Purpose/Objectives To describe factors related to diagnosis, identity disclosure, and social support among lesbian, gay, bisexual, and transgender (LGBT) patients with cancer, and to explore associations between these factors and self-rated health. Design Cross-sectional self-report survey design using descriptive and exploratory multivariate statistical approaches. Setting Online, Internet-based. Sample 291 LGBT patients (89% Caucasian; 50% gay, 36% lesbian, 7% bisexual, 3% transgender) with mixed cancers. Methods Participants completed a researcher-designed online survey assessing experiences of cancer diagnosis among LGBT patients at a single time point. Main Research Variables Demographics, which provider(s) delivered the patients’ cancer diagnoses, to whom patients had disclosed their LGBT identity, how they disclosed, who was on their social support team at the time of diagnosis, and current self-rated health. Findings 79% of participants reported disclosing their identities to more than one cancer care provider. Participants most commonly introduced the topic of LGBT identity themselves, sometimes as a way to correct heterosexual assumptions (34%). Friends were the most common members of LGBT patients’ support teams (79%). Four disclosure and support factors were consistently associated with better self-rated health. Conclusions Disclosure of LGBT identity is a common experience in the context of cancer care, and disclosure and support factors are associated with better self-reported health among LGBT patients. Implications for Nursing Creating safe environments for LGBT patients to disclose could improve cancer care delivery to this underserved population. Nurses and other providers should acknowledge and include diverse support team members in LGBT patients’ care.

Despite indications that lesbian, gay, bisexual, transgender, and queer (LGBTQ) patients have unique needs when seeking healthcare, the experiences of LGBTQ patients in the context of cancer care have not been fully explored. This qualitative study investigated recommendations offered by LGBTQ patients with cancer for improving cancer care. Methods: 273 LGBTQ people across the United States who had been diagnosed with cancer completed an online survey that included open-ended questions. Using responses to these questions, two researchers independently conducted open coding. A code book was generated collaboratively and the data were coded independently. Codes were clustered and refined and the data were independently re-coded. Results: Five themes emerged. LGBTQ patients with cancer: (1) are affected by providers' LGBTQ-specific knowledge and skills, assumptions, and mistreatment; (2) negotiate disclosure of identities based on safety of clinical encounters; (3) have differing experiences based on multiple intersecting identities; (4) receive more effective care when members of their support networks are included; and (5) are self-advocates and undergo transformative experiences in the face of morbidity and marginalization.

Atheists represent an understudied population in palliative care medicine. Although professional and regulatory organizations require an individualized plan of care for each patient and family, little is known about atheist preferences for end-of-life (EOL) care. The aims of this pilot study were twofold: (1) to explore the EOL preferences for atheists, and (2) to apply a threefold model of spiritual care (intrapersonal, interpersonal, and natural interconnectedness) to assess the appropriateness of potential interventions for a group of atheists. Eighty-eight participants completed either an online or paper survey. Analyses of open-ended and closed questions were consistent with prior studies on EOL preferences, including components of a ;;good death.'' The results related to the first aim of the study, to explore EOL preferences, suggests that participants view of a good death was expanded to include respect for nonbelief and the withholding of prayer or other references to God. Strong preference for physician-assisted suicide and evidence-based medical interventions were central themes from participants. The second aim of the study, to apply a threefold definition of spirituality--which includes intrapersonal, interpersonal, and natural focus--appears appropriate in planning interventions for atheists at EOL. Participants expressed a deep desire to find meaning in their own lives (intrapersonal), to maintain connection with family and friends (interpersonal), and to continue to experience and appreciate the natural world (natural interconnectedness) through the dying experience. Additional research is necessary to explore the preferences for this understudied group. Further clarification of the use of the term "atheist'' is also necessary to ensure that the inclusion of all individuals with nontheist beliefs are represented in future research efforts.

An understood goal of faculty when using simulations and role play as teaching strategies is to make them as realistic as possible. The author discusses moulage, a makeup technique that can be used to enhance a simulated learning experience and reinforce prior learning regarding cellular damage and repair. The use of moulage in other undergraduate didactic courses such as nursing research is presented.