How can women receive more equitable care? #BreakTheBias

Dr. Heyland stands for women in healthcare. #BreakTheBias

March 8th is International Women’s Day. The theme for this day is to #breakthebias.

“Imagine a gender equal world.
A world free of bias, stereotypes, and discrimination.
A world that is diverse, equitable, and inclusive.
A world where difference is valued and celebrated.
Together we can forge women’s equality.
Collectively we can all #BreakTheBias.”

~ https://www.internationalwomensday.com

Inequitable Healthcare 

There is a relationship between gender and the nature of treatments used when people are seriously ill. Women and non-binary individuals have a much different experience than men in the treatments they receive for serious illness.[1]

For example, women are much less likely to receive aggressive care in the last months of life. ‘Aggressive care’ could include admission to ICU, use of life-sustaining treatments, or chemotherapy. This could be related to their values, because they are also less likely to express a preference for such care. But then why are they also less likely to receive adequate pain management? Or are less likely to receive early palliative care

Basing an individual’s medical treatment (consciously or not) based on their gender contributes to the ongoing problem of people not receiving care that aligns with their values. Medical errors like these often results in:

  • people experiencing prolonged suffering by receiving treatments they would prefer not to, or
  • ‘letting people go’ when they might have preferred to fight longer for their life and recovery. 

To correct these errors and prevent women, men, and non-binary individuals from getting care based on gender stereotypes, each individual needs to express their own values when it comes to their care. 

A woman in a hospital bed

How to #BreakTheBias and get the right care

There are simple steps that everyone can take to help ensure you get more equitable care, regardless of your gender, when you experience a serious illness or injury. 

1. Educate yourself

Learn about what your treatment options are and what decisions you might have to make if you become seriously ill. You’ll want to inform yourself about healthcare treatments before you outline your preferences for care, so you know what you’re signing up for. Additionally, you’ll want to understand the risks and benefits of different treatments (for example: CPR) so you can make informed decisions about your care. 

2. Clarify your values

Writing down your values in advance prepares you for future decision-making scenarios. Making medical decisions in advance doesn’t actually help, because you can’t foresee the situation you’ll be in. However, clarifying your values and what is important to you will help you be more prepared for those decisions. It will also help prepare others for decisions when they know what your values are. And that leads to the last step:

3. Communicate your Values and Informed Preferences (VIPs) 

Communicate your VIP’s to your circle of loved ones including your legal representative so they can advocate for you. This step is key! What good is having a plan for medical care if no one knows about it?

As mentioned above, communicating your values helps to prepare those who will make decisions for you to make those decision. It gives them a starting place so they can make decisions based on what they know you value. When you are unable to speak for yourself, others will have to make decisions for you. It will be much easier for them when they are prepared to do so. 

here are different levels of care intensity that patients should consider
There are different levels of care intensity that patients should consider.

Making Your Voice Heard 

It is recommended that you have your values and preferences in writing so that if something happens to you, your wishes are accessible to those who need them. 

You can create an Advance Serious Illness Plan online, which is a document that educates you about the types of care you can receive, helps you define your values and preferences for medical care, and even helps you enable your loved ones to be able to represent your values on your behalf.

Advance serious illness planning increases the chances of receiving the medical care that patients prefer and therefore, overcomes whatever gender bias may be operational in the healthcare system.[2]

If you are interested in Advance Serious Illness Planning, you can learn more here.

Creating an Advance Serious Illness Plan helps to outline your values for better decision making
Creating an Advance Serious Illness Plan helps to outline your values for better decision making.

On a Personal Note 

At some point in everyone’s life, whether you have an advance serious illness plan or not, you will be in a position where you will need to advocate for your own care, or a loved one’s. 

This struck home for me as I assisted my 96-year-old mother-in-law in achieving her wishes of dying at home. I had to push the system to get the resources needed— including a palliative care consult– to make that happen (for more on that story, check out this blog). 

My wife commented to me afterwards, “How would someone who didn’t know the health care system be able to navigate that journey?” Unfortunately, she has a point. All too often, people are ill-equipped to navigate the healthcare system on their own. People need better access to educational resources to better prepare them for these situations. That’s why Advance Serious Illness Planning is so important. 

Being prepared helped me advocate for my mother-in-law to get the right care. We can all prepare to advocate for ourselves and loved ones when we educate ourselves, clarify our values, communicate our VIP’s, and have a plan for serious illness. 

Let’s end healthcare inequality by making sure everyone gets the care they want, based on their own individual values and preferences. Let’s #BreakTheBias. 

[1]Gott M, Morgan T, Williams L. Gender and palliative care: a call to arms. Palliative Care and Social Practice. January 2020. doi:10.1177/2632352420957997

[2]Heyland DK, Heyland R, Bailey A, Howard M. A novel decision aid to help plan for serious illness: a multisite randomized trial. CMAJ Open. 2020 Apr 28;8(2):E289-E296. doi: 10.9778/cmajo.20190179. PubMed PMID: 32345707.

https://www.internationalwomensday.com #BreakTheBias

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To live well, age well, and die well, you need to Plan Well