Research on the health and health care needs of gender and sexual minority (GSM) people is burgeoning, in part due to increased awareness of the importance of identifying the health care needs of these long-neglected populations. This increase in knowledge related to GSM health is a critical part of improving the quality of GSM people’s health and health care. This chapter considers how practitioners might integrate existing knowledge about GSM health into their clinical work to establish an affirmative context for GSM patients. More contemporary approaches take a more process-oriented view, focused on the appreciation of cultural differences at personal, professional, organizational, and societal levels. These approaches place greater emphasis on training clinicians to think critically about how patients’ cultural backgrounds and identities impact their life experiences. The authors draw on these approaches to provide practical recommendations for providers to deliver competent care to GSM individuals.

This chapter presents reasons for why many individuals prefer receiving mental health care in a primary care setting. In fact, more persons with a mental health problem or illness are treated by a primary care provider than by a specialty mental health care provider. The chapter also presents the background for integration, including definitions, models, barriers, and evidence from the general integration literature. It describes the history of integration in rural areas and best practices of integrating care in rural areas. The chapter presents practical strategies for integrating care in rural areas. It provides case studies of integrated care in rural communities. The chapter reviews the experience and lessons learned by four rural primary care providers who have successfully integrated care. A number of national trends and policy initiatives are likely to influence access to rural mental health care in the years ahead.

This chapter describes four specific minority groups within rural areas namely African American; Hispanic; lesbian, gay, bisexual, and transgender (LGBT); and American Indian/Alaskan Native. It also describes leading health issues such as diabetes, heart disease, stroke, hypertension, and cancer among rural Hispanics, contributing factors to health disparities among rural Hispanics. The chapter offers recommendations to improve health and eliminate disparities among rural Hispanic populations. For rural African American communities, community-based settings like churches have been found to engender higher participation and retention rates for health promotion programs. Factors such as poverty, health insurance, and having a health care provider contribute to the health disparities among rural Hispanics. Innovations such as telehealth and community-based participatory research hold much promise for advancing health within rural minority groups such initiatives should be encouraged, supported, and appropriately funded to begin to address health inequity in the doubly underserved populations.

This chapter focuses on more integrated approach or process for developing a health intervention for ethnic minority groups that incorporates accepted principles of medicine and scientific methodology. The changing demographic has led to complex challenges in the U.S. health care system. The delivery of effective health care services hinges on health care professionals’ ability to recognize varied understandings of and approaches to health care across cultures. Health care providers may employ different strategies to increase participation of service users by bridging barriers to communication and understanding that stem from these racial, ethnic, cultural, and linguistic differences. In the context of health or health care improvement, little debate exists concerning the recognized need to help ethnic minority patients maintain and restore health. There are two general approaches for developing culturally appropriate health interventions. The first approach is from science to practice and the second approach is from practice to science.

This chapter discusses the role of measures in behavioral intervention research and criteria for measure selection. It discusses the types of measures available, methods for collecting outcome data and the role of technology in measurement. In randomized controlled trials (RCTs), choices have to be made as to what constitutes primary versus secondary outcome measures. Measures can be classified according to measurement scale as subjective or objective or whether they are qualitative or quantitative. Measures at the individual level can target the study participant or an informant such as a caregiver or health care provider. Measures at the community or organizational level are typically gathered when an intervention is focused on implementation of an intervention in settings such as a school, clinic, hospital, housing units, or community. Psychometric properties influence the quality of the information gathered from a measure and include factors such as level of measurement, reliability, validity, and sensitivity.

Basic Approach to Infection Control and Epidemiology

This chapter offers theoretically and experientially based approaches to help oncology clinicians in their interactions with family caregivers of adult patients approaching their end-of-life (EOL). It presents a theoretical framework for use by clinicians to interpret and gain understanding of interactions with family caregivers of the dying adult oncology patient. It is vitally important for healthcare providers to broaden their understanding of the patient with cancer to the context in which the person lives as a parent, grandparent, spouse/partner, friend, employee, and community member. The chapter presents several compelling reasons to assess and support care partners or family caregivers. Family caregivers of adults can experience greater distress and anxiety than the patient over 40% of care partners and family caregivers report at least 10 unmet needs including gaps in illness management information and lack of emotional support.

This chapter provides an overview of the experience of caregivers, and interventions that can be implemented at various points throughout the trajectory of the illness. Caregivers are often called upon to understand complex medication regimens, contact 'hard to reach' medical providers, navigate a difficult health and legal system, advocate for services, negotiate with insurance companies, and/or manage the household, finances, and children. The needs of caregivers are often overlooked by healthcare providers, friends, and family members in the face of the complex needs of the person with cancer. A growing number of psychosocial interventions have been developed specifically to address the psychosocial burden on caregivers. However, as each caregiver and care situation is unique, interventions need to be tailored depending on the patient's medical condition, emotional and physical needs, and required medical/nursing tasks.

Performing a palliative care interview involves listening to the patient's life story and learning about what is important to the patient. This includes addressing the physical, psychosocial, and spiritual dimensions of the patient and his or her family, each of which affects the quality of life. Similar to the clinical interview with the adult living with a serious illness, identifying what matters most to the child and parent is critical. Domains to be assessed during a clinical interview are: quality of life; coping and adaptation; and communication. Ideally, initiation of conversations about serious illness occur before the terminal nature of a child's illness is known definitively. Some parents may want to protect their children from difficult conversations. This chapter explains why are clinical palliative care interviews so difficult for healthcare providers.