Shared decision-making around anal cancer screening among black bisexual and gay men in the USA

Abstract

Shared decision making is a strategy to achieve health equity by strengthening patient-provider relationships and improve health outcomes. There is a paucity of research examining these factors among patients who identify as sexual or gender minorities and racial/ethnic minorities. Through intrapersonal, interpersonal and societal lenses, this project evaluates the relationship between intersectionality and shared decision making around anal cancer screening in Black gay and bisexual men, given their disproportionate rates of anal cancer. Thirty semi-structured, one-on-one interviews and two focus groups were conducted from 2016-2017. Participants were asked openended questions regarding intersectionality, relationships with healthcare providers and making shared decisions about anal cancer screening. 45 individuals participated; 30 in individual interviews and 15 in focus groups. All participants identified as black and male. 13 identified as bisexual and 32 as gay. Analysis revealed that the interaction of internalized racism, biphobia/ homophobia, provider bias and medical apartheid lead to reduced healthcare engagement and discomfort with discussing sexual practices, potentially hindering patients from engaging in shared decision making. Non-judgmental healthcare settings and provider relationships in which patients communicate openly about each aspect of their identity will promote effective shared decision making about anal cancer screening, and thus potentially impact downstream anal cancer rates.

Teaching Intersectionality of Sexual Orientation, Gender Identity, and Race/Ethnicity in a Health Disparities Course

“… 12 – 16 The project captured the stories, views, preferences, and recommendations of these patients through audiotaped interviews and focus groups. 7 , 17 , 18 After analyzing these data, our team invited five participants to be reinterviewed and share their stories through video. We created five 10- to 15-minute videos to capture a range of lived experiences and stories navigating health care, including a Latina lesbian gender nonconforming individual with a history of obesity/body image issues, an older African American gay man, an African American transfemme individual with chronic health conditions, a Latina transsexual woman, and an Asian American transmasculine individual who was a survivor of intimate partner violence (all self-defined identities).…”

Shared decision making for HIV pre-exposure prophylaxis (PrEP) with black transgender women

“…This model was developed to provide an understanding of SDM with Black lesbian, gay, bisexual, transgender and queer persons (Figure 1) (Peek et al 2016). It has been previously applied to understanding the relationship between intersectionality and SDM for anal cancer screening among Black gay and bisexual men (Acree et al 2019).…”

“…In the Peek Model, the patient, the health provider and their relationship are viewed in multiple ways (Acree et al 2019;Peek et al 2016). The individual level, or the level of self-perception, describes how both the patient and provider view themselves in the context of their identity (e.g.…”

“…These lead to improved self-management and treatment adherence for the patient, as well as job satisfaction, cultural competence and ability to provide patient-centred care for the provider (Peek et al 2016). The end result is improved health outcomes for the patient through better care delivery (Acree et al 2019;Peek et al 2016).…”

Facilitators and Barriers to Take Up Clinician-Collected and Self-Collected HPV Tests among Chinese Men Who Have Sex with Men

“…Perceptions had significant influences on HIV and other sexually transmitted infections (STI) screening behaviors among MSM, and they are modifiable through interventions [ 30 , 31 , 32 ]. Qualitative studies suggested that perceived stigma originated from service providers related to their sexual orientation or HIV sero-status; barriers for MSM to receive HPV tests included embarrassment and discomfort, fear of positive results, and perceived low risk of anal cancers [ 26 , 33 , 34 ]. These factors were considered by this study.…”