Cancer in the lesbian, gay, bisexual, transgender/transsexual, or queer/questioning (LGBTQ+) population has remained underresearched, and information that is known is less likely to reach oncology professionals who could use it to improve care. In “Care of the LGBTQ+ Patient With Cancer,” Carlton Brown, RN, PhD, AOCN®, NEA-BC, FAAN, president of Zenith Health Care Solutions, Inc., in Portland, OR, and David Rice, PhD, MSN, RN, NP, NEA-BC, director of education, evidence-based practice, and research at the City of Hope National Medical Center in Duarte, CA, examined the delivery of quality cancer care in people identifying as LGBTQ+, along with strategies for addressing their unique needs and minimizing barriers to care. They presented the session on Thursday, April 11, 2019, at the ONS 44th Annual Congress in Anaheim, CA.
LGBTQ+ in Cancer and Health Care
Between 5% and 10% of people in the U.S. identify themselves as LGBTQ+, Brown said. Applying those percentages to the almost 16 million Americans currently living with cancer, an estimated 1.2 million LGBTQ+ cancer survivors are living in the U.S. However, “evidence suggests that the incidence of some cancers is higher in LGBTQ+ populations and that there are many uncounted cancer survivors who consider themselves LGBTQ+,” he said.
A basic understanding of terminology used to describe people who identify as LGBTQ+ is crucial, Brown said, because some health disparities are a result of provider knowledge gaps and medical intake forms that do not allow full disclosure of sexual orientation or gender identity. Many LGBTQ+ individuals have also had negative experiences with healthcare providers who project biases. Studies have shown the need for education and policies that develop and support culturally competent providers.
Further exploring gaps in care, Brown discussed socioeconomic risk factors, such as higher poverty and lower health insurance coverage that also contribute to disparities in the LGBTQ+ population. When cancer risk is considered, disparities are compounded by lower cancer screening rates, higher reports of psychological distress, and modifiable lifestyle behaviors, such as higher tobacco and alcohol use and higher rates of sexually transmitted infections, including HIV.
LGBTQ+ Cultural Competency
A culturally competent workforce that maintains awareness and continuously improves skills through LGBTQ+ training is needed, Rice said. Additionally, oncology nursing professionals must “address the clinical and cultural needs of LGBTQ+ patients and families and create a welcoming, inclusive environment that will help improve the care of sexual and gender minority patients.” Health systems must support cultural competence through advocacy, collaboration, and development of policies and treatment-related protocols that address the LGBTQ+ population’s unique health issues.
Rice included best practices for creating a welcoming environment, along with resources to assist care professionals and health systems in improving the provision of LGBTQ+ care, treatment, and services. He cited a key takeaway from an expert panel presentation on the topic: “The cancer continuum can have an even greater negative impact on the LGBTQ+ population, with potentially higher cancer risks, lower screening, and worse outcomes than the general population.”
In closing, Rice summarized some basic tips for oncology nurses:
- Be respectful, compassionate, genuine, and open.
- Recognize your own implicit and explicit biases.
- Educate yourself and your colleagues.
- Learn and use gender neutral language.
- Don’t make assumptions.
- Ask every patient, every time.
- Ensure a trusting, safe care environment for every patient and family.
- Stand up for your patients.
- Learn from your patients.