Search

1. Employing a clinical case vignette, participants will build frameworks for serious illness conversations with transgender patients when lived gender expression is challenged by medical circumstances. 2. Utilizing an example of effective collaboration between a primary surgical team and Palliative Care team, participants will analyze useful ways to support vulnerable LGBTQI+ patients. Our case presents a unique example where valued aspects of a transgender woman's gender expression conflicted with life-prolonging care, demonstrating how interprofessional Palliative Care teams can complement primary team efforts in serious illness conversations. Acknowledging that physical changes attached to identity can have disproportionate emotional effects was key to success in her care. Historically, LGBTQI+ individuals have faced numerous inequities in American medicine. Transgender individuals have been especially vulnerable in situations of serious illness when lived gender identity and expression may be challenged. This case presents a unique example where valued aspects of transgender woman's gender expression conflicted with likely curative care, demonstrating how interprofessional Palliative Care teams can navigate such discussions. A 56 year old Black, transgender woman with history of breast augmentation, vaginoplasty, and cosmetic silicone hip and buttock injections done overseas in the 1990s was admitted for right buttock wound worsening despite outpatient limited debridement and wound vac. Admission imaging showed significant necrosis of the silicon-injected tissues in her bilateral buttocks and hips so the surgical team recommended serial wide tissue debridement with significant deformity expected. Due to the impact of surgery on the patient's identity and expression, she initially declined intervention. Through careful exploration with the surgical and Palliative Care teams, the patient shared the tremendous amount of loss represented by pursuing likely curative yet image-altering surgery. Validation and recognition of this loss allowed the patient to move forward with surgical intervention. Ongoing palliative social work support and surgical attending advocacy have been key to maintaining dignity thorough her prolonged hospitalization. This patient had excellent continuity and rapport with her surgeon and access to life-saving interventions, however she could not accept the plan until teams looked at her glamorous photos and worked through her anticipatory grief. Acknowledging that physical changes attached to identity can have disproportionate emotional effects was key to success in her care. Involving Palliative teams can seem like punishment for the dissenting patient but our interprofessional team along with an advocacy-minded surgical team resulted in acceptance of a goal-concordant aggressive care plan. Diversity, Equity, Inclusion, Belonging, Justice; Communication [ABSTRACT FROM AUTHOR]