Exploring lesbian, gay and bisexual patients' accounts of their experiences of cancer care in the UK

Investigating the Needs and Concerns of Lesbian, Gay, Bisexual, Transgender, Queer, or Questioning Cancer Patients

The needs and concerns of lesbian, gay, bisexual, transgender, queer, or questioning (LGBTQ+) patients with cancer remain poorly understood. This is important as LGBTQ+ patients have an elevated risk of developing certain cancers and have poorer oncologic outcomes compared to non-LGBTQ+ patients. The lack of research may be linked to the complexity of studying the needs and concerns of this patient population. This review aimed to describe the evidence that sought to identify the needs and concerns of LGBTQ+ cancer patients. Studies were extracted using keywords such as "LGBTQ" and "Oncology." Patient participants were excluded if they did not identify as LGBTQ+ and if they did not have cancer or were not cancer survivors. Healthcare professionals were excluded if they were not oncology specific. A total of 22 studies met our inclusion criteria. LGBTQ+ cancer patients expressed concerns surrounding heteronormative assumptions made by healthcare professionals, a lack of LGBTQ±specific cancer support groups, and psychosexual concerns such as erectile dysfunction following cancer treatment. Oncology healthcare professionals lacked the knowledge and education that are required to manage this patient cohort. Further research is required to investigate the needs and concerns of LGBTQ+ cancer patients specifically in the radiation oncology setting.

Bisexual People Experience Worse Health Outcomes in England: Evidence from a Cross-Sectional Survey in Primary Care

Persistent inequalities in relation to health outcomes continue to exist among patients identifying as lesbian, gay, and bisexual (LGB), and very little is known about outcomes specific to bisexual populations. This study's aim was to compare the health of individuals identifying as LGB with heterosexual counterparts within primary care in England. Cross-sectional survey data from the year 10 (2015/2016) English General Practice Patient Survey (GPPS) dataset, which consisted of 836,312 responses (38.9% response rate), including 23,834 people who identified as gay, lesbian, bisexual or "other" was analyzed. Health outcomes were assessed through self-reported quality of life, physical and mental health, and confidence in managing own health. Multifactorial logistic regression (adjusting for age, ethnic group, working status, and socioeconomic status) were conducted. Long-term physical and mental health problems were more than twice as likely to be reported for people within LGB groups compared to the heterosexual group for both genders, except bisexual women where the odds were more than four times greater (OR = 4.275, 95% CI, 3.896, 4.691; p < .001). Bisexual women were half as likely to report the absence of a long-term health problem (OR = 0.452, 95% CI 0.419, 0.488; p < .001). LGB groups across both genders, reported a higher proportion of individuals that did not feel confident in managing their health and experienced significantly worse quality of life compared to heterosexuals. LGB patients consistently report poorer health outcomes than heterosexual patients. Bisexual people of both genders consistently experienced worse physical and mental health outcomes compared with the other recorded sexual orientations.

Disparities in cancer care among sexual and gender minority adolescent and young adult patients: A scoping review

BACKGROUND

Adolescent and young adult cancer patients (AYAs) who are sexual and gender minorities (SGM) are a rapidly increasing population that experiences unmet cancer-related needs. Despite emerging awareness, little is known about cancer care and outcomes for this vulnerable population. The purpose of this scoping review was to explore current knowledge and gaps in the literature on cancer care and outcomes for AYAs who identify as SGM.

METHODS

We reviewed empirical knowledge on SGM AYAs by identifying, describing, and critically appraising the literature to date. We conducted a comprehensive search on OVID MEDLINE, PsycINFO, and CINAHL in February 2022. Additionally, we developed and piloted a conceptual framework for appraising SGM AYA research.

RESULTS

A total of 37 articles were included in the final review. Most studies focused exclusively on SGM-related outcomes as the primary aim of the study (81.1%, n = 30), whereas others included some focus on SGM-related outcomes (18.9%, n = 7). The majority of studies included AYAs as part of a broader age range (86.0%, n = 32), and only a few studies examined exclusively AYA samples (14.0%, n = 5). Gaps in scientific evidence on SGM AYAs were seen across the cancer care continuum.

CONCLUSION

Numerous gaps in knowledge of cancer care and outcomes exist for SGM AYAs diagnosed with cancer. Future efforts should fill this void with high-quality empirical studies that reveal unknown disparities in care and outcomes and are inclusive of the intersectionality of SGM AYAs with other minoritized experiences, thereby advancing health equity in meaningful ways.

A Meta-Ethnography on the Impact of Cancer for Lesbian and Queer Women and Their Partners

Lesbian and queer women face unique experiences navigating cancer care, including challenges in accessing services that incorporate their relational supports. Given the importance of social support for survivorship, this study examines the impact of cancer on lesbian/queer women in romantic relationships. We conducted the seven stages of Noblit and Hare's meta-ethnography. PubMed/MEDLINE, PsycINFO, SocINDEX, and Social Sciences Abstract databases were searched. Two hundred and ninety citations were initially identified, 179 abstracts were reviewed, and 20 articles were coded. Themes were (a) intersectionality of lesbian/queer identity in the cancer context; (b) institutional and systemic supports and barriers; (c) navigation of disclosure; (d) characteristics of affirmative cancer care; (e) survivors' critical reliance on their partner(s); and (f) shifts in connection after cancer. Findings indicate the importance of accounting for intrapersonal, interpersonal, institutional, and socio-cultural-political factors for understanding the impact of cancer for lesbian and queer women and their romantic partners. Affirmative cancer care for sexual minorities fully validates and integrates partners in care, removes heteronormative assumptions in services provided, and offers LGB+ patient and partner support services.

Help me to come out gracefully! Working with lesbian, gay, and bisexual, people affected by cancer to develop a national practitioner guide supporting inclusive care

INTRODUCTION

The healthcare support needs of the lesbian, gay, bisexual (LGB) and transgender community are becoming an emerging area of healthcare research. Providing person-centred care is World Health Organisation policy and as such it is important that Radiography services can demonstrate areas in which they are working with people to design, develop and feedback on the services that they receive. This research aimed to establish how cancer treatment impacted on the identities of LGB people, their experiences of care, and their engagement with developing a practitioner guide.

METHODS

This cooperative inquiry is underpinned by person-centred philosophy and participatory research principles. Participants were nine lesbian, gay, and bisexual people affected by cancer. Each engaged in two facilitated, audio-recorded conversations to explore their experiences of cancer care. An analytical framework based on Mezirow's Transformational Theory was used to organise the data, followed by detailed content analysis to develop themes.

RESULTS

Participants included men and women, aged 45-68, who had experienced different cancers. They explored how cancer treatment had impacted on them, and worked with the researcher and stakeholders to establish a seven-recommendation practitioner guide aimed at improving LGB people's care experiences. Their accounts revealed a broad range of issues that both corroborate and build on existing evidence. Themes highlighted expectations and experiences of both assumptions and prejudice in healthcare interactions. These experiences, along with misinterpretation of relationships with significant others, led to feelings of discomfort and reserve about self-expression. Findings of the research are presented in the following key areas: Dilemmas of attending oncology appointments; Inclusive experiences of care; and Formulation of the practitioner guide.

CONCLUSION

The research findings enabled development of a national practitioner guide with the participants and key stakeholders to raise awareness of the needs of LGB persons affected by cancer and support better care.

IMPLICATIONS FOR PRACTICE

By providing real-life accounts this research adds to understanding of how LGB persons interact with services, developing evidence to support cultural competence within the profession of Radiography and oncology services more broadly.

Knowing to Ask and Feeling Safe to Tell - Understanding the Influences of HCP-Patient Interactions in Cancer Care for LGBTQ+ Children and Young People

Background

Lesbian, gay, bisexual, transgender, queer or questioning (LGBTQ+) people experience healthcare inequalities in cancer care. Previous studies have focused on knowledge, attitudes and behaviours of healthcare professionals (HCPs) treating adults with cancer and how these contribute to inequalities. To date, no research has focused on HCPs treating LGBTQ+ children and adolescents with cancer in the UK. This is important given that this group may be at a critical time for exploring their gender identity and sexual orientation, whilst also facing a cancer diagnosis. We aimed to explore the knowledge, attitudes and behaviours of paediatric, teenage and young adult oncology HCPs treating LGBTQ+ patients in the UK.

Methods

We carried out semi-structured interviews with 8 HCPs in paediatric, teenage and young adult (TYA) oncology from the Royal Marsden NHS Foundation Trust. Eight questions were asked, which centred around participants' knowledge, attitudes and behaviours regarding management of LGBTQ+ patients in oncology. Interview transcripts were analysed by inductive thematic analysis.

Results

We identified 10 themes, including novel themes (how HCPs acquire knowledge and expectations of a 'third party' to be the expert) which may underlie previously observed trends in knowledge, attitudes and behaviours of HCPs. We highlight other themes and HCP concerns specific to care of LGBTQ+ patients in paediatrics (influence of the parental-carer dynamic, concerns around patient age and development as a barrier to disclosure) which require further research. We found evidence of the interrelatedness of HCP knowledge, attitudes and behaviours and the ability of these elements to positively influence each other. We mapped our themes across these elements to form a new suggested framework for improving HCP-patient interactions in LGBTQ+ Cancer Care. We found a need both for individual HCP education and organisational change, with creation of a culture of psychological safety to improve patient care.

Conclusion

Knowledge, attitudes and behaviours of HCPs are closely interdependent when providing care to young LGBTQ+ patients with cancer. The authors suggest that future efforts to improve care of these patients address this complexity by spanning the domains of our suggested framework. Whilst HCP education is essential, change must also occur at an organisational level.

Service Provider Perspectives of Minority Stress among Black, Asian and Minority Ethnic Lesbian, Gay and Bisexual People in the UK

Mental health inequalities among Black, Asian and Minority Ethnic (BAME) people from lesbian, gay and bisexual (LGB) communities persist and remain under-researched. This study is the first in the UK to explore, from the perspective of service providers, minority stress experienced by BAME LGB people. Twenty-three participants were interviewed and data were analyzed using qualitative thematic analysis. Minority stress theory was utilized to inform the analysis, yielding the following themes: (1) Stress induced by conflicting sociocultural norms, (2) interpersonal inhibitors of coming out, (3) and problematic coping. BAME LGB individuals are exposed to stressors due to their intersecting sexual, gender, religious, and cultural identities. Major psychological stressors include stigmatized identity, expectations of a heterosexual marriage, and maladaptive coping strategies. This study sheds light on the potential steps that can be taken to ensure effective coping responses among BAME LGB people.

Cancer care disparities in the LGBT community

PURPOSE OF REVIEW

A review of the recent literature (2019-2021) around the current disparities in care for LGBT individuals with cancer.

RECENT FINDINGS

Recent studies highlight that there continue to be multiple barriers to LGBT individuals with cancer receiving equity of care. These include healthcare professionals (HCPs) lack of knowledge of LGBT-specific issues and an under appreciation of the importance of sexuality and gender in order to provide holistic, person-centred care. Suggestions are made of how embedding training, updating guidelines, and improving communication skills could help to address this care disparity.

SUMMARY

Lesbian, gay, bisexual and/or trans (LGBT) individuals have an increased risk of certain illnesses, including certain types of cancer. They belong to a minority group, who may be subjected to discrimination and so are less likely to present for screening or engage with healthcare professionals. This review of recent studies highlights that LGBT individuals still fear discrimination from HCPs, and that many HCPs themselves admit to poor knowledge of LGBT specific issues and the importance of sexuality and gender identity when providing cancer care. Advances in education programmes, including enhanced communication skills and creating LGBT safe spaces are all vital in reducing the disparity in LGBT cancer care.

Encouraging patients to disclose their lesbian, gay, bisexual, or transgender (LGBT) status: oncology health care providers' perspectives

A compelling touted strategy for reducing discrimination towards lesbian, gay, bisexual, and transgender (LGBT) patients is improving communicative competence of health care providers (HCPs); however, evidence base for describing communication practices between HCPs and LGBT patients is scarce. The purpose of this study was to qualitatively examine HCP experiences and perspectives as they relate to patient sexual orientation and gender identity (SOGI) disclosure, perceived communication and structural/administrative challenges in interactions with LGBT patients, and suggestions for improving care of LGBT patients. The sample consisted of 1,253 HCPs, who provided open-ended responses to an online cross-sectional survey conducted at a Comprehensive Cancer Center in the Northeastern United States. The open-ended responses were inductively and deductively coded for key themes and sub-themes. The results demonstrated an array of useful communication strategies employed by oncology HCPs to encourage LGBT patients' SOGI disclosure (direct questions regarding sexual orientation, use of the term "partner," and using correct pronouns), communication and structural/administrative challenges faced by HCPs in providing care (HCP own fears and biases, transgender patient care, insurance issues, and procedural challenges for LGBT patients), and suggested recommendations from oncology HCPs to improve their care delivery for LGBT patients (more provider-based training, improving awareness of LGBT-friendly resources, establishing trusting relationships, and not assuming sexuality or gender identity). These findings have implications for developing and evaluating training programs to improve LGBT sensitivity and communication among HCPs, and encourage SOGI disclosure in an open and judgment-free health care environment.

Follow-up surveillance among colorectal cancer survivors of different sexual orientations

PURPOSE

The purpose of this study was to examine receipt of follow-up surveillance among sexual minority and heterosexual survivors and identify survivor-, physician-, and practice-level characteristics associated with follow-up surveillance.

METHODS

An average of 3 years after their stage I-III colorectal cancer diagnosis, we recruited survivors from four cancer registries. A questionnaire, which queried about sexual orientation and other eligibility criteria, was mailed to all cancer survivors. Subsequently, 418 eligible survivors without recurrent disease participated in a telephone survey. Colorectal cancer-specific follow-up surveillance was defined as colonoscopy, carcinoembryonic antigen (CEA) test, or imaging test. We used logistic regression with forward selection to obtain models that best explained each follow-up test.

RESULTS

About 10% of survivors received no follow-up surveillance, while 70% had colonoscopies. While survivors irrespective of sexual orientation received follow-up surveillance, sexual minority survivors had 3 times the odds of receiving imaging tests compared to heterosexual survivors. Having a designated provider of any specialty was most salient for the receipt of surveillance.

CONCLUSIONS

Sexual minority survivors' greater receipt of imaging tests may indicate providers perceive them at greater risk for recurrence than heterosexual survivors. Future studies need to examine provider behaviors towards monitoring colorectal cancer survivors of diverse sexual orientations.

IMPLICATIONS FOR CANCER SURVIVORS

Guidelines recommend surveillance of colorectal cancer survivors to improve survival. This study showed that having a designated provider for follow-up is most salient for the receipt of surveillance, most survivors receive surveillance, and sexual minority survivors had more imaging tests compared to heterosexual survivors.

Inequalities in older LGBT people's health and care needs in the United Kingdom: a systematic scoping review

The hostile environment that older lesbian, gay, bisexual and transgender (LGBT) people faced at younger ages in the United Kingdom (UK) may have a lasting negative impact on their health. This systematic scoping review adds to the current knowledge base through comprehensively synthesising evidence on what is known about the extent and nature of health and care inequalities, as well as highlighting gaps in the evidence which point the way towards future research priorities. We searched four databases, undertook manual searching, and included studies which presented empirical findings on LGBT people aged 50+ in the UK and their physical and mental health or social care status. From a total of 5,738 records, 48 papers from 42 studies were eligible and included for data extraction. The synthesis finds that inequities exist across physical and mental health, as well as in social care, exposure to violence and loneliness. Social care environments appeared as a focal point for inequities and formal care environments severely compromised the identity and relationships that older LGBT people developed over their lifecourse. Conversely, the literature demonstrated how some older LGBT people successfully negotiated age-related transitions, e.g. emphasising the important role of LGBT-focused social groups in offsetting social isolation and loneliness. While there exist clear policy implications around the requirement for formal care environments to change to accommodate an increasingly diverse older population, there is also a need to explore how to support older LGBT people to maintain their independence for longer, reducing the need for formal care.

Breast cancer and gynecologic risks in lesbian and bisexual women

ABSTRACT

Lesbian and bisexual women may be at an increased risk for gynecologic infections and breast cancer due to a higher prevalence of factors such as obesity, smoking, and lower pregnancy rates. This article discusses the role of healthcare professionals in preventive screening for breast and gynecologic cancers and promoting healthy living in these patients by avoiding smoking, maintaining an ideal body weight, and limiting alcohol consumption.

The Politics of LGBT+ Health Inequality: Conclusions from a UK Scoping Review

This scoping review of UK evidence aimed to describe what is known about Lesbian, Gay, Bisexual, and Trans (LGBT+) health inequalities in relation to cancer, mental health, and palliative care to inform research, policy and public health interventions. Using a scoping review methodology, we identified studies from database searches, citation tracking, and expert consultation. The in/exclusion criteria was based on the PICOS framework. The data were charted and then summarised to map the theoretical approaches and the main types of evidence and identify knowledge gaps. In total, 279 articles were screened and 83 were included in the final review. We found that there is limited UK research examining LGBT+ health inequality in cancer, mental health and palliative care. We would argue that this thin evidence base is partly due to national policy discussions of LGBT+ health inequality that are framed within a depoliticised ‘it’s getting better’ narrative, and an unwillingness to adequately acknowledge the unjust social and economic relations that produce LGBT+ health inequality. In addition, LGBT+ health inequality is depoliticised by existing public health explanatory theories, models and frameworks that exclude sexual orientation and gender diversity as dimensions of power that interlock with those of socio-economic, race and ethnicity. This is a barrier to developing public health interventions that can successfully tackle LGBT+ health inequality

A Systematic Review of the Health and Healthcare Inequalities for People with Intersex Variance

Extensive research documents the health inequalities LGBTI people experience, however far less is known for people with intersex variation. This paper presents a review of intersex health and healthcare inequalities by evaluating research published from 2012 to 2019. In total 9181 citations were identified with 74 records screened of which 16 were included. A synthesis of results spans nine quantitative, five qualitative and two narrative reviews. Literature was searched in Medline, Web of Science, Cochrane, PsycInfo and CINAHL. People with intersex variance experience a higher incidence of anxiety, depression and psychological distress compared to the general population linked to stigma and discrimination. Progressive healthcare treatment, including support to question normative binaries of sex and gender, aids understand of somatic intersex variance and non-binary gender identity, especially when invasive treatment options are avoided or delayed until individuals are able to self-identify or provide consent to treatment. Findings support rethinking sex and gender to reflect greater diversity within a more nuanced sex-gender spectrum, although gaps in research remain around the general health profile and the healthcare experiences of people with intersex variance. More large-scale research is needed, co-produced with peers who have lived experience of intersex variation to ensure policy, education and healthcare advances with greater inclusivity and ethical accountability.

Healthcare professionals' assumptions as barriers to LGBTI healthcare

Lesbian, gay, bisexual, trans and intersex (LGBTI) people experience significant healthcare inequalities and barriers to healthcare services. Contextualised within six Member States of the European Union (EU), this paper discusses efforts to identify and explore the nature of barriers to healthcare as part of Health4LGBTI, a 2-year pilot project funded by the EU. Data were generated through focus groups and interviews with LGBTI people and healthcare professionals and analysed using thematic analysis. Findings reveal that barriers to healthcare are underpinned by two related assumptions held by healthcare professionals: first, the assumption that patients are heterosexual, cisgender and non-intersex by default; second, the assumption that LGBTI people do not experience significant problems (and therefore that their experience is mostly irrelevant to healthcare). On the other hand, it is notable that responding healthcare professionals were broadly 'LGBTI-friendly'. Thus, we argue that efforts to improve LGBTI healthcare should not be limited to engaging with healthcare professionals with negative views of LGBTI people. Rather, such efforts should also tackle these assumptions amongst LGBTI-friendly healthcare professionals.

Older LGBT+ health inequalities in the UK: setting a research agenda

Lesbian, gay, bisexual and trans+ (LGBT+) people report poorer health than the general population and worse experiences of healthcare particularly cancer, palliative/end-of-life, dementia and mental health provision. This is attributable to: (a) social inequalities, including 'minority stress'; (b) associated health-risk behaviours (eg, smoking, excessive drug/alcohol use, obesity); (c) loneliness and isolation, affecting physical/mental health and mortality; (d) anticipated/experienced discrimination and (e) inadequate understandings of needs among healthcare providers. Older LGBT+ people are particularly affected, due to the effects of both cumulative disadvantage and ageing. There is a need for greater and more robust research data to support growing international and national government initiatives aimed at addressing these health inequalities. We identify seven key research strategies: (1) Production of large data sets; (2) Comparative data collection; (3) Addressing diversity and intersectionality among LGBT+ older people; (4) Investigation of healthcare services' capacity to deliver LGBT+ affirmative healthcare and associated education and training needs; (5) Identification of effective health promotion and/or treatment interventions for older LGBT+ people, and subgroups within this umbrella category; (6) Development of an (older) LGBT+ health equity model; (7) Utilisation of social justice concepts to ensure meaningful, change-orientated data production which will inform and support government policy, health promotion and healthcare interventions.

A Systematic Review of Sexual Minority Women's Experiences of Health Care in the UK

Sexual minority women (SMW) experience worse health and disproportionate behavioural risks to health than heterosexual women. This mixed-methods systematic review evaluated recent studies on health experiences of UK SMW, published 2010–2018. Analysis was through narrative thematic description and synthesis. Identified were 23,103 citations, 26 studies included, of which 22 provided qualitative and nine quantitative results. SMW had worse health experiences that might impact negatively on access, service uptake and health outcomes. Findings highlighted significant barriers facing SMW, including heteronormative assumptions, perceptions and experiences of negative responses to coming out, ignorance and prejudice from healthcare professionals, and barriers to raising concerns or complaints. Little information was available about bisexual and trans women’s issues. Findings highlighted the need for explicit and consistent education for healthcare professionals on SMW issues, and stronger application of non-discrimination policies in clinical settings.

Disclosure in lesbian, gay and bisexual cancer care: towards a salutogenic healthcare environment

Background

The literature on sexual orientation disclosure is arguably one of the most developed in the field of lesbian, gay and bisexual (LGB) people in healthcare in English speaking countries however, relatively little research has been conducted into disclosure in cancer care. Studies have been mainly undertaken in primary care where distinct circumstances pertain and where the benefits of disclosure include obtaining appropriate health information, treatment advice and avoiding misdiagnosis.

Methods

We conducted an in-depth qualitative study primarily recruiting patients through oncology care in hospital settings and through LGB community cancer support groups. Data were gathered through semi-structured interviews with 30 LGB patients with different cancer types.

Results

Data were analysed using thematic analysis and interpreted and interrogated through salutogenesis theory which offers a useful lens through which to consider the health promoting effects of sexual orientation disclosure in cancer care. We present three themes as part of the analysis: Authenticity as a driver for disclosure in cancer care, Partners as a (potential) salutogenic resource and Creating safe, healing environments conducive to disclosure. The findings are reported and discussed in relation to three inter-related concepts from current salutogenesis theorising including a sense of coherence, generalised resistance resources and healing environments which can facilitate sexual orientation disclosure.

Conclusion

Our findings enable a more nuanced approach to understanding disclosure in this context. This study contributes to the literature through its articulation of the salutogenic potential of disclosure (if responded to appropriately) for LGB patients as individuals, in relationship to their partners or carers and the role of creating a visible healing-oriented optimal environment to promote quality of life and recovery.

Electronic supplementary material

The online version of this article (10.1186/s12885-019-5895-7) contains supplementary material, which is available to authorized users.

Co-producing knowledge of lesbian, gay, bisexual, trans and intersex (LGBTI) health-care inequalities via rapid reviews of grey literature in 27 EU Member States

Background

The health inequalities experienced by lesbian, gay, bisexual, trans and intersex (LGBTI) people are well documented with several reviews of global research summarizing key inequalities. These reviews also show how the health‐care needs of LGBTI people are often poorly understood whilst suggesting that targeted initiatives to reduce inequalities should involve LGBTI people.

Objectives

To determine what is known about the health‐care inequalities faced by LGBTI people? What are the barriers faced by LGBTI people whilst accessing health care, and health professionals when providing care? What examples of promising practice exist?

Design

Rapid reviews of grey literature were co‐produced with LGBTI people in 27 countries followed by a thematic analysis and synthesis across all data sets. The review included grey literature from each country that might not otherwise be accessible due to language barriers.

Main results

Rapid reviews showed that LGBTI people faced various inequalities and barriers whilst accessing health care. Where heterosexuality, binary gender and assumed male/female sex characteristics were upheld as the norm, and where LGBTI people differed from these norms, discrimination could result. In consultations where LGBTI people feared discrimination and did not disclose their LGBTI status, health professionals lacked the information required for appropriate assessments.

Conclusion

With greater understanding of sexual orientation (LGB people), gender identity (trans people) and sex characteristics (intersex people), combined with access to contemporary knowledge and training, health professionals can work in collaboration with researchers, policymakers and LGBTI people to develop systems that are better attuned to the needs of all service users.

The Experiences of Gay and Bisexual Men Post-Prostate Cancer Treatment: A Meta-Synthesis of Qualitative Studies

Studies suggest that gay and bisexual men are affected by the psychological aspects of prostate cancer treatment differently than that of heterosexual men; however the data have not yet been synthesized. The focus of this meta-synthesis is to explore gay and bisexual men's experiences of prostate cancer posttreatment. Empirical research published in peer reviewed journals between January 1990 and January 2018 were identified in six databases: CINAHL, Cochrane, Medline, PsycINFO, PubMed, and Web of Science. Titles and abstracts were checked by two reviewers. The six studies that met the inclusion criteria were selected and reviewed for quality and the extracted data were then synthesized. The main themes that emerged were sexual impact, physical and psychological difficulties, challenges to intimacy, and support mechanisms. Gay and bisexual men can have specific sexual roles and developing prostate cancer and undergoing treatment may compromise their ability to perform their sexual role. The needs of heterosexual men were perceived to be accommodated more often than that of gay and bisexual men because of engrained heteronormativity in the health-care system. The review suggests that more support groups specifically for gay and bisexual men should be established, while urologists should cater to the sexual and masculine implications of treatment, and not frame problems for gay and bisexual men in heterosexual terms. By failing to address the salient needs and concerns of gay and bisexual men, health-care professionals are reinforcing invisibility and marginalization of gay and bisexual men with prostate cancer.

Experiences and unmet needs of lesbian, gay, and bisexual people with cancer care: A systematic review and meta-synthesis

OBJECTIVES

To explore the cancer care experiences and unmet needs of people who identify as a sexual or gender minority.

METHODS

A qualitative systematic review and meta-synthesis was undertaken based on a registered protocol. Following literature searching and study selection, study quality was examined by using the Critical Appraisal Skill Programme Checklist. Qualitative data were extracted verbatim from included studies and synthesized by using thematic analysis.

RESULTS

Fifteen studies that included lesbian, gay, and bisexual (LGB) people living with or beyond cancer were included in the review. Studies including gender minorities were not identified. Most of the study participants were sexual minority women with breast cancer or sexual minority men with prostate cancer. Meta-synthesis of 106 individual findings generated 6 overarching themes pertaining to sexual orientation disclosure, experiences and fear of homophobia, positive and negative health-care professional behaviors, heterocentric systems and care, inadequacy of available support groups, and unmet needs for patient-centered care and LGB-specific information. Lesbian, gay, and bisexual people often reported feelings of anxiety, invisibility, isolation, and frustration throughout the cancer care continuum.

CONCLUSIONS

Analysis of the experiences of LGB people with cancer care shows that LGB people face numerous challenges due to their sexual orientation and receive care that does not adequately address their needs. Training and education of health-care professionals are strongly recommended to address some of these challenges and practice gaps. Culturally appropriate care includes avoiding heterosexual assumptions, use of inclusive language, the provision of tailored information, and involving partners in care.

Sexual orientation disclosure in health care: a systematic review

BACKGROUND

Significant health disparities between sexual minority individuals (that is, lesbian, gay, bisexual, or transgender [LGBT]) and heterosexual individuals have been demonstrated.

AIM

To understand the barriers and facilitators to sexual orientation (SO) disclosure experienced by LGBT adults in healthcare settings.

DESIGN AND SETTING

Mixed methods systematic review, including qualitative, quantitative, and mixed methods papers following PRISMA guidelines.

METHOD

Study quality was assessed using the Mixed Methods Appraisal Tool (MMAT) and a qualitative synthesis was performed. Studies were included if their participants were aged ≥18 years who either identified as LGBT, had a same-sex sexual relationship, or were attracted to a member of the same sex.

RESULTS

The review included 31 studies representing 2442 participants. Four overarching themes were identified as barriers or facilitators to SO disclosure: the moment of disclosure, the expected outcome of disclosure, the healthcare professional, and the environment or setting of disclosure. The most prominent themes were the perceived relevance of SO to care, the communication skills and language used by healthcare professionals, and the fear of poor treatment or reaction to disclosure.

CONCLUSION

The facilitators and barriers to SO disclosure by LGBT individuals are widespread but most were modifiable and could therefore be targeted to improve healthcare professionals' awareness of their patients' SO. Healthcare professionals should be aware of the broad range of factors that influence SO disclosure and the potential disadvantageous effects of non-disclosure on care. The environment in which patients are seen should be welcoming of different SOs as well as ensuring that healthcare professionals' communication skills, both verbal and non-verbal, are accepting and inclusive.