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Cathcart-Rake EJ, Jatoi A, Dressler EV, Kittel C, Weaver KE, Nightingale C, Neuman H, Loh KP, Kamen C. Sexual Orientation and Gender Identity Data Collection in Cancer Care: A Nationwide Landscape Assessment Update. JCO Oncol Pract 2024:OP2300724. [PMID: 38768413 DOI: 10.1200/op.23.00724] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Revised: 03/08/2024] [Accepted: 04/08/2024] [Indexed: 05/22/2024] Open
Abstract
PURPOSE Routine collection of sexual orientation (SO) and gender identity (GI; collectively SOGI) in cancer clinics advances cancer care equity. METHODS In 2022, NCI Community Oncology Research Program (NCORP) practice groups were asked about routine collection of SOGI data in the electronic health record. The proportions of practice groups reporting collection of SO and/or GI data were calculated, and practice group characteristics were assessed for associations. RESULTS Of 271 practice groups nationwide, 42% (n = 112) collect SO data, 58% (n = 157) collect GI data, and 35% (n = 96) collect both. In multivariate analyses, SO data collection was associated with practice groups having minority outreach staff (odds ratio [OR], 2.07 [95% CI, 1.12 to 3.81]; P = .02); GI data collection was associated with practice groups located in the Northeastern United States (OR, 2.08 [95% CI, 0.73 to 5.91]; P = .045), and those with a higher proportion of new patients who were White (OR, 1.02 [95% CI, 1.01 to 1.04]; P < .001). Practice groups in the South were least likely to collect SOGI data (OR, 0.49 [95% CI, 0.26 to 0.94]; P = .004). There were no statistically significant differences in SO and/or GI collection on the basis of the practice group's proportion of Medicaid/Medicare patients, number of new patients with cancer per year, or practice ownership. CONCLUSION Slightly over one third of NCORP practice groups report routinely collecting SOGI data. There are regional differences in data collection, underscoring the need to craft targeted, region-specific interventions focused on boosting the capture and recording of SOGI data in an affirming manner.
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Affiliation(s)
| | - Aminah Jatoi
- Department of Oncology, Mayo Clinic, Rochester, MN
| | - Emily V Dressler
- Department of Biostatistics and Data Science, Wake Forest University School of Medicine, Winston-Salem, NC
| | - Carol Kittel
- Department of Biostatistics and Data Science, Wake Forest University School of Medicine, Winston-Salem, NC
| | - Kathryn E Weaver
- Department of Social Sciences and Health Policy, Wake Forest University School of Medicine, Winston-Salem, NC
| | - Chandylen Nightingale
- Department of Social Sciences and Health Policy, Wake Forest University School of Medicine, Winston-Salem, NC
| | - Heather Neuman
- Department of Surgery, University of Wisconsin, Madison, WI
| | - Kah Poh Loh
- Department of Surgery, University of Rochester, Rochester, NY
| | - Charles Kamen
- Department of Surgery, University of Rochester, Rochester, NY
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Schneidewind M. Implementing LGBTQ Culturally Appropriate Affirmation Training in the Southern United States: An Evidence-Based Practice Project. J Contin Educ Nurs 2024; 55:121-129. [PMID: 38063797 DOI: 10.3928/00220124-20231130-04] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/02/2024]
Abstract
BACKGROUND The lesbian, gay, bisexual, transgender, or queer (LGBTQ) community is diverse, and members have a shared need for culturally competent health care (CCH). Best practices show that culturally appropriate affirmation training (CAAT) bridges the sociocultural knowledge gap between patient and provider, resulting in increased access to CCH. METHOD The pre-/posttest project design used validated tools to measure group changes in knowledge, attitude, and skills before and after delivery of LGBTQ CAAT. The sample included staff interacting with or making decisions on behalf of patients (n = 11) at a nonprofit clinic in the southern United States. RESULTS A Wilcoxon signed-rank test showed an increase in health care team scores for knowledge, attitude, and skills (knowledge, p = .006, r = -.59; attitude, p = .123, r = -.33; skills, p = .005, r = -.60). Qualitative analysis (thematic analysis) (a) showed that participants explored sensitive subjects in a nonjudgmental way; (b) connected the dots between minority stress, bias, and patient-provider trust; and (c) showed increased staff confidence in providing care to LGBTQ patients. CONCLUSION As staff undergo LGBTQ CAAT, access to CCH will increase, health outcomes will improve, and LGBTQ health disparities will decrease. [J Contin Educ Nurs. 2024;55(3):121-129.].
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Leone AG, Casolino R, Trapani D, Miceli R, Massagrande M, Morano F, La Verde N, Dalu D, Berardi R, Marsoni S, Lambertini M, Iula B, Carieri E, Converti M, Di Maio M, Beretta GD, Perrone F, Pietrantonio F, Cinieri S. Position paper of the Italian association of medical oncology on health disparities among transgender and gender-diverse people: the Assisi recommendations. EClinicalMedicine 2023; 65:102277. [PMID: 37877000 PMCID: PMC10590834 DOI: 10.1016/j.eclinm.2023.102277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2023] [Revised: 09/28/2023] [Accepted: 10/02/2023] [Indexed: 10/26/2023] Open
Abstract
Transgender and gender-diverse individuals experience substantial health disparities across the cancer care continuum. Despite well recognized unique healthcare needs, there are barriers in accessing cancer prevention and treatment services, influenced by disadvantages in key social-economic determinants of health which result in worse clinical outcomes, as compared to the general population. The Italian Association of Medical Oncology (AIOM) acknowledges the critical relevance of this issue. The "Assisi Recommendations" here summarize the outcomes of the "AIOM Oncology Ethics Day" dedicated to gender differences in oncology and cancer care of transgender and gender-diverse people. The recommendations generated during a 2-day multidisciplinary discussion address the various aspects of cancer care experience of transgender and gender-diverse people. The promotion of research in this field, through the generation of new evidence and the collection of prospective data, has been identified as a priority action to mitigate these disparities. By acknowledging the challenges of cancer care in transgender and gender-diverse people and recognizing the need for dedicated policy and clinical recommendations, AIOM demonstrates its commitment to improving the health and well-being of all patients with cancer, regardless of their gender identity or any other personal or social circumstances, as part of health-for-all societal vision.
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Affiliation(s)
- Alberto Giovanni Leone
- Medical Oncology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Via G. Venezian 1, Milan 21033, Italy
| | - Raffaella Casolino
- Wolfson Wohl Cancer Research Centre, Institute of Cancer Sciences, University of Glasgow, Glasgow, UK
| | - Dario Trapani
- European Institute of Oncology, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Milan, Italy
- Department of Oncology and Hemato-oncology (DIPO), University of Milan, Milan, Italy
| | - Rosalba Miceli
- Department of Biostatistics for Clinical Research, Fondazione IRCCS Istituto Nazionale dei Tumori, Via G. Venezian 1, Milan 21033, Italy
| | | | - Federica Morano
- Medical Oncology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Via G. Venezian 1, Milan 21033, Italy
| | - Nicla La Verde
- Department of Oncology, Luigi Sacco Hospital, ASST Fatebenefratelli Sacco, Milan, Italy
| | - Davide Dalu
- Department of Oncology, Luigi Sacco Hospital, ASST Fatebenefratelli Sacco, Milan, Italy
| | - Rossana Berardi
- Oncology Clinic, Università Politecnica delle Marche, AOU delle Marche, Ancona, Italy
| | - Silvia Marsoni
- IFOM - the FIRC Institute of Molecular Oncology, Milan, Italy
| | - Matteo Lambertini
- Department of Internal Medicine and Medical Specialties (DiMI), School of Medicine, University of Genova, Genova, Italy
- Department of Medical Oncology, U.O. Clinica di Oncologia Medica, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Bianca Iula
- ACET - Associazione per la Cultura e l’etica Transgenere (Association for Transgender Culture and Ethics), Milan, Italy Degree: N/A
| | | | - Manlio Converti
- AMIGAY Aps - Associazione Italiana Medici e Personale Sanitario, LGBTQIA+ e Friendly (Italian Association of LGBTQIA+ Medical care Providers), Italy
| | - Massimo Di Maio
- Department of Oncology, University of Turin, A.O. Ordine Mauriziano, Turin, Italy
- National Secretary of the Italian Association of Medical Oncology (AIOM), Italy
| | - Giordano Domenico Beretta
- UOC Oncologia Medica, ASL Pescara P.O., Pescara, Italy
- National President of the Italian Foundation of Medical Oncology (Fondazione AIOM), Italy
| | - Francesco Perrone
- Clinical Trial Unit, Istituto Nazionale Tumori, IRCCS, Fondazione G. Pascale, Napoli, Italy
- President-elect of the Italian Association of Medical Oncology (AIOM), Italy
| | - Filippo Pietrantonio
- Medical Oncology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Via G. Venezian 1, Milan 21033, Italy
| | - Saverio Cinieri
- Medical Oncology Unit, Ospedale di Summa A. Perrino, Brindisi, Italy
- National President of the Italian Association of Medical Oncology (AIOM), Italy
| | - the Italian Foundation of Medical Oncology (Fondazione AIOM)
- Medical Oncology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Via G. Venezian 1, Milan 21033, Italy
- Wolfson Wohl Cancer Research Centre, Institute of Cancer Sciences, University of Glasgow, Glasgow, UK
- European Institute of Oncology, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Milan, Italy
- Department of Oncology and Hemato-oncology (DIPO), University of Milan, Milan, Italy
- Department of Biostatistics for Clinical Research, Fondazione IRCCS Istituto Nazionale dei Tumori, Via G. Venezian 1, Milan 21033, Italy
- ELMA Research, Milan, Italy
- Department of Oncology, Luigi Sacco Hospital, ASST Fatebenefratelli Sacco, Milan, Italy
- Oncology Clinic, Università Politecnica delle Marche, AOU delle Marche, Ancona, Italy
- IFOM - the FIRC Institute of Molecular Oncology, Milan, Italy
- Department of Internal Medicine and Medical Specialties (DiMI), School of Medicine, University of Genova, Genova, Italy
- Department of Medical Oncology, U.O. Clinica di Oncologia Medica, IRCCS Ospedale Policlinico San Martino, Genova, Italy
- ACET - Associazione per la Cultura e l’etica Transgenere (Association for Transgender Culture and Ethics), Milan, Italy Degree: N/A
- Independent Researcher, Italy Degree: N/A
- AMIGAY Aps - Associazione Italiana Medici e Personale Sanitario, LGBTQIA+ e Friendly (Italian Association of LGBTQIA+ Medical care Providers), Italy
- Department of Oncology, University of Turin, A.O. Ordine Mauriziano, Turin, Italy
- National Secretary of the Italian Association of Medical Oncology (AIOM), Italy
- UOC Oncologia Medica, ASL Pescara P.O., Pescara, Italy
- National President of the Italian Foundation of Medical Oncology (Fondazione AIOM), Italy
- Clinical Trial Unit, Istituto Nazionale Tumori, IRCCS, Fondazione G. Pascale, Napoli, Italy
- President-elect of the Italian Association of Medical Oncology (AIOM), Italy
- Medical Oncology Unit, Ospedale di Summa A. Perrino, Brindisi, Italy
- National President of the Italian Association of Medical Oncology (AIOM), Italy
| | - Italian Association of Medical Oncology (AIOM)
- Medical Oncology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Via G. Venezian 1, Milan 21033, Italy
- Wolfson Wohl Cancer Research Centre, Institute of Cancer Sciences, University of Glasgow, Glasgow, UK
- European Institute of Oncology, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Milan, Italy
- Department of Oncology and Hemato-oncology (DIPO), University of Milan, Milan, Italy
- Department of Biostatistics for Clinical Research, Fondazione IRCCS Istituto Nazionale dei Tumori, Via G. Venezian 1, Milan 21033, Italy
- ELMA Research, Milan, Italy
- Department of Oncology, Luigi Sacco Hospital, ASST Fatebenefratelli Sacco, Milan, Italy
- Oncology Clinic, Università Politecnica delle Marche, AOU delle Marche, Ancona, Italy
- IFOM - the FIRC Institute of Molecular Oncology, Milan, Italy
- Department of Internal Medicine and Medical Specialties (DiMI), School of Medicine, University of Genova, Genova, Italy
- Department of Medical Oncology, U.O. Clinica di Oncologia Medica, IRCCS Ospedale Policlinico San Martino, Genova, Italy
- ACET - Associazione per la Cultura e l’etica Transgenere (Association for Transgender Culture and Ethics), Milan, Italy Degree: N/A
- Independent Researcher, Italy Degree: N/A
- AMIGAY Aps - Associazione Italiana Medici e Personale Sanitario, LGBTQIA+ e Friendly (Italian Association of LGBTQIA+ Medical care Providers), Italy
- Department of Oncology, University of Turin, A.O. Ordine Mauriziano, Turin, Italy
- National Secretary of the Italian Association of Medical Oncology (AIOM), Italy
- UOC Oncologia Medica, ASL Pescara P.O., Pescara, Italy
- National President of the Italian Foundation of Medical Oncology (Fondazione AIOM), Italy
- Clinical Trial Unit, Istituto Nazionale Tumori, IRCCS, Fondazione G. Pascale, Napoli, Italy
- President-elect of the Italian Association of Medical Oncology (AIOM), Italy
- Medical Oncology Unit, Ospedale di Summa A. Perrino, Brindisi, Italy
- National President of the Italian Association of Medical Oncology (AIOM), Italy
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Ding JM, Thomas RH, Guzzo TJ, Lee DJ. Assessing Baseline Knowledge and Usage Patterns of Sexual Orientation/Gender Identity Affirming Electronic Health Record Modules Within a Urology Division at a Single Tertiary Care Institution. Urology 2023; 180:113-120. [PMID: 37406862 DOI: 10.1016/j.urology.2023.04.047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2022] [Revised: 04/13/2023] [Accepted: 04/27/2023] [Indexed: 07/07/2023]
Abstract
OBJECTIVE To evaluate how sexual orientation and gender identity (SOGI)-affirming electronic health record (EHR) modules (which enable seamless location and documentation of patient SOGI data) are being used by providers/staff within a urology practice. MATERIALS AND METHODS All 120 patient-facing providers/staff at a tertiary urology program were offered a 39-question Qualtrics-based survey, which assessed respondents' cultural competency, baseline knowledge of SOGI EHR modules, and SOGI module usage patterns. Cultural competency was assessed using the LGBT-Development of Clinical Skills Scale (LGBT-DOCCS). RESULTS 96 qualified providers/staff completed the survey (response rate, 89%). Only 25% of respondents received training on finding/collecting SOGI data in the EHR. Respondents possessed high levels of LGBTQ attitudinal awareness (M=6.38/7) but low clinical preparedness (M=4.32/7), in large part due to perceived inadequate training to work with LGBT patients. Major drivers of clinical preparedness were respondent role and number of LGBT patients seen in the past year. While respondents uniformly report ease finding SOGI data, all providers/staff (particularly physicians) rarely use formal SOGI documentation tools. Few respondents partook in SOGI EHR training; those that did were significantly more likely to use formal SOGI documentation tools. CONCLUSION This study revealed that providers/staff possess high general LGBTQ cultural competency and ability to find relevant SOGI data in the EHR, while also highlighting limited training in SOGI-affirming EHR tools and low usage of formal documentation tools. This framework could be a roadmap for evaluating SOGI-affirming EHR use by urology practices as such features increase in popularity.
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Affiliation(s)
- James M Ding
- Division of Urology, Department of Surgery, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA.
| | - Rosemary H Thomas
- Penn Medicine Program for LGBT Health, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
| | - Thomas J Guzzo
- Division of Urology, Department of Surgery, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
| | - Daniel J Lee
- Division of Urology, Department of Surgery, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA; Corporal Michael J. Crescenz VA Medical Center, US Department of Veterans Affairs, Philadelphia, PA
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Lauckner C, Lambert D, Truszczynski N, Jann JT, Hansen N. A qualitative assessment of barriers to healthcare and HIV prevention services among men who have sex with men in non-metropolitan areas of the south. AIDS Care 2023; 35:1563-1569. [PMID: 35914115 DOI: 10.1080/09540121.2022.2105798] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Accepted: 07/19/2022] [Indexed: 10/16/2022]
Abstract
HIV cases are increasing in the rural Southern United States, especially among men who have sex with men (MSM). To facilitate healthcare access and encourage HIV prevention for non-metropolitan MSM, it is essential to examine their barriers to care. This qualitative study conducted semi-structured interviews with 20 MSM living in non-metropolitan areas of the South. Analysis revealed that MSM experience multiple barriers accessing healthcare in non-metropolitan areas such as finding knowledgeable and affirming providers with desired characteristics and beliefs and communicating with providers about sexual health and HIV prevention. To aid in identification, many respondents expressed a desire for providers to publicly signal that they provide care for sexual and gender minority patients and are an inclusive clinical space. Overall, results suggest that MSM face unique healthcare-related challenges, beyond those typically experienced by the broader population in non-metropolitan areas, because of tailored identity-based needs. To better support MSM in non-metropolitan areas, especially in the South where increased experiences of stigma are found, providers should seek further training regarding sexual health communication and HIV prevention, indicate on websites and in offices that they support sexual and gender minority patients, and provide telehealth services to MSM living in more geographically isolated areas.
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Affiliation(s)
- Carolyn Lauckner
- Center for Health Equity Transformation, University of Kentucky, Lexington, KY, USA
| | - Danielle Lambert
- Department of Epidemiology and Biostatistics, University of Georgia, Athens, GA, USA
| | | | | | - Nathan Hansen
- Department of Health Promotion & Behavior, University of Georgia, Athens, GA, USA
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Yang MJ, Pérez-Morales J, Quinn GP, Miller JD, Simmons VN, Schabath MB. Psychosocial characteristics and quality of life among sexual and gender minority patients with cancer. JNCI Cancer Spectr 2023; 7:pkad061. [PMID: 37572311 PMCID: PMC10587999 DOI: 10.1093/jncics/pkad061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Revised: 07/17/2023] [Accepted: 08/07/2023] [Indexed: 08/14/2023] Open
Abstract
BACKGROUND Underserved and minoritized patients with cancer often experience more psychosocial concerns and inferior quality of life (QOL) compared with majority populations. This study compared patient-reported psychosocial characteristics and QOL among self-identified sexual and gender minority patients with cancer vs cisgender-heterosexual patients with cancer treated at a National Cancer Institute-designated comprehensive cancer center in the United States. METHODS Self-report data from 51 503 patients were obtained from an institutional standard-of-care electronic patient questionnaire that was completed prior to, or on the day of, the patient's initial visit. The electronic patient questionnaire collects demographic information, including sexual orientation and gender identity, psychosocial variables, and QOL using the validated Short Form Health Survey-12. Sexual orientation and gender identity information was used to identify self-identified sexual and gender minority and cisgender-heterosexual persons (ie, non-self-identified sexual and gender minority). Using parametric analyses, psychosocial variables and QOL measures were compared for self-identified sexual and gender minority vs non-self-identified sexual and gender minority patients with cancer. RESULTS Compared with non-self-identified sexual and gender minority patients (n = 50 116), self-identified sexual and gender minority patients (n = 1387, 2.7%) reported statistically significantly greater concerns regarding getting help during treatment (2.6% vs 4.3%, respectively; P = .001) and concerns with ability to seek care (16.7% vs 21.6%, respectively, P < .001). Self-identified sexual and gender minority patients reported statistically significantly elevated mental health concerns and daily emotional and pain interference (all P < .001), whereas there was no statistically significant difference in daily interference due to physical functioning. CONCLUSION These data reveal real-world disparities among self-identified sexual and gender minority patients with cancer, which can be used to develop psychosocial interventions tailored to address the unique psychosocial and QOL needs of this underserved and minoritized population and to ultimately improve cancer care.
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Affiliation(s)
- Min-Jeong Yang
- Department of Health Outcomes and Behavior, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Jaileene Pérez-Morales
- Department of Cancer Epidemiology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Gwendolyn P Quinn
- Department of Obstetrics and Gynecology, New York University Grossman School of Medicine, New York, NY, USA
- Department of Population Health, New York University Grossman School of Medicine, New York, NY, USA
| | - Jarred D Miller
- Department of Cancer Epidemiology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Vani N Simmons
- Department of Oncologic Sciences, College of Medicine, University of South Florida, Tampa, FL, USA
- Department of Psychology, University of South Florida, Tampa, FL, USA
| | - Matthew B Schabath
- Department of Cancer Epidemiology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
- Department of Oncologic Sciences, College of Medicine, University of South Florida, Tampa, FL, USA
- Department of Thoracic Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
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Yu H, Flores DD, Bonett S, Bauermeister JA. LGBTQ + cultural competency training for health professionals: a systematic review. BMC MEDICAL EDUCATION 2023; 23:558. [PMID: 37559033 PMCID: PMC10410776 DOI: 10.1186/s12909-023-04373-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Accepted: 05/17/2023] [Indexed: 08/11/2023]
Abstract
BACKGROUND Health disparities experienced by LGBTQ + individuals have been partially attributed to health professionals' lack of cultural competence to work with them. Cultural competence, the intricate integration of knowledge, skills, attitudes, and behaviors that improve cross-cultural communication and interpersonal relationships, has been used as a training framework to enhance interactions between LGBTQ + patients and health professionals. Despite multiple published LGBTQ + cultural competency trainings, there has been no quantitative appraisal and synthesis of them. This systematic review assessed articles evaluating the design and effectiveness of these trainings and examined the magnitude of their effect on cultural competence outcomes. METHODS Included studies quantitatively examined the effectiveness of LGBTQ + cultural competency trainings for health professionals across all disciplines in various healthcare settings. 2,069 citations were retrieved from five electronic databases with 44 articles meeting inclusion criteria. The risk of bias in the included studies was assessed by two authors utilizing the Joanna Briggs Institute critical appraisal checklists. Data extracted included study design, country/region, sample characteristic, training setting, theoretical framework, training topic, modality, duration, trainer, training target, measurement instrument, effect size and key findings. This review followed the PRISMA statement and checklist to ensure proper reporting. RESULTS 75% of the studies were published between 2017 and 2023. Four study designs were used: randomized controlled trial (n = 1), quasi-experimental pretest-posttest without control (n = 39), posttest only with control (n = 1) and posttest only without control (n = 3). Training modalities were multiple modalities with (n = 9) and without simulation (n = 25); single modality with simulation (n = 1); and with didactic lectures (n = 9). Trainings averaged 3.2 h. Ten studies employed LGBTQ + trainers. The training sessions resulted in statistically significant improvements in the following cultural competence constructs: (1) knowledge of LGBTQ + culture and health (n = 28, effect size range = 0.28 - 1.49), (2) skills to work with LGBTQ + clients (n = 8, effect size range = 0.12 - 1.12), (3) attitudes toward LGBTQ + individuals (n = 14, effect size range = 0.19 - 1.03), and (4) behaviors toward LGBTQ + affirming practices (n = 7, effect size range = 0.51 - 1.11). CONCLUSIONS The findings of this review highlight the potential of LGBTQ + cultural competency training to enhance cultural competence constructs, including (1) knowledge of LGBTQ + culture and health, (2) skills to work with LGBTQ + clients, (3) attitudes toward LGBTQ + individuals, and (4) behaviors toward LGBTQ + affirming practices, through an interdisciplinary and multi-modal approach. Despite the promising results of LGBTQ + cultural competency training in improving health professionals' cultural competence, there are limitations in study designs, sample sizes, theoretical framing, and the absence of longitudinal assessments and patient-reported outcomes, which call for more rigorous research. Moreover, the increasing number of state and federal policies that restrict LGBTQ + health services highlight the urgency of equipping health professionals with culturally responsive training. Organizations and health systems must prioritize organizational-level changes that support LGBTQ + inclusive practices to provide access to safe and affirming healthcare services for LGBTQ + individuals.
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Affiliation(s)
- Hyunmin Yu
- School of Nursing, University of Pennsylvania, 418 Curie Blvd, Philadelphia, PA 19104 USA
| | - Dalmacio Dennis Flores
- School of Nursing, University of Pennsylvania, 418 Curie Blvd, Philadelphia, PA 19104 USA
| | - Stephen Bonett
- School of Nursing, University of Pennsylvania, 418 Curie Blvd, Philadelphia, PA 19104 USA
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Alpert AB, Rivers L, Manzano C, Ruddick R, Adams S, Obedin-Maliver J, Harvey RD, Griggs JJ, Operario D. Debunking Sex and Disentangling Gender From Oncology. J Clin Oncol 2023; 41:3791-3795. [PMID: 37235816 PMCID: PMC10860932 DOI: 10.1200/jco.22.02037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2022] [Revised: 03/05/2023] [Accepted: 03/28/2023] [Indexed: 05/28/2023] Open
Affiliation(s)
- Ash B. Alpert
- Center for Gerontology, Brown University School of Public Health, Providence, RI
- Department of Health Services, Policy, and Practice, Brown University School of Public Health, Providence, RI
- Department of Public Health Sciences, University of Rochester Medical Center, Rochester, NY
| | | | | | | | | | - Juno Obedin-Maliver
- Department of Obstetrics and Gynecology, Stanford University School of Medicine, Palo Alto, CA
- Department of Epidemiology and Population Health, Stanford University School of Medicine, Palo Alto, CA
- The PRIDE Study, Stanford University School of Medicine, Palo Alto, CA
| | - R. Donald Harvey
- Departments of Hematology and Medical Oncology and Pharmacology and Chemical Biology, Emory University School of Medicine, Atlanta, GA
- Winship Cancer Institute of Emory University, Atlanta, GA
| | - Jennifer J. Griggs
- Department of Internal Medicine, Hematology & Oncology Division, University of Michigan, Ann Arbor, MI
- Department of Health Management & Policy, School of Public Health, University of Michigan, Ann Arbor, MI
| | - Don Operario
- Department of Behavioral, Social, and Health Education Sciences, Emory University, Atlanta, GA
- Department of Behavioral and Social Sciences, Brown University, Providence, RI
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Kano M, Tamí-Maury I, Pratt-Chapman ML, Chang S, Kosich M, Quinn GP, Poteat T, Kanetsky PA, Elk R, Boehmer U, Sanchez J, Kamen C, Sanchez NF. Piloting the Sexual and Gender Minority Cancer Curricular Advances for Research and Education (SGM Cancer CARE) Workshop: Research Training in the Service of SGM Cancer Health Equity. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2023; 38:1066-1076. [PMID: 36399283 PMCID: PMC9673892 DOI: 10.1007/s13187-022-02233-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 10/30/2022] [Indexed: 06/02/2023]
Abstract
The purpose of this study is to describe the context, curriculum design, and pilot evaluation of the educational program "Sexual and Gender Minority Cancer Curricular Advances for Research and Education" (SGM Cancer CARE), a workshop for early-career researchers and healthcare providers interested in gaining knowledge and skills in sexual and gender minority (SGM) cancer research and healthcare advocacy. A needs assessment of a sample of clinicians and researchers (n = 104) and feedback from an Advisory Board informed the curriculum design of the SGM Cancer CARE workshop. Four SGM-tailored modules, focusing on epidemiology, clinical research, behavioral science and interventions, and community-based participatory approaches, were developed and tested in a 2.5-day virtual format among 19 clinicians and researchers. A fifth module to provide feedback to participants on brief presentations about their SGM cancer research ideas or related efforts was added later. A mixed-methods evaluation comprised of pre- and post-modular online evaluation surveys and virtual focus groups was used to determine the degree to which the workshop curriculum met participant needs. Compared to pre-module evaluations, participants reported a marked increase in SGM cancer research knowledge in post-module scores. Quantitative results were supported by our qualitative findings. In open field response survey questions and post-workshop focus groups, participants reported being extremely pleased with the content and delivery format of the SGM Cancer CARE workshop. Participants did regret not having the opportunity to connect with instructors, mentors, and colleagues in person. The SGM Cancer CARE curriculum was shown to increase the knowledge, skills, and level of preparedness of early-career clinicians and scientists to conduct culturally relevant and appropriate research needed to improve care for SGM persons across the cancer care continuum from prevention to survivorship.
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Affiliation(s)
- Miria Kano
- Division of Epidemiology, Biostatistics, and Preventive Medicine, Department of Internal Medicine, University of New Mexico Health Science Center, Albuquerque, NM, USA.
| | - Irene Tamí-Maury
- Department of Epidemiology, School of Public Health, Human Genetics, and Environmental Sciences, The University of Texas Health Science Center at Houston, Houston, TX, USA.
| | - Mandi L Pratt-Chapman
- Department of Medicine, The George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | - Shine Chang
- Division of Cancer Prevention and Population Sciences, Department of Epidemiology and Cancer Prevention Research Training Program, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Mikaela Kosich
- Biostatistics Shared Resource, The University of New Mexico Comprehensive Cancer Center, Albuquerque, NM, USA
| | - Gwendolyn P Quinn
- Department of OBGYN, Perlmutter Cancer Center, Grossman School of Medicine, New York University, New York, NY, USA
| | - Tonia Poteat
- Department of Social Medicine, Lineberger Cancer Center, University of North Carolina School of Medicine, Chapel Hill, NC, USA
| | - Peter A Kanetsky
- Department of Cancer Epidemiology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Ronit Elk
- Department of Medicine, University of Alabama, Birmingham, AL, USA
| | - Ulrike Boehmer
- Department of Community Health Sciences, Boston University School of Public Health, Boston, MA, USA
| | - Julian Sanchez
- Department of Gastrointestinal Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Charles Kamen
- Department of Surgery, Cancer Control, University of Rochester Medical Center, Rochester, NY, USA
| | - Nelson F Sanchez
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
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10
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Jivraj N, Shapiro GK, Schulz-Quach C, Van de Laar E, Liu ZA, Weiss J, Croke J. Evaluating Healthcare Professionals' Knowledge, Attitudes, Practices and Education Interest in LGBTQ2 + Cancer Care. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2022:10.1007/s13187-022-02244-x. [PMID: 36454364 DOI: 10.1007/s13187-022-02244-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 11/27/2022] [Indexed: 06/17/2023]
Abstract
The lesbian, gay, bisexual, transgender, queer/questioning and two-spirited, plus (LGBTQ2 +) community experiences cancer-related health disparities and inequities. Our objective was to assess LGBTQ2 + knowledge, attitudes, practices and education interest of healthcare professionals (HCPs), identify opportunities to improve care and inform the development of an HCP education curriculum. This was a mixed methods quality improvement study conducted within a tertiary academic cancer centre. An email was sent to all gynaecologic oncology disease site staff (n = 92) with a secure link to an online survey. We measured respondents' sociodemographic characteristics and LGBTQ2 + knowledge, attitudes, practice behaviours and education interest. Open comments explored HCP experiences and reservations caring for LGBTQ2 + patients and suggestions to improve care. Seventy-five out of ninety-two (82%) HCPs completed the survey, with 7% identifying as LGBTQ2 + . HCPs reported feeling less comfortable (88% vs. 80%, p = 0.031) and knowledgeable (44% vs. 27%, p < 0.001) caring for transgender patients compared to LGBQ2 + patients. Most (76%) were unaware whether LGBTQ2 + -specific patient educational materials existed within their institution. Almost all (92% strongly agreed/agreed) were interested in receiving LGBTQ2 + -specific education. Two themes emerged from analysis of open comments: (i) HCPs are concerned of offending LGBTQ2 + individuals because of their lack of knowledge and (ii) HCPs desire LGBTQ2 + -specific health training, specifically in asking pronouns and caring for transgender patients. HCPs report competency gaps in caring for LGBTQ2 + patients with cancer but desire education. In response, we recommend institutions develop an educational curriculum for HCPs improve communication and inclusivity in cancer care.
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Affiliation(s)
- Nazlin Jivraj
- Gynecology Oncology Ambulatory Care, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Gilla K Shapiro
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
- Palliative and End-of-Life Care (GIPPEC), Global Institute of Psychosocial, University of Toronto, Toronto, ON, Canada
| | - Christian Schulz-Quach
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
- Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Emily Van de Laar
- Division of Gynecologic Oncology, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Zhihui Amy Liu
- Department of Biostatistics, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Jessica Weiss
- Department of Biostatistics, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Jennifer Croke
- Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada.
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11
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Chan ASW, Leung LM, Li JSF, Ho JMC, Tam HL, Hsu WL, Iu ANOS, Tang PMK, Yan E. Impacts of psychological wellbeing with HIV/AIDS and cancer among sexual and gender minorities: A systematic review and meta-analysis. Front Public Health 2022; 10:912980. [PMID: 36523575 PMCID: PMC9746694 DOI: 10.3389/fpubh.2022.912980] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Accepted: 10/27/2022] [Indexed: 11/21/2022] Open
Abstract
Background The agony and economic strain of cancer and HIV/AIDS therapies severely impact patients' psychological wellbeing. Meanwhile, sexual minorities experience discrimination and mental illness. LGBT individuals with cancer and HIV/AIDS play two roles. It is important to understand and examine this groups mental wellbeing. Objective The purpose of this study is to synthesize current studies on the impact of HIV/AIDS and cancer on LGBT patients' psychological wellbeing. Methods This research uses a systematic literature review at first and later stage a meta-analysis was run on the same review. In this study, data from Google academic and Web of Science has been used to filter literature. PRISMA 2020 Flow Diagram seeks research on LGBT cancer and HIV/AIDS patients. The above sites yielded 370 related papers, some of which were removed due to age or inaccuracy. Finally, meta-analyses was done on 27 HIV/AIDS and 33 cancer patients's analyse. Results The research included 9,898 LGBT cancer sufferers with AIDS and 14,465 cancer sufferers with HIV/AIDS. Using meta-analysis, we discovered the gap in psychological wellbeing scores between HIV/AIDS LGBT and non-LGBT groups ranged from -10.86 to 15.63. The overall score disparity between the HIV/AIDS LGBT and non-LGBT groups was 1.270 (95% CI = 0.990-1.560, Z = 86.58, P < 0.1). The disparity in psychological wellbeing scores between cancer LGBT group and general group varies from -8.77 to 20.94 in the 34 papers examined in this study. Overall, the psychological wellbeing score disparity between the cancer LGBT subset and the general group was 12.48 (95% CI was 10.05-14.92, Test Z-value was 268.40, P-value was <0.1). Conclusion Inflammation and fibrosis in HIV/AIDS and cancer sufferers adversely affect their psychological wellbeing.
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Affiliation(s)
- Alex Siu Wing Chan
- Department of Applied Social Sciences, Faculty of Health and Social Sciences, The Hong Kong Polytechnic University, Kowloon, Hong Kong SAR, China,*Correspondence: Alex Siu Wing Chan ;
| | - Lok Man Leung
- Department of Applied Social Sciences, Faculty of Health and Social Sciences, The Hong Kong Polytechnic University, Kowloon, Hong Kong SAR, China
| | - Jane Siu Fan Li
- Department of Anatomical and Cellular Pathology, State Key Laboratory of Translational Oncology, The Chinese University of Hong Kong, Hong Kong, Hong Kong SAR, China
| | - Jacqueline Mei Chi Ho
- Faculty of Health and Social Sciences, School of Nursing, Hong Kong Polytechnic University, Kowloon, Hong Kong SAR, China
| | - Hon Lon Tam
- Faculty of Medicine, Nethersole School of Nursing, The Chinese University of Hong Kong, Kowloon, Hong Kong SAR, China
| | - Wing Leung Hsu
- Aceso Medical Centre, Hong Kong, Hong Kong SAR, China,Department of Pharmacy, Health and Well-being, University of Sunderland, Sunderland, United Kingdom
| | - April Nicole On Sang Iu
- Department of Psychology, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, NSW, Australia
| | - Patrick Ming Kuen Tang
- Department of Anatomical and Cellular Pathology, State Key Laboratory of Translational Oncology, The Chinese University of Hong Kong, Hong Kong, Hong Kong SAR, China,Elsie Yan
| | - Elsie Yan
- Department of Applied Social Sciences, Faculty of Health and Social Sciences, The Hong Kong Polytechnic University, Kowloon, Hong Kong SAR, China,Patrick Ming Kuen Tang
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12
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Primary Healthcare Nurse’s Barriers and Facilitators to Providing Sexual and Reproductive Healthcare Services of LGBTQI Individuals: A Qualitative Study. Healthcare (Basel) 2022; 10:healthcare10112208. [DOI: 10.3390/healthcare10112208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Revised: 10/18/2022] [Accepted: 11/01/2022] [Indexed: 11/06/2022] Open
Abstract
In most cases, we only hear Lesbians, Gays, Bisexuals, Transgender, Queer, and Intersex (LGBTQI) patients complaining about nurses being the reason for not accessing and utilizing healthcare services; for example, studies reports on the different attitudes of healthcare providers including nurses against LGBTQI patients. However, factors influencing the behavior of South African Primary Healthcare (PHC) Nurses toward LGBTQI patients are rarely reported. The study aimed to explore how PHC nurses experienced and perceived sexual and reproductive health services for LGBTQI individuals in Tshwane, Gauteng Province, South Africa. The study followed qualitative research using an exploratory design approach. The sample included 27 PHC nurses from Tshwane, Gauteng Province, South Africa. In-depth face-to-face interviews were coded and analyzed using Thematic Content Analysis (TCA) which included five interrelated steps. The results revealed three main themes: barriers to the provision of LGBTQI-related SRHS, facilitators for the provision of SRHS to LGBTQI individuals, and strategies to improve LGBTQI individuals’ SRHS accessibility and availability. Common barriers were related to the institutions, PHC nurses, the general public, and LGBTQI patients themselves. Regardless of the challenges faced by PHC nurses, there were some enabling factors that pushed them to continue rendering SHRS to LGBTQI patients who came to their clinics. Almost all PHC nurses suggested the importance of awareness, transparency, collaboration, and the need for training related to LGBTQI healthcare issues.
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13
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Benedict C, Shaffer KM, Wirtz MR, Ford JS, Reese JB. Current Considerations in Interventions to Address Sexual Function and Improve Care for Women with Cancer. CURRENT SEXUAL HEALTH REPORTS 2022. [DOI: 10.1007/s11930-022-00343-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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14
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Wang YC, Miao NF, You MH. Attitudes toward, knowledge of, and beliefs regarding providing care to LGBT patients among student nurses, nurses, and nursing educators: A cross-sectional survey. NURSE EDUCATION TODAY 2022; 116:105472. [PMID: 35834866 DOI: 10.1016/j.nedt.2022.105472] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Revised: 06/12/2022] [Accepted: 07/06/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Studies have assessed attitudes toward, knowledge of, and beliefs regarding providing care for lesbian, gay, bisexual, and transgender (LGBT) patients among student nurses, nurses, and nursing educators individually, but few studies have compared these aspects among these groups. OBJECTIVES To examine the attitudes toward, knowledge of, and beliefs regarding providing care for LGBT patients among student nurses, nurses, and nursing educators in Taiwan. DESIGN Cross-sectional survey. SETTINGS The study was advertised in 8 nursing schools, 14 nursing associations, 209 nursing homes, and 2 online chatrooms in Taiwan. PARTICIPANTS A total of 1150 participants were recruited: 447 student nurses, 475 nurses, and 228 nursing educators. METHODS Data were collected between August 2021 and January 2022 through a questionnaire with five sections: demographics, knowledge of LGBT health, the Knowledge about Homosexuality Questionnaire, the Attitude Toward Lesbian and Gay Men Scale, and the Gay Affirmative Practice Scale. RESULTS The results suggest that the participants had limited knowledge of LGBT health. The nursing educators had the lowest scores for knowledge of LGBT health and homosexuality and the most negative attitudes toward lesbians and gay men among the groups; however, they were most likely to report their beliefs regarding providing nursing care to LGBT patients than the other two groups. CONCLUSIONS The results indicate the importance of providing nursing educators with training courses and resources related to culturally competent care to improve education for nursing students and care for LGBT patients.
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Affiliation(s)
- Ya-Ching Wang
- School of Nursing, College of Medicine, National Taiwan University, Taipei, Taiwan; Department of Nursing, National Taiwan University Hospital, Taipei, Taiwan.
| | - Nae-Fang Miao
- Post-Baccalaureate Program in Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan.
| | - Mei-Hui You
- Graduate Institute of Gender Education, National Kaohsiung Normal University, Taiwan.
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15
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Tamargo CL, Mitchell EP, Wagner L, Simon MA, Carlos RC, Giantonio BJ, Schabath MB, Quinn GP. “I need more knowledge”: Qualitative analysis of oncology providers’ experiences with sexual and gender minority patients. Front Psychol 2022; 13:763348. [PMID: 36046410 PMCID: PMC9421156 DOI: 10.3389/fpsyg.2022.763348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Accepted: 07/22/2022] [Indexed: 11/13/2022] Open
Abstract
Background While societal acceptance for sexual and gender minority (SGM) individuals is increasing, this group continues to face barriers to quality healthcare. Little is known about clinicians’ experiences with SGM patients in the oncology setting. To address this, a mixed method survey was administered to members of the ECOG-ACRIN Cancer Research Group. Materials and methods We report results from the open-ended portion of the survey. Four questions asked clinicians to describe experiences with SGM patients, reservations in caring for them, suggestions for improvement in SGM cancer care, and additional comments. Data were analyzed using content analysis and the constant comparison method. Results The majority of respondents noted they had no or little familiarity with SGM patients. A minority of respondents noted experience with gay and lesbian patients, but not transgender patients; many who reported experience with transgender patients also noted difficulty navigating the correct use of pronouns. Many respondents also highlighted positive experiences with SGM patients. Suggestions for improvement in SGM cancer care included providing widespread training, attending to unique end-of-life care issues among SGM patients, and engaging in efforts to build trust. Conclusion Clinicians have minimal experiences with SGM patients with cancer but desire training. Training the entire workforce may improve trust with, outreach efforts to, and cancer care delivery to the SGM community.
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Affiliation(s)
- Christina L. Tamargo
- Department of Internal Medicine, Johns Hopkins Hospital, Baltimore, MD, United States
| | - Edith P. Mitchell
- Department of Medical Oncology, Thomas Jefferson University, Philadelphia, PA, United States
| | - Lynne Wagner
- Department of Social Sciences and Health Policy, Wake Forest University, Winston-Salem, NC, United States
| | - Melissa A. Simon
- Department of Obstetrics and Gynecology, Robert H. Lurie Comprehensive Cancer Center, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | - Ruth C. Carlos
- Department of Radiology, University of Michigan, Ann Arbor, MI, United States
| | - Bruce J. Giantonio
- Department of Hematology/Oncology, Massachusetts General Hospital, Boston, MA, United States
| | - Matthew B. Schabath
- Department of Cancer Epidemiology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL, United States
- *Correspondence: Matthew B. Schabath,
| | - Gwendolyn P. Quinn
- Department of Obstetrics and Gynecology and Population Health, NYU Grossman School of Medicine, New York, NY, United States
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16
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Power R, Ussher JM, Perz J, Allison K, Hawkey AJ. “Surviving Discrimination by Pulling Together”: LGBTQI Cancer Patient and Carer Experiences of Minority Stress and Social Support. Front Oncol 2022; 12:918016. [PMID: 35814403 PMCID: PMC9263127 DOI: 10.3389/fonc.2022.918016] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Accepted: 05/24/2022] [Indexed: 11/16/2022] Open
Abstract
Background Lesbian, gay, bisexual, transgender, queer and/or intersex (LGBTQI) people with cancer and their carers report poorer psychological outcomes than the general non-LGBTQI cancer population. There is growing acknowledgement that these health inequities can be explained by minority stress, which can be buffered by social support. Study Aim To examine subjective experiences of minority stress and social support for LGBTQI people with cancer and their carers, drawing on qualitative findings from the Out with Cancer study. Method An online survey including open ended items was completed by 430 LGBTQI cancer patients and 132 partners and other carers, representing a range of tumor types, sexual and gender identities, age and intersex status. A sub-sample of 104 patients and 31 carers completed an interview, with a follow-up photovoice activity and second interview completed by 45 patients and 10 carers. Data was thematically analysed using an intersectional theoretical framework. Results Historical and present-day experiences of discrimination, violence, family rejection and exclusion created a legacy of distress and fear. This impacted on trust of healthcare professionals and contributed to distress and unmet needs in cancer survivorship and care. Social support, often provided by partners and other chosen family, including intimate partners and other LGBTQI people, buffered the negative impacts of minority stress, helping LGBTQI patients deal with cancer. However, some participants lacked support due to not having a partner, rejection from family of origin and lack of support within LGBTQI communities, increasing vulnerability to poor psychological wellbeing. Despite the chronic, cumulative impacts of minority stress, LGBTQI patients and carers were not passive recipients of discriminatory and exclusion in cancer care, demonstrating agency and resistance through collective action and advocacy. Conclusion LGBTQI people have unique socio-political histories and present-day psycho-social experiences that contribute to distress during cancer. Social support serves to buffer and ameliorate this distress. There is a need for cancer healthcare professionals and support services to be aware of and responsive to these potential vulnerabilities, including the intersectional differences in experiences of minority stress and social support. There is also a need for recognition and facilitation of social support among LGBTQI people with cancer and their carers.
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17
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Alpert AB, Scout NFN, Schabath MB, Adams S, Obedin-Maliver J, Safer JD. Gender- and Sexual Orientation- Based Inequities: Promoting Inclusion, Visibility, and Data Accuracy in Oncology. Am Soc Clin Oncol Educ Book 2022; 42:1-17. [PMID: 35658501 DOI: 10.1200/edbk_350175] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Sexual and gender minority (SGM) people, including agender, asexual, bisexual, gay, gender diverse, genderqueer, genderfluid, intersex, lesbian, nonbinary, pansexual, queer, and transgender people, comprise approximately 10% or more of the U.S. population. Thus, most oncologists see SGM patients whether they know it or not. SGM people experience stigma and structural discrimination that lead to cancer disparities. Because of the lack of systematic and comprehensive data collection, data regarding SGM cancer incidence, outcomes, and treatment responses are limited. Collection of data regarding sexual orientation, gender identity, transgender identity and/or experience, anatomy, and serum hormone concentrations in oncology settings would drastically increase collective knowledge about the impact of stigma and biologic markers on cancer outcomes. Increasing the safety of oncology settings for SGM people will require individual, institutional, and systems changes that will likely improve oncologic care for all patients.
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Affiliation(s)
- Ash B Alpert
- Center for Gerontology and Healthcare Research, Department of Health Services, Policy & Practice, Brown University School of Public Health, Providence, RI.,Department of Public Health Sciences, University of Rochester Medical Center, Rochester, NY
| | - N F N Scout
- National LGBT Cancer Network, Providence, RI
| | - Matthew B Schabath
- Department of Cancer Epidemiology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL
| | - Spencer Adams
- School of Interdisciplinary Health Programs, Western Michigan University, Kalamazoo, MI
| | - Juno Obedin-Maliver
- Department of Obstetrics and Gynecology, Stanford University School of Medicine, Palo Alto, CA
| | - Joshua D Safer
- Division of Endocrinology, Icahn School of Medicine at Mount Sinai, New York, NY.,Mount Sinai Center for Transgender Medicine and Surgery, New York, NY
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18
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Pratt-Chapman ML. Learning Outcomes of Diverse Oncology Professionals After the TEAM Cultural Competency Training. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2022; 37:662-667. [PMID: 32902787 PMCID: PMC9205792 DOI: 10.1007/s13187-020-01865-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 09/02/2020] [Indexed: 05/29/2023]
Abstract
Racial, ethnic, sexual, and gender minorities are more likely to report challenges with oncology provider communication and quality of care. The Together-Equitable-Accessible-Meaningful (TEAM) training was developed to improve health equity across cancer care organizations by guiding teams of interprofessional learners through planning and implementation of quality improvements to advance equitable, accessible, and patient-centered cancer care. This study compared changes to self-reported cultural competence as measured by the Cultural Competency Assessment (CCA); Lesbian, Gay, Bisexual, and Transgender Development of Clinical Skills Scale (LGBT-DOCSS); and Interprofessional Socialization and Valuing Scale (ISVS). The primary aim of the study was to assess changes to self-reported cultural competence; the secondary aim was to examine changes to interprofessional valuation from baseline to post-intervention. Results indicated statistically significant improvements in self-reported Cultural Competency Behaviors (p = .055), a subscale of the CCA, and Attitudinal Awareness toward sexual and gender minorities (p = .046), a subscale of the LGBT-DOCSS, using p < .10 as statistically significant. These subscale results drove statistically significant improvements for their respective composite scales. No other statistically significant results were found. This study suggests that cultural competency training among interprofessional oncology health care professionals can be effective. Given the growing diversity within the USA, additional opportunities for cultural competency training are needed.
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Affiliation(s)
- Mandi L Pratt-Chapman
- The George Washington University School of Medicine and Health Sciences, Washington, DC, USA.
- The GW Cancer Center, The George Washington University, 2600 Virginia Ave, #324, Washington, DC, 20037, USA.
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19
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Ussher JM, Power R, Perz J, Hawkey AJ, Allison K. LGBTQI Inclusive Cancer Care: A Discourse Analytic Study of Health Care Professional, Patient and Carer Perspectives. Front Oncol 2022; 12:832657. [PMID: 35619900 PMCID: PMC9127408 DOI: 10.3389/fonc.2022.832657] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Accepted: 03/11/2022] [Indexed: 12/01/2022] Open
Abstract
Background Awareness of the specific needs of LGBTQI cancer patients has led to calls for inclusivity, cultural competence, cultural safety and cultural humility in cancer care. Examination of oncology healthcare professionals’ (HCP) perspectives is central to identifying barriers and facilitators to inclusive LGBTQI cancer care. Study Aim This study examined oncology HCPs perspectives in relation to LGBTQI cancer care, and the implications of HCP perspectives and practices for LGBTQI patients and their caregivers. Method 357 oncology HCPs in nursing (40%), medical (24%), allied health (19%) and leadership (11%) positions took part in a survey; 48 HCPs completed an interview. 430 LGBTQI patients, representing a range of tumor types, sexual and gender identities, age and intersex status, and 132 carers completed a survey, and 104 LGBTQI patients and 31 carers undertook an interview. Data were analysed using thematic discourse analysis. Results Three HCP subject positions – ways of thinking and behaving in relation to the self and LGBTQI patients – were identified:’Inclusive and reflective’ practitioners characterized LGBTQI patients as potentially vulnerable and offered inclusive care, drawing on an affirmative construction of LGBTQI health. This resulted in LGBTQI patients and their carers feeling safe and respected, willing to disclose sexual orientation and gender identity (SOGI) status, and satisfied with cancer care. ‘Egalitarian practitioners’ drew on discourses of ethical responsibility, positioning themselves as treating all patients the same, not seeing the relevance of SOGI information. This was associated with absence of LGBTQI-specific information, patient and carer anxiety about disclosure of SOGI, feelings of invisibility, and dissatisfaction with healthcare. ‘Anti-inclusive’ practitioners’ expressed open hostility and prejudice towards LGBTQI patients, reflecting a cultural discourse of homophobia and transphobia. This was associated with patient and carer distress, feelings of negative judgement, and exclusion of same-gender partners. Conclusion Derogatory views and descriptions of LGBTQI patients, and cis-normative practices need to be challenged, to ensure that HCPs offer inclusive and affirmative care. Building HCP’s communicative competence to work with LGBTQI patients needs to become an essential part of basic training and ongoing professional development. Visible indicators of LGBTQI inclusivity are essential, alongside targeted resources and information for LGBTQI people.
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Affiliation(s)
- Jane M Ussher
- Translational Health Research Institute, School of Medicine, Western Sydney University, Sydney, NSW, Australia
| | - Rosalie Power
- Translational Health Research Institute, School of Medicine, Western Sydney University, Sydney, NSW, Australia
| | - Janette Perz
- Translational Health Research Institute, School of Medicine, Western Sydney University, Sydney, NSW, Australia
| | - Alexandra J Hawkey
- Translational Health Research Institute, School of Medicine, Western Sydney University, Sydney, NSW, Australia
| | - Kimberley Allison
- Translational Health Research Institute, School of Medicine, Western Sydney University, Sydney, NSW, Australia
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20
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Seay J, Hernandez EN, Pérez-Morales J, Quinn GP, Schabath MB. Assessing the effectiveness of a LGBT cultural competency training for oncologists: study protocol for a randomized pragmatic trial. Trials 2022; 23:314. [PMID: 35428352 PMCID: PMC9013168 DOI: 10.1186/s13063-022-06274-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Accepted: 04/02/2022] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND LGBT patients may have unique psychosocial cancer care needs, and healthcare providers should have knowledge and understanding of these unique needs to effectively address disparities through the delivery of personalized healthcare. As such, our group developed and piloted a web-based LGBT cultural competency training designed specifically for oncologists called the Curriculum for Oncologists on LGBT populations to Optimize Relevance and Skills (COLORS). We designed a randomized pragmatic trial for oncologists to compare the effectiveness of the COLORS training versus a general online LGBT cultural competency training in improving LGBT-related knowledge, attitudes, and clinical practices. METHODS/DESIGN Study procedures include an 8-step approach for recruitment, randomization, retention, and completion of the interventions. Oncologists of any subspecialty who are currently practicing physicians will be identified from the American Medical Association Masterfile. Approximately 5000 oncologists will be sent a FedEx envelope with an invitation letter and study timeline. Electronic consent is obtained using a secure REDCap (Research Electronic Data Capture) portal hosted at the Moffitt Cancer Center (Tampa, FL) where the oncologists will complete the eligibility questionnaire, pre-training assessments, and then will be randomized to complete the COLORS training or an online general healthcare training offered by the National LGBT Health Education Center. Effectiveness of both trainings will be assessed utilizing self-reported measures of LGBT-related knowledge, attitudes, and affirming clinical practices. The measures will be collected before and directly after training completion, as well as 3-month post-training completion. The primary outcomes are changes in knowledge, attitudes, and practice behaviors regarding LGBT cancer patients from pre-test to post-test training in the COLORS training vs. the comparison training. DISCUSSION The overarching premise of this trial is to assess the effectiveness of the COLORS cultural competency training program. If successful, among oncologists who completed the COLORS training should yield statistically significantly improvements in knowledge, attitudes, and affirming practice.
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Affiliation(s)
- Julia Seay
- grid.415874.b0000 0001 2292 6021Naval Health Research Center, San Diego, CA 92152 USA
| | - Eryk N. Hernandez
- grid.468198.a0000 0000 9891 5233Department of Cancer Epidemiology, H. Lee Moffitt Cancer Center & Research Institute, 12902 Magnolia Drive MRC-CANCONT, Tampa, FL 33612 USA
| | - Jaileene Pérez-Morales
- grid.468198.a0000 0000 9891 5233Department of Cancer Epidemiology, H. Lee Moffitt Cancer Center & Research Institute, 12902 Magnolia Drive MRC-CANCONT, Tampa, FL 33612 USA
| | - Gwendolyn P. Quinn
- grid.137628.90000 0004 1936 8753Department of Obstetrics and Gynecology, Grossman School of Medicine, New York, NY 10016 USA
| | - Matthew B. Schabath
- grid.468198.a0000 0000 9891 5233Department of Cancer Epidemiology, H. Lee Moffitt Cancer Center & Research Institute, 12902 Magnolia Drive MRC-CANCONT, Tampa, FL 33612 USA ,grid.468198.a0000 0000 9891 5233Department of Thoracic Oncology, H. Lee Moffitt Cancer Center & Research Institute, 12902 Magnolia Drive MRC-CANCONT, Tampa, FL 33612 USA
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Need for Inclusive Consideration of Transgender and Gender Diverse People in E-Health Services: A Systematic Review. J Clin Med 2022; 11:jcm11041090. [PMID: 35207359 PMCID: PMC8880545 DOI: 10.3390/jcm11041090] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Revised: 02/07/2022] [Accepted: 02/16/2022] [Indexed: 02/01/2023] Open
Abstract
Many transgender and gender diverse (TGD) people use the internet to find ways out of isolation, network, and share information on health-related topics. Thus, e-health services could reduce the health burden of TGD people and facilitate access to health care. Following the PRISMA guidelines, we conducted a systematic review on e-health approaches that could improve trans health care (i.e., services directly for TGD people or training programs for health care professionals, HCPs) and their effectiveness, acceptability, and feasibility. We searched PubMed, Web of Science, and PubPsych databases for publications from January 2000 to June 2021 with final updates before publication. The systematic review identified e-health services across 27 studies from 8 different countries. Few studies evaluated e-health services exclusively for TGD people. However, use of an e-health service was found to be effective and beneficial: TGD people improved in health-related outcomes, and HCPs improved in professional expertise. Service users find e-health services helpful and easy to integrate into their daily lives. Recommendations for further development of e-health services in trans health care are provided. In the future, given the rapidly evolving e-health research and care field, new treatment approaches for TGD people should be subject to ongoing evaluation and development.
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22
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Quinn GP, Tishelman AC, Chen D, Nahata L. Reproductive health risks and clinician practices with gender diverse adolescents and young adults. Andrology 2021; 9:1689-1697. [PMID: 33942552 PMCID: PMC8566321 DOI: 10.1111/andr.13026] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Revised: 04/27/2021] [Accepted: 04/28/2021] [Indexed: 02/01/2023]
Abstract
BACKGROUND Reproductive health counseling is essential for adolescents and young adults (AYAs). Transgender and gender diverse (TGD) AYAs would benefit from tailored counseling given concerns about iatrogenic infertility and sexual dysfunction, and high rates of interpersonal violence, unplanned pregnancies and sexually transmitted infections, yet there are multiple obstacles to providing this care at the patient/family and clinician levels. OBJECTIVES This narrative review summarizes the literature on reproductive health considerations for TGD AYAs, current practices, and clinician barriers and facilitators to providing culturally sensitive reproductive care for TGD AYAs. Specific areas of focus include reproductive health goals, risks, and access barriers; clinician knowledge practices and challenges; and strategies for improving counseling practices. MATERIALS AND METHODS PubMed, Google Scholar, Medline, Web of Science, and PsycInfo databases were searched using the following terms: transgender, non-binary, gender expansive, gender non-conforming, reproductive health, sexual health, fertility, family planning/building, contraception, sexual dysfunction; gender-affirming hormones/surgery, clinician, physician or provider knowledge and attitudes; counseling. RESULTS Many TGD AYAs desire biological children and improved sexual experiences. TGD AYAs may experience infertility and sexual dysfunction associated with transition; have disproportionate HIV/STI risk; experience high rates of interpersonal/sexual violence and trauma; and encounter barriers to accessing competent medical care. Clinicians lack knowledge about reproductive health needs of TGD AYAs; inconsistently discuss family building options; perceive counseling challenges; and desire more training in this area. DISCUSSION Enriched communication training for medical/mental health clinicians is necessary to provide a skilled workforce for TGD AYAs. Web-based reproductive health training with other populations (eg oncology) demonstrates efficacy for improving communication skills and confidence in counseling, CONCLUSION: This review highlights barriers to adequate reproductive care encountered by TGD AYAs, exacerbated in underserved minority youth. Dedicated training for providers, and programs increasing access are important goals for improving care. The need for additional research is also emphasized.
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Affiliation(s)
- Gwendolyn P. Quinn
- Grossman School of Medicine, Departments of OB-GYN and Population Health, NY, NY, USA
| | - Amy C. Tishelman
- Boston Children’s Hospital, Departments of Psychiatry and Endocrinology, Boston, MA, USA
- Harvard Medical School, Departments of Psychiatry and Endocrinology, Boston, MA, USA
| | - Diane Chen
- Potocsnak Family Division of Adolescent and Young Adult Medicine, and Pritzker Department of Psychiatry and Behavioral Health, Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, IL, USA
- Departments of Psychiatry and Behavioral Sciences, and Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Leena Nahata
- Department of Pediatrics, The Ohio State University College of Medicine; Section of Endocrinology, Nationwide Children’s Hospital, Columbus, OH, USA
- Center for Biobehavioral Health, Abigail Wexner Research Institute, Columbus, OH, USA
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23
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Boehmer U, Ozonoff A, Winter M, Berklein F, Potter J, Hartshorn KL, Ward KC, Ceballos RM, Clark MA. Health-related quality of life among colorectal cancer survivors of diverse sexual orientations. Cancer 2021; 127:3847-3855. [PMID: 34237147 DOI: 10.1002/cncr.33762] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Revised: 05/18/2021] [Accepted: 05/19/2021] [Indexed: 11/09/2022]
Abstract
BACKGROUND The purpose of this study was to examine the health-related quality of life of sexual minority survivors in comparison with heterosexual survivors. METHODS Four hundred eighty eligible survivors participated in a telephone survey that measured survivors' outcomes, which consisted of physical and mental quality of life and self-rated fair or poor health. These survivors were diagnosed with stage I, II, or III colorectal cancer an average of 3 years before the survey and were recruited from 4 cancer registries. Using forward selection with generalized linear models or logistic regression models, the authors considered 4 domains-personal factors, environmental factors, health condition characteristics, and body function and structure-as correlates for each survivorship outcome. RESULTS The authors found that unadjusted physical quality of life and self-rated fair/poor health were similar for all survivors. Sexual minority survivors had poorer unadjusted mental quality of life in comparison with heterosexual survivors. After adjustments for covariates, this difference was no longer statistically significant. Three domains (personal factors, health condition characteristics, and body function and structure) explained colorectal cancer survivors' fair/poor health and 46% of the variance in physical quality of life, whereas 56% of the variance in mental quality of life was explained by personal factors, body function and structure, and environmental factors. CONCLUSIONS This study has identified modifiable factors that can be used to improve cancer survivors' quality of life and are, therefore, relevant to ongoing efforts to improve the survivorship experience.
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Affiliation(s)
- Ulrike Boehmer
- Department of Community Health Sciences, Boston University School of Public Health, Boston, Massachusetts
| | - Al Ozonoff
- Harvard Medical School, Boston, Massachusetts.,Boston Children's Hospital, Boston, Massachusetts
| | - Michael Winter
- Biostatistics and Epidemiology Data Analytics Center, Boston University School of Public Health, Boston, Massachusetts
| | - Flora Berklein
- Biostatistics and Epidemiology Data Analytics Center, Boston University School of Public Health, Boston, Massachusetts
| | - Jennifer Potter
- Harvard Medical School, Boston, Massachusetts.,Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts.,Fenway Institute, Boston, Massachusetts
| | - Kevan L Hartshorn
- Section of Hematology Oncology, Boston University School of Medicine, Boston, Massachusetts
| | - Kevin C Ward
- Department of Epidemiology, Emory University, Atlanta, Georgia
| | - Rachel M Ceballos
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Melissa A Clark
- Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Massachusetts
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Frederick NN, Bingen K, Bober SL, Cherven B, Xu X, Quinn GP, Ji L, Freyer DR. Pediatric oncology clinician communication about sexual health with adolescents and young adults: A report from the children's oncology group. Cancer Med 2021; 10:5110-5119. [PMID: 34128352 PMCID: PMC8335832 DOI: 10.1002/cam4.4077] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Revised: 05/22/2021] [Accepted: 05/24/2021] [Indexed: 12/19/2022] Open
Abstract
Background Sexual health (SH) is an important concern for adolescents and young adults (AYAs). This study determined current SH communication practices, barriers, and additional resources needed among pediatric oncology clinicians who treat AYAs. Methods A cross‐sectional survey was developed by the Children's Oncology Group (COG) AYA Committee and sent to pediatric oncologists (n = 1,987; 85.9%) and advanced practice providers (APPs, n = 326; 14.1%) at 226 COG institutions. Responses were tabulated and compared using tests of proportion and trend. Results The sample comprised 602 respondents from 168 institutions and was proportionally representative (468 oncologists [77.7%], 76 APPs [12.6%], 58 unidentified [9.6%]; institutional and provider response rates 74.3% and 26.2%, respectively). Almost half of respondents (41.7%) reported no/small role in SH care. Medical topics were discussed most often, including contraception (67.2%), puberty (43.5%), and sexual activity (37.5%). Topics never/rarely discussed included gender identity (64.5%), sexual orientation (53.7%), and sexual function (50.3%). Frequently cited communication barriers included lack of time, low priority, perceived patient discomfort, and the presence of a parent/guardian. Respondents endorsed the need for further education/resources on sexual function (66.1%), gender identity/sexual orientation (59.5%), and body image (46.6%). Preferred education modalities included dissemination of published guidelines (64.7%), skills training modules (62.9%), and webinars (45.3%). By provider type, responses were similar overall but differed for perception of role, barriers identified, and resources desired. Conclusions Many pediatric oncology clinicians play minimal roles in SH care of AYAs and most SH topics are rarely discussed. Provider‐directed education/training interventions have potential for improving SH care of AYA cancer patients.
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Affiliation(s)
- Natasha N Frederick
- Center for Cancer and Blood Disorders, Connecticut Children's Medical Center, Hartford, CT, USA.,University of Connecticut College of Medicine, Storrs, CT, USA
| | - Kristin Bingen
- Department of Pediatrics, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Sharon L Bober
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Brooke Cherven
- Aflac Cancer and Blood Disorders Center at Children's Healthcare of Atlanta, Atlanta, GA, USA.,Emory University School of Medicine, Atlanta, GA, USA
| | - Xinxin Xu
- Children's Oncology Group, Monrovia, CA, USA
| | - Gwendolyn P Quinn
- Departments of OB-GYN, Population Health, Division of Medical Ethics, Grossman School of Medicine, New York University, New York, NY, USA
| | - Lingyun Ji
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - David R Freyer
- Cancer and Blood Disease Institute, Children's Hospital Los Angeles, USC Norris Comprehensive Cancer Center, Los Angeles, CA, USA.,Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
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25
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Sutter ME, Simmons VN, Sutton SK, Vadaparampil ST, Sanchez JA, Bowman-Curci M, Duarte L, Schabath MB, Quinn GP. Oncologists' experiences caring for LGBTQ patients with cancer: Qualitative analysis of items on a national survey. PATIENT EDUCATION AND COUNSELING 2021; 104:871-876. [PMID: 32981814 PMCID: PMC7982350 DOI: 10.1016/j.pec.2020.09.022] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Revised: 09/06/2020] [Accepted: 09/15/2020] [Indexed: 05/31/2023]
Abstract
OBJECTIVES Sexual and gender minority (SGM) individuals experience cancer-related health disparities and reduced quality of cancer care compared to the general population in part due to a lack of knowledgeable providers. This study explored oncologists' experiences and perspectives in providing patient-centered care for SGM individuals with cancer. METHODS We conducted a qualitative analysis of oncologists' responses to four open-ended items on a national survey eliciting their experiences, reservations, and suggestions in treating SGM patients. RESULTS Over 50 % of the 149 respondents of the national survey responded to at least one open-ended item. Many oncologists reported positive experiences reflecting personal growth and affirmative care practices, such as open, non-judgmental communication, compassion, competence, and supporting patients' identity. There was a notable lack of experience with transgender patients in particular. Lack of knowledge, interpersonal communication concerns (e.g., fear of offending patients), and microaggressions ("don't ask, don't tell") were identified as barriers to providing affirming care. CONCLUSIONS Oncologists recognize their knowledge deficits and need strategies to overcome communication barriers and microaggressions among the cancer care team to provide SGM-affirming care. PRACTICE IMPLICATIONS Curricula are needed to train oncologists in SGM healthcare needs and affirming communication skills to facilitate patient-centered care for SGM individuals with cancer.
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Affiliation(s)
- Megan E Sutter
- Departments of Obstetrics and Gynecology and Population Health, New York University Grossman School of Medicine, New York, NY, USA
| | - Vani N Simmons
- Department of Health Outcomes and Behavior, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL, USA; Morsani School of Medicine, University of South Florida, Tampa, FL, USA
| | - Steven K Sutton
- Morsani School of Medicine, University of South Florida, Tampa, FL, USA; Department of Biostatistics and Bioinformatics, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL, USA
| | - Susan T Vadaparampil
- Department of Health Outcomes and Behavior, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL, USA; Morsani School of Medicine, University of South Florida, Tampa, FL, USA
| | - Julian A Sanchez
- Department of Health Outcomes and Behavior, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL, USA
| | - Meghan Bowman-Curci
- Department of Health Outcomes and Behavior, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL, USA
| | - Luisa Duarte
- Department of Health Outcomes and Behavior, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL, USA
| | - Matthew B Schabath
- Morsani School of Medicine, University of South Florida, Tampa, FL, USA; Department of Cancer Epidemiology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL, USA
| | - Gwendolyn P Quinn
- Departments of Obstetrics and Gynecology and Population Health, New York University Grossman School of Medicine, New York, NY, USA; Perlmutter Cancer Center, NYU Langone Health, New York, NY, USA.
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"Sex Can Be a Great Medicine": Sexual Health in Oncology Care for Sexual and Gender Minority Cancer Patients. CURRENT SEXUAL HEALTH REPORTS 2020; 12:320-328. [PMID: 33776600 DOI: 10.1007/s11930-020-00285-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Purpose of review Until recently, sexual and gender minority (SGM) people have been largely invisible in health care and health services research. However, understanding the needs and experiences of SGM cancer patients is critical to providing high-quality care, including needs and experiences related to sexual health. In this narrative review, we highlight that the literature on sexual health for SGM people with cancer is lacking, summarize existing literature on disparities affecting SGM patients with cancer, and discuss factors associated with these disparities. We conclude with recommendations and suggestions for future research in this area. Recent Findings Emerging evidence suggests that SGM people are at a higher risk for breast, cervical, endometrial, HPV-related, and lung cancers, as well as poor cancer outcomes, due to behavioral risk factors and health care system factors (e.g. lower access to health care insurance, discrimination in non-affirming care settings, negative health care interactions with providers). Additional research suggests that lack of clear guidelines for cancer screening in SGM patients, particularly for transgender and gender diverse patients, negatively impacts cancer screening uptake among SGM people. A growing number of studies have suggested greater sexual challenges following cancer treatment for sexual minority men with prostate cancer, while other studies highlight positive outcomes for sexual minority women following cancer treatment, such as benefit finding and resilience. Research on transgender and gender diverse patients is lacking. Summary Collection of sexual orientation and gender identity data across clinical enterprises and population-based surveys, mandatory health care provider training on cultural and clinical competency with SGM patients, and additional research inclusive of and focused on SGM cancer patients are key strategies to advance evidence-based clinical cancer care for diverse SGM populations.
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Alpert A, Kamen C, Schabath MB, Hamel L, Seay J, Quinn GP. What Exactly Are We Measuring? Evaluating Sexual and Gender Minority Cultural Humility Training for Oncology Care Clinicians. J Clin Oncol 2020; 38:2605-2609. [PMID: 32552279 DOI: 10.1200/jco.19.03300] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Affiliation(s)
- Ash Alpert
- Division of Hematology and Medical Oncology, Department of Medicine, Wilmot Cancer Institute, University of Rochester Medical Center, Rochester, NY
| | - Charles Kamen
- Department of Surgery, Wilmot Cancer Institute, University of Rochester Medical Center, Rochester, NY, USA
| | - Matthew B Schabath
- Departments of Cancer Epidemiology and Thoracic Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL
| | - Lauren Hamel
- Department of Oncology, Karmanos Cancer Institute, Wayne State University School of Medicine, Detroit, MI
| | - Julia Seay
- Department of Medicine, University of Miami Miller School of Medicine, Miami, FL
| | - Gwendolyn P Quinn
- Department of Obstetrics and Gynecology, Perlmutter Cancer Center, New York University School of Medicine, New York, NY
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