“This is some mess right here”: Exploring interactions between Black sexual minority women and health care providers for breast cancer screening and care

Abstract

BACKGROUND: Few studies have explored how the intersection of race and sexual identity contribute to breast cancer disparities for Black sexual minority women (SMW). Issues within patient-provider relationships, including bias, contribute to health disparities for minority groups. The authors used constructs from self-determination theory (SDT) to explore the nature of health care provider interactions in breast cancer screening and care among Black SMW. METHODS: Participants were sampled nationally through social media, targeted emails, and referrals. Qualitative, in-depth interviews were conducted with 15 Black cisgender SMW, ages 38 to 64 years, who had a breast cancer diagnosis or recent abnormal mammogram. Interviews were conducted face-to-face or online, audio-recorded, and transcribed verbatim. Two analysts coded the interviews. Codes were analyzed across interviews to identify themes salient to SDT. RESULTS: Themes aligned with the SDT constructs of relatedness and autonomy. Some participants discussed feeling most understood by Black and/or female providers who shared at least 1 of their identities. Feeling understood through shared identity contributed to participants feeling seen and heard by their providers. Participants who discussed negative experiences with providers believed that the provider made negative assumptions about them based on their race and/or sexual orientation. CONCLUSIONS: When interacting with health care providers for breast cancer screening and care, Black SMW face specific challenges related to their multiply marginalized social position. Reducing health care provider bias toward Black SMW may improve patients' desires to continue in care. Providing equitable care while acknowledging and respecting women with multiply marginalized identities may improve the nature of these interactions.

The intersection of racism, discrimination, bias, and homophobia toward African American sexual minority patients with cancer within the health care system

“…Sexual minority women have a lower prevalence of screening mammograms in comparison with heterosexual women for several reasons, including their perceptions of heterosexism and homophobia among providers 22 . In a study of breast cancer screening of Black sexual minority women, Greene et al 23 found that those who had negative experiences with their providers reported that they had in fact made assumptions about them and failed to create supportive and welcoming environments, and this resulted in feelings of alienation among those seeking care. The reality is that there is significant bias on behalf of providers.…”

Beyond Black and White: race and sexual identity as contributors to healthcare system distrust after breast cancer screening among US women

“…In addition to interactions with providers, sexual minorities may be discriminated against by the HCS itself. For example, from our team's previous qualitative work with Black SM women one breast cancer patient expressed frustration that there was a breast cancer support group specifically geared toward male but not female partners of breast cancer survivors 40 . Altogether, these results and examples suggest an increased need for interventions at the provider and healthcare system levels in cancer screening and care to regain trust among racial and SM patients.…”

Delays in breast cancer care by race and sexual orientation: Results from a national survey with diverse women in the United States

“…1). In a recent qualitative study with BSMW breast cancer care survivors, Greene et al 44 identified several strategies that health care providers could use to improve engagement, including creating a relatable atmosphere that supports the autonomy and self‐efficacy of the person seeking care.…”