Attitudes, knowledge and practice behaviours of oncology health care professionals towards lesbian, gay, bisexual, transgender, queer and intersex (LGBTQI) patients and their carers: A mixed-methods study

Ussher, Jane M.; Perz, Janette; Allison, Kimberley R.; Power, Rosalie; Hawkey, Alexandra; Dowsett, Gary W.; Hickey, Martha; Parton, Chloe; McDonald, Fiona E. J.; Davis, Ian D.; Quinn, Gwendolyn P.; Boydell, Katherine M.; Robinson, Kerry H.; Chambers, Suzanne K.; Anazodo, Antoinette

doi:10.1016/j.pec.2021.12.008

Cited by 32 publications

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“…This cross-sectional study was part of a broader mixed-methods project, the ‘Out with Cancer Study’ ( 41 , 52 ). The overall project examined LGBTQI cancer and cancer care from the perspectives of LGBTQI patients and their caregivers, and HCPs; audited Australian cancer resources for LGBTQI cultural competence and reviewed international LGBTQI cancer resources; and produced targeted LGBTQI cancer resources and healthcare professional practice guidelines ( Figure 1 ).…”

Section: Methodsmentioning

confidence: 99%

“…We specifically targeted oncology medical practitioners, nurses, allied health professionals (e.g., social workers, psychologists, occupational and physiotherapists) and individuals working in leadership roles in cancer care, health and preventative agencies such as support group leaders, program/service managers and consumer representatives/advocates. The study procedures and quantitative survey results from HCPs have been published elsewhere ( 41 ). Briefly, a sample of 357 HCPs working with people with cancer in nursing (40%), medical (24%), allied health (19%) and leadership (11%) positions, took part in an online anonymous survey.…”

Section: Methodsmentioning

confidence: 99%

“…The HCP survey ( 41 ) assessed attitudes toward LGBTQI cancer care, knowledge of LGBTQI health needs and LGBTQI inclusive practice behaviors. At the end of each section, HCP participants were asked to provide written responses to the open-ended question, “is there anything you would like to tell us about your answers to these questions?”.…”

Section: Methodsmentioning

confidence: 99%

“…Greater knowledge of LGBTQI healthcare needs is associated with positive attitudes and intentions to offer inclusive and affirmative care for LGBTQI cancer patients ( 36 – 38 ). However, surveys of oncology physicians ( 1 , 2 , 37 ), radiation therapists ( 39 ), nurses and other advanced care professionals ( 36 , 38 , 40 , 41 ) consistently report low levels of knowledge about LGBTQI patients. This includes lack of knowledge about cancer risk factors and psychosocial vulnerabilities specific to LGBTQI people ( 1 , 38 , 40 ), and feeling ill-informed about LGBTQI cancer patients’ unique needs ( 2 , 39 , 42 ).…”

Section: Introductionmentioning

confidence: 99%

“…This includes lack of knowledge about cancer risk factors and psychosocial vulnerabilities specific to LGBTQI people ( 1 , 38 , 40 ), and feeling ill-informed about LGBTQI cancer patients’ unique needs ( 2 , 39 , 42 ). Lack of knowledge has implications for HCP confidence and comfort in treating LGBTQI patients ( 1 , 2 , 37 ), with sexual health ( 43 ), fertility ( 44 ), and the needs of trans ( 1 , 14 , 45 ) and intersex patients ( 41 ) being areas where communication challenges are most likely. Moreover, even the majority of HCPs who report being comfortable treating LGBTQI patients in cancer care surveys ( 1 , 2 , 40 , 42 ), report a desire for education and training ( 1 , 36 , 37 , 41 ) focused on the needs and best ways of working with the LGBTQI population.…”

Section: Introductionmentioning

confidence: 99%

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LGBTQI Inclusive Cancer Care: A Discourse Analytic Study of Health Care Professional, Patient and Carer Perspectives

et al. 2022

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BackgroundAwareness 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 AimThis 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.Method357 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.ResultsThree 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.ConclusionDerogatory 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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Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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LGBTQI Inclusive Cancer Care: A Discourse Analytic Study of Health Care Professional, Patient and Carer Perspectives

et al. 2022

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“Everything's a fight”: A qualitative study of the cancer survivorship experiences of transgender and gender diverse Australians

et al. 2023

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Background: There is widespread recognition of the need to achieve equitable outcomes for all cancer survivors. This requires understanding of the experiences and outcomes of vulnerable groups. People who identify as sexually or gender diverse are known to be at risk of inferior cancer and survivorship outcomes, however, the posttreatment survivorship experiences of transgender and gender diverse (TGD) people have not been well studied. This study explored the survivorship experiences of people who identify as TGD, focusing on the physical and psychological aspects of the posttreatment survivorship phase and their experiences of follow-up cancer care.Methods: A qualitative study of 10 TGD cancer survivors. Interviews were transcribed verbatim and data were analyzed by thematic analysis.Results: Six themes were generated from the data. TGD people reported (1) anxiety when attending appointments and avoidance of necessary follow-up care, (2) experiences of transphobia and discrimination within oncology care settings and(3) lack of consideration of TGD identity by providers. Themes further describe (4) physical aspects of being both TGD and a cancer survivor, (5) absence of inclusive and diverse supportive care resources, as well as (6) positive growth after cancer. Conclusion:Approaches to mitigate these issues are urgently called for. These include training in TGD health for health-care providers, inclusion of TGD health in medical and nursing curricula, processes to collect and use gender identity and preferred pronoun data in clinical settings, and development of TGD-inclusive information and peer-support resources. K E Y W O R D Shealth Services for transgender persons gender identity, healthcare disparities, neoplasms, survivorship, transgender persons How to cite this article: Lisy K, Kerr L, Jefford M, Fisher C. "Everything's a fight": A qualitative study of the cancer survivorship experiences of transgender and gender diverse Australians.

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Reinforcing or Disrupting Gender Affirmation: The Impact of Cancer on Transgender Embodiment and Identity

et al. 2023

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There is a pressing need for greater understanding and focus on cancer survivorship and informal cancer caring of trans people (binary and non-binary), across tumor types, to inform culturally safe trans inclusive cancer information and care. This qualitative study, part of the mixed methods Out with Cancer project, examined experiences of trans embodiment and identity after cancer diagnosis and treatment. We drew on open-ended survey responses from 63 trans cancer survivors and 23 trans cancer carers, as well as interviews and a photo-elicitation activity with a subset of 22 participants (15 cancer survivors, 7 cancer carers). Reflexive thematic analysis identified three themes: Cancer enhances trans embodiment, through experiences of gender euphoria following cancer treatment, and acceleration of decisions about gender affirmation; cancer erases or inhibits gender affirmation; trans embodiment is invisible or pathologized in cancer care. These findings demonstrate that trans embodiment and identity, as well as the process of gender affirmation, may be disrupted by cancer or informal cancer caring. Conversely, cancer and cancer treatment can positively impact the embodied identity and lives of trans people, despite the anxiety and strain of negotiating medical procedures. However, if healthcare professionals operate within a cis-heteronormative framework and do not understand the meaning of embodied change following cancer treatment for trans individuals, these positive benefits may not be realized.

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Attitudes, knowledge and practice behaviours of oncology health care professionals towards lesbian, gay, bisexual, transgender, queer and intersex (LGBTQI) patients and their carers: A mixed-methods study

Cited by 32 publications

References 34 publications

LGBTQI Inclusive Cancer Care: A Discourse Analytic Study of Health Care Professional, Patient and Carer Perspectives

LGBTQI Inclusive Cancer Care: A Discourse Analytic Study of Health Care Professional, Patient and Carer Perspectives

“Everything's a fight”: A qualitative study of the cancer survivorship experiences of transgender and gender diverse Australians

Reinforcing or Disrupting Gender Affirmation: The Impact of Cancer on Transgender Embodiment and Identity

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