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

Abstract

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.

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

“…The scoping review yielded 31 studies relevant to LGBT+ cancer care in the United Kingdom. Of these studies, 12 focused on anal and/or prostate cancer [ 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 ], 2 focused on cervical cancer [ 35 , 36 ], 5 focused on unspecified cancers [ 37 , 38 , 39 , 40 , 41 ], 3 focused on breast cancer [ 42 , 43 , 44 ], and 9 focused on HPV-related work [ 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 ]. These studies used a range of methods including qualitative studies (7) [ 26 , 32 , 38 , 39 , 42 , 49 , 51 ], quantitative studies (9) [ 28 , 35 , 40 , 41 , 44 , 47 , 48 , 50 , 52 ], systematic reviews (2) [ 43 , 54 ], meta-syntheses (2) [ 23 , …”

“…A total of 7 papers looked at LGBT+-specific screening, cost efficiencies, prevalence and risk factors [ 24 , 29 , 41 , 43 , 46 , 47 , 53 ]. A total of 8 papers looked at LGBT+ patient experiences pre, during, and/or post-treatment [ 23 , 26 , 31 , 32 , 35 , 38 , 39 , 40 ]. A total of 11 studies explored LGBT+ people’s cancer awareness and the efficacy/acceptability of treatments/testing/screening [ 25 , 27 , 28 , 33 , 36 , 42 , 44 , 45 , 50 , 51 , 54 ].…”

Applying a Capabilities Approach to Understanding Older LGBT People’s Disclosures of Identity in Community Primary Care

“…The use of health capabilities in this context is novel, but close parallels can be drawn with other literature exploring disclosure in healthcare, which frequently highlight the significance of questions around the relevance and purpose of disclosure [ 11 , 19 , 20 ], and the balancing act older LGBT people may face in weighing up the pros and cons of disclosure in different settings [ 42 , 44 , 45 , 46 ]. Past analysis has also emphasized that the health and wellbeing benefits of disclosing LGBT status go beyond purely biomedical conceptualisations of health [ 18 , 23 ]. This analysis develops such accounts by suggesting that the health capabilities model can be used as a conceptual framework to map the range of purposes that disclosure may serve in enhancing health.…”

“…It further assumes that it will always be objectively clear to both patient and clinician whether or not discussing and recording LGBT identity has a purpose, and that this purpose must be medical in nature. However, some LGBT people may want their sexuality or gender identity recorded for other reasons, for example because it is an important part of their identity [ 18 ].…”

“…For older LGBT people, the combination of this perception that LGBT health is a sexual health matter, along with the cultural assumption that older people are desexualised may further heighten assumptions that being LGBT has little significance in later-life healthcare [ 21 , 22 ]. However, interviews with LGB people themselves point to various understandings of interactions between sexual orientation and health: while some individuals do focus upon a biomedical account of relevance, others emphasise that disclosing details of self can promote holistic wellbeing through factors such as sense of personal authenticity or recognition of key emotional relationships and social networks [ 18 , 23 ].…”