What Exactly Are We Measuring? Evaluating Sexual and Gender Minority Cultural Humility Training for Oncology Care Clinicians

Alpert, Ash B.; Kamen, Charles; Schabath, Matthew B.; Hamel, Lauren M.; Seay, Julia; Quinn, Gwendolyn P.

doi:10.1200/jco.19.03300

Cited by 21 publications

(17 citation statements)

References 44 publications

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“…Lack of knowledge or confidence on the part of HCPs in caring for LGBTQI cancer patients has been reported in previous research ( 1 , 2 , 36 – 38 , 40 ). This has led to the development of training programs ( 25 , 26 , 97 , 98 ) and publication of practical strategies to facilitate communicative competence in the provision of LGBTQI cancer care ( 4 , 6 , 28 , 99 – 103 ). However, the success of such strategies depends on HCPs being reflective in their practice, acknowledging their own limitations and accepting the necessity of professional training or development, and understanding the complexities and differences within LGBTIQ communities ( 41 ).…”

Section: Discussionmentioning

confidence: 99%

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: Discussionmentioning

confidence: 99%

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

et al. 2022

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“…The patient nondiscrimination policy should be considered as a foundational component of the multilevel organizational, structural, and clinical changes that should be implemented in cancer centers to build safe healthcare environments for marginalized patient populations, such as those in the SGM community. 32 These potential changes include other protective measures, such as hiring and retaining SGM-identified faculty to facilitate concordant patient interactions; developing resources, clinical spaces, and materials that are inclusive of SGM patients; and collection of sexual orientation and gender identity data in clinical practice. 32 The strengths of our study are balanced by its limitations.…”

Section: Discussionmentioning

confidence: 99%

“…32 These potential changes include other protective measures, such as hiring and retaining SGM-identified faculty to facilitate concordant patient interactions; developing resources, clinical spaces, and materials that are inclusive of SGM patients; and collection of sexual orientation and gender identity data in clinical practice. 32 The strengths of our study are balanced by its limitations. First, we only captured patient nondiscrimination policies that were available through online searches by 2 separate data collectors, although other centers may have had nondiscrimination policies available elsewhere, including in nonpublicly viewable forums.…”

Section: Discussionmentioning

confidence: 99%

Representation of Sexual and Gender Minority People in Patient Nondiscrimination Policies of Cancer Centers in the United States

Berrahou

Snow

Swanson

et al. 2022

Journal of the National Comprehensive Cancer Network

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Background: Sexual and gender minority (SGM) people are an underserved population who face high rates of discrimination in healthcare, including receipt of cancer treatment. Several national organizations have identified the importance of patient nondiscrimination policies that explicitly recognize SGM people in creating safe healthcare environments. Methods: We performed a web-based analysis of NCI-designated Cancer Centers to evaluate the landscape of patient nondiscrimination policies in major cancer centers with regard to representation of SGM people. Results: We found that 82% of cancer centers had a patient nondiscrimination policy on their website. The most commonly mentioned SGM-related term was “sex” (n=48; 89%), followed by “sexual orientation” (n=37; 69%) and “gender identity” (n=36; 67%). None of the policies included “sex assigned at birth” or “LGBTQ/SGM identity.” Of the policies reviewed, 65% included protections for both sexual orientation and gender identity. Cancer centers with academic affiliations were significantly more likely to have policies that included both of these protections compared with nonacademic institutions (100% vs 79%; P=.005). Conclusions: Our study shows that patient nondiscrimination policies across NCI-designated Cancer Centers are not always accessible to patients and their families online and do not consistently represent SGM people in their content. Because the SGM population is both at higher risk for cancer and for discrimination in the healthcare setting, it is crucial to create inclusive, safe, and equitable cancer care environments for this group. Administrators and clinicians should view the patient nondiscrimination policy as an opportunity to offer expansive protections to SGM people that extend beyond those offered in federal and state laws. Additionally, the patient nondiscrimination policy should be visible and accessible to patients seeking cancer care as a signal of safety and inclusion.

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“…Training is a key component to this (117). To advance cultural humility training in the care of SGM prostate cancer patients, it is insufficient to simply provide a basic, introductory "SGM 101" seminar or case review of an SGM patient.…”

Section: Part 3 Addressing a Cultural Dividementioning

confidence: 99%

Every urologist and oncologist should know about treating sexual and gender minority prostate cancer patients: translating research findings into clinical practice

Rosser

Rider

Kapoor³

et al. 2021

Transl Androl Urol

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In 2016, the NIH designated sexual and gender minorities (SGM) a health disparity population.The next year, the American Society of Clinical Oncology highlighted the need to improve the suboptimal cancer and survivorship care received by SGM populations. There are currently no evidence-based training programs in culturally competent care of prostate cancer patients who are gay, bisexual and/or transgender. In this selective review, we summarize findings from the largest quantitative studies focused on sexual minority prostate cancer survivors and from 65 interviews with NIH staff, clinicians, and cancer clinics in 11 US cities.The report is divided into three parts and uses a question and answer format to address 21 questions relevant to clinicians providing care to SGM prostate cancer patients. First, we identify population-specific issues that are culturally relevant in the care of SGM patients with prostate cancer. While a body of research has emerged on sexual minority prostate cancer patients, the literature on gender minorities is limited to single case reports and inadequate to inform practice. This review covers definitions, population size, cultural and historical context, sexual behavior, population invisibility, sexual orientation and gender identity (SOGI) in the electronic medical record, disparities and evidence of discrimination in treatment provision. The second part focuses on promoting evidence-informed, patient-centered care. This includes current practices in assessing sexual orientation, management of disclosure of sexual orientation, how to address common problems sexual minority men experience post-treatment, common questions sexual minority patients have, management of urinary incontinence, HIV and STI risk during and post-treatment, and sub-groups of sexual minority patients with worse outcomes. It then identifies how male partners differ in prostate cancer support, current research on rehabilitation for sexual minority men, issues in advanced prostate cancer, and things to avoid with minority patients. Finally, we examine the cultural divide between provider and patient, advocating for cultural humility when working with minority patients. Training programs and continuing education can help providers both to become more aware of their own cultural assumptions, informed about health disparities, and able to provide quality care, and to make clinics more welcoming to SGM patients. 2 Rosser et al. Treating SGM prostate cancer patients

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What Exactly Are We Measuring? Evaluating Sexual and Gender Minority Cultural Humility Training for Oncology Care Clinicians

Abstract: Author affiliations and support information (if applicable) appear at the end of this article.

Cited by 21 publications

References 44 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

Representation of Sexual and Gender Minority People in Patient Nondiscrimination Policies of Cancer Centers in the United States

Every urologist and oncologist should know about treating sexual and gender minority prostate cancer patients: translating research findings into clinical practice

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