Trust, Disclosure, and Exclusion in Serious Illness Care for Older Gay Men in the Deep South
Published in the Journal of Pain and Symptom Management, a qualitative study explores how older gay men (50+) and their caregivers in the Deep South interpret serious illness care experiences. Drawing on community-based participatory research and interviews, the study identifies five key themes: discriminatory experiences and bias, clinician communication gaps, exclusion from decision-making, system-level care failures, and disclosure-related trust and safety. Findings show that while overt discrimination was present, participants more frequently experienced subtle forms of exclusion, such as dismissive communication, non-recognition of partners, and unclear information, that cumulatively eroded trust. The study highlights how even everyday clinical interactions in serious illness care can carry heightened meaning, shaping disclosure decisions, engagement in care, and perceptions of safety, particularly in contexts marked by historical and structural inequities.