudyT. (2022). Health disparities among lesbian, gay, and bisexual service members and veterans. American Journal of Preventive Medicine, 63(4), 521–531. https://doi.org/10.1016/j.amepre.2022.04.034
9.
ChenJ.McLarenH.JonesM.ShamsL. (2022). The aging experiences of LGBTQ ethnic minority older adults: A systematic review. The Gerontologist, 62(3), e162–e177. https://doi.org/10.1093/geront/gnaa134
10.
ConnorsJ.CasaresM. C.HonigbergM. C.DavisJ. A. (2020). LGBTQ health disparities. In LehmanJ. R.DiazK.NgH.PettyE. M.ThatikuntaM.EckstrandK. (Eds.), The equal curriculum (pp. 13–31). Springer International Publishing. https://doi.org/10.1007/978-3-030-24025-7_2
11.
DeanL. T.GreeneN.AdamsM. A.GeffenS. R.MaloneJ.TredwayK.PoteatT. (2021). Beyond black and white: Race and sexual identity as contributors to healthcare system distrust after breast cancer screening among US women. Psycho-Oncology, 30(7), 1145–1150. https://doi.org/10.1002/pon.5670
de VriesB.GutmanG. (2016). End-of-life preparations among LGBT older adults. Generations, 40(2), 46–48.
14.
DicksonL.BuntingS.NannaA.TaylorM.HeinL.SpencerM. (2021). Appointment of a healthcare power of attorney among older lesbian, gay, bisexual, transgender, and queer (LGBTQ) adults in the southern United States. The American Journal of Hospice & Palliative Care, 38(11), 1291–1298. https://doi.org/10.1177/1049909120979787
15.
FingerhutA. W.AbdouC. M. (2017). The role of healthcare stereotype threat and social identity threat in LGB health disparities. Journal of Social Issues, 73(3), 493–507. https://doi.org/10.1111/josi.12228
16.
FingerhutA. W.MartosA. J.ChoiS. K.AbdouC. M. (2022). Healthcare stereotype threat and health outcomes among LGB individuals. Annals of Behavioral Medicine, 56(6), 562–572. https://doi.org/10.1093/abm/kaab060
17.
FlattJ. D.CiceroE. C.KittleK. R.Brennan-IngM. (2022). Recommendations for advancing research with sexual and gender minority older adults. The Journals of Gerontology. Series B, Psychological Sciences and Social Sciences, 77(1), 1–9. https://doi.org/10.1093/geronb/gbab127
18.
FlattJ. D.CiceroE. C.KittleK. R.Brennan-IngM.AndersonJ. G.WhartonW.HughesT. L. (2022). Advancing gerontological health research with sexual and gender minorities across the globe. Journal of Gerontological Nursing, 48(4), 13–20. https://doi.org/10.3928/00989134-20220304-03
19.
FogliaM. B.Fredriksen-GoldsenK. I. (2014). Health disparities among LGBT older adults and the role of nonconscious bias. Hastings Center Report, 44 Suppl 4(04), S40–S44. https://doi.org/10.1002/hast.369
20.
Fredriksen-GoldsenK.KimH.EmletC.MuracoA.EroshevaE.Hoy-EllisC.GoldsenJ.PetryH. (2011). The aging and health report: Disparities and resilience among lesbian, gay, bisexual, and transgender older adults. Institute for Multigenerational Health.
21.
FrommeE. K.ZiveD.SchmidtT. A.CookJ. N.TolleS. W. (2014). Association between physician orders for life-sustaining treatment for scope of treatment and in-hospital death in Oregon. Journal of the American Geriatrics Society, 62(7), 1246–1251. https://doi.org/10.1111/jgs.12889
22.
GoldhammerH.KrinskyL.KeuroghlianA. S. (2019). Meeting the behavioral health needs of LGBT older adults. Journal of the American Geriatrics Society, 67(8), 1565–1570. https://doi.org/10.1111/jgs.15974
23.
GostinL. O.FeldblumC.WebberD. W. (1999). Disability discrimination in America: HIV/AIDS and other health conditions. JAMA, 281(8), 745–752. https://doi.org/10.1001/jama.281.8.745
24.
GreenD. C.WheelerE. M. (2019). A qualitative exploration of facilitators for health service use among aging gay men living with HIV. Journal of the International Association of Providers of AIDS Care (JIAPAC), 18(4), Article 2325958219880569. https://doi.org/10.1177/2325958219880569
25.
HaldaneC.LouN. M.HarleyJ. M. (2023). Social-historical accounts of hope and resilience: Experiences of prominent sexual orientation minority Elders. Journal of Homosexuality, 70(3), 387–426. https://doi.org/10.1080/00918369.2021.1990689
26.
HarrisP. A.TaylorR.MinorB. L.ElliottV.FernandezM.O'NealL.McLeodL.DelacquaG.DelacquaF.KirbyJ.DudaS. N.ConsortiumR. E. (2019). The REDCap consortium: Building an international community of software platform partners. Journal of Biomedical Informatics, 95, Article 103208. https://doi.org/10.1016/j.jbi.2019.103208
27.
HashK. M.NettingF. E. (2007). Long-term planning and decision-making among midlife and older gay men and lesbians. Journal of Social Work in End-of-Life and Palliative Care, 3(2), 59–77. https://doi.org/10.1300/J457v03n02_05
28.
Health and Retirement Study. (2018). University of Michigan.
29.
HoughtonA. (2018). Maintaining dignity: Understanding and responding to the challenges facing older LGBT Americans. AARP Research. https://doi.org/10.26419%252Fres.00217.001
30.
HunterN. D. (1990). Epidemic of fear: A survey of AIDS discrimination in the 1980s and policy recommendations for the 1990s. American Civil Liberties Union.
31.
KassN. E.FadenR. R.FoxR.DudleyJ. (1992). Homosexual and bisexual men's perceptions of discrimination in health services. American Journal of Public Health, 82(9), 1277–1279. https://doi.org/10.2105/ajph.82.9.1277
32.
KrauseK. D.HalkitisP. N. (2022). Mental health correlates of HIV-related resilience among older gay men living with HIV/AIDS in New York city: The GOLD studies. Journal of Gay & Lesbian Mental Health, 28(3), 1–28. https://doi.org/10.1080/19359705.2022.2152517
33.
LampeN. M.BarbeeH.TranN. M.BastowS.McKayT. (2023). Health disparities among lesbian, gay, bisexual, transgender, and queer older adults: A structural competency approach. International Journal of Aging and Human Development, 98(8), 1–17. https://doi.org/10.1177/00914150231171838
34.
MarsackJ.StephensonR. (2017). Exploring the utilization of end-of-life documentation among an online sample of sexual- and gender-minority individuals in the United States. Journal of Gay & Lesbian Social Services, 29(3), 273–279. https://doi.org/10.1080/10538720.2017.1320254
35.
MarshallA.CahillS. (2022). Barriers and opportunities for the mental health of LGBT older adults and older people living with HIV: A systematic literature review. Aging & Mental Health, 26(9), 1845–1854. https://doi.org/10.1080/13607863.2021.2003300
36.
Ojeda-LeitnerD.LewisR. K. (2021). Assessing health-related stereotype threats and mental healthcare experiences among a LGBT sample. Journal of Prevention & Intervention in the Community, 49(3), 251–265. https://doi.org/10.1080/10852352.2019.1654262
37.
PierceG. (2023). How older white gay men and lesbians leverage advantages to navigate healthcare. Journal of Homosexuality, 70(9), 1743–1762. https://doi.org/10.1080/00918369.2022.2042661
38.
PinnamaneniM.PayneL.JacksonJ.ChengC. I.CascioM. A. (2022). Disparities in chronic physical health conditions in sexual and gender minority people using the United States Behavioral Risk Factor Surveillance System. Preventive Medicine Reports, 28(7), Article 101881. https://doi.org/10.1016/j.pmedr.2022.101881
39.
ReichA. J.PerezS.FlemingJ.GazarianP.ManfulA.LadinK.TjiaJ.SemcoR.PrigersonH.WeissmanJ. S.CandrianC. (2022). Advance care planning experiences among sexual and gender minority people. JAMA Network Open, 5(7), Article e2222993. https://doi.org/10.1001/jamanetworkopen.2022.22993
40.
RomanelliR. J.RosenblattA. S.MarcumZ. A.FlattJ. D. (2023). Cognitive impairment in sexual and gender minority groups: A scoping review of the literature. LGBT Health, 11(3), 178–192. https://doi.org/10.1089/lgbt.2023.0095
41.
RosatiF.PistellaJ.GiovanardiG.BaioccoR. (2021). Queer generativity in lesbian, gay, and bisexual older adults: Personal, relational, and political/social behaviours. Journal of Community & Applied Social Psychology, 31(6), 673–689. https://doi.org/10.1002/casp.2529
42.
SaundersR. K.CarrD. C.BurdetteA. M. (2023). Health care stereotype threat and sexual and gender minority well-being. Journal of Health and Social Behavior, 65(1), 20–37. https://doi.org/10.1177/00221465231205549
43.
ScottS. B.KnoppK.YangJ. P.DoQ. A.GaskaK. A. (2023). Sexual minority women, health care discrimination, and poor health outcomes: A mediation model through delayed care. LGBT Health, 10(3), 202–210. https://doi.org/10.1089/lgbt.2021.0414
44.
SeelmanK. L.AdamsM. A.PoteatT. (2017). Interventions for healthy aging among mature Black lesbians: Recommendations gathered through community-based research. Journal of Women & Aging, 29(6), 530–542. https://doi.org/10.1080/08952841.2016.1256733
45.
SeelmanK. L.LewinsonT.EnglemanL.AllenA. (2019). Motivations for advance care and end-of-life planning among lesbian, gay, and bisexual older adults. Qualitative Social Work: QSW: Research and Practice, 18(6), 1002–1016. https://doi.org/10.1177/1473325018792396
46.
SiconolfiD.ThomasE. G.ChenE. K.HaberlenS. A.FriedmanM. R.WareD.MeanleyS.Brennan-IngM.BrownA. L.EganJ. E.BolanR.StosorV.PlankeyM. (2023). Advance care planning among sexual minority men: Sociodemographic, health care, and health status predictors. Journal of Aging and Health, 36(3–4), 147–160. https://doi.org/10.1177/08982643231177725
47.
SileoK. M.BaldwinA.HuynhT. A.OlfersA.WooJ.GreeneS. L.CasillasG. L.TaylorB. S. (2022). Assessing LGBTQ+ stigma among healthcare professionals: An application of the health stigma and discrimination framework in a qualitative, community-based participatory research study. Journal of Health Psychology, 27(9), 2181–2196. https://doi.org/10.1177/13591053211027652
48.
SilveiraM. J.KimS. Y.LangaK. M. (2010). Advance directives and outcomes of surrogate decision making before death. New England Journal of Medicine, 362(13), 1211–1218. https://doi.org/10.1056/NEJMsa0907901
49.
SingletonM.AdamsM. A.PoteatT. (2022). Older black lesbians' needs and expectations in relation to long-term care facility use. International Journal of Environmental Research and Public Health, 19(22), Article 15336. https://doi.org/10.3390/ijerph192215336
50.
SingletonM. C.GreenD. C.EnguidanosS. M. (2023). Identifying healthcare stereotype threat in older gay men living with HIV. Journal of Applied Gerontology, 42(9), 1965–1973. https://doi.org/10.1177/07334648231167944
SteinG. L.BonuckK. A. (2001). Attitudes on end-of-life care and advance care planning in the lesbian and gay community. Journal of Palliative Medicine, 4(2), 173–190. https://doi.org/10.1089/109662101750290218
53.
SudoreR. L.FriedT. R. (2010). Redefining the “planning” in advance care planning: Preparing for end-of-life decision making. Annals of Internal Medicine, 153(4), 256–261. https://doi.org/10.7326/0003-4819-153-4-201008170-00008
54.
SudoreR. L.HeylandD. K.BarnesD. E.HowardM.FassbenderK.RobinsonC. A.BoscardinJ.YouJ. J. (2017). Measuring advance care planning: Optimizing the advance care planning engagement survey. Journal of Pain and Symptom Management, 53(4), 669–681. https://doi.org/10.1016/j.jpainsymman.2016.10.367
55.
SudoreR. L.StewartA. L.KnightS. J.McMahanR. D.FeuzM.MiaoY.BarnesD. E. (2013). Development and validation of a questionnaire to detect behavior change in multiple advance care planning behaviors. PLoS One, 8(9), Article e72465. https://doi.org/10.1371/journal.pone.0072465
56.
TenoJ. M.GruneirA.SchwartzZ.NandaA.WetleT. (2007). Association between advance directives and quality of end-of-life care: A national study. Journal of the American Geriatrics Society, 55(2), 189–194. https://doi.org/10.1111/j.1532-5415.2007.01045.x
57.
ThomeerM. B.DonnellyR.ReczekC.UmbersonD. (2017). Planning for future care and the end of life: A qualitative analysis of gay, lesbian, and heterosexual couples. Journal of Health and Social Behavior, 58(4), 473–487. https://doi.org/10.1177/0022146517735524
58.
ThorpeS.TannerA. E.HargonsC. N. (2022). Sexual identity factors and minority stressors associated with healthcare stereotype threat and access to care among Black sexual minority women. Journal of Gay & Lesbian Social Services, 35(2), 183–203. https://doi.org/10.1080/10538720.2022.2056398
59.
Van SluytmanL. G.TorresD. (2014). Hidden or uninvited? A content analysis of elder LGBT of color literature in gerontology. Journal of Gerontological Social Work, 57(2–4), 130–160. https://doi.org/10.1080/01634372.2013.877551
