Outlook: Newsletter of the Society of Behavorial Medicine

Fall 2022

Outlook main page »

LGBTQIA+ and Cancer Care: A Beginner’s Guide for Healthcare Providers

Kara A. Nishimuta, PhD (She/They)✉; Alaina L. Carr, PhD (She/Her)✉; and Claire Conley, PhD (She/Her)✉; Cancer SIG


Lesbian, Gay, Bisexual, Transgender, Queer/Questioning, Intersex, Asexual (LGBTQIA+) individuals with cancer face many barriers to cancer care. These barriers may include reduced access to employer health insurance and social stigma. Also, few healthcare providers are experienced in working with LGBTQIA+ individuals.1,2 Due to concerns about discrimination and/or expected lack of understanding from providers, LGBTQIA+ individuals may not discuss their sexual orientation and gender identity information with their healthcare provider even if this information is relevant to their care.1 Healthcare providers may feel unprepared to discuss sexual orientation and gender identity with their LGBTQIA+ patients.

Healthcare providers need to take positive steps toward promoting the health of LGBTQIA+ patients to reduce these barriers to cancer care and improve overall care and outcomes. This article serves to help healthcare providers create a more inclusive and welcoming environment for LGBTQIA+ cancer patients and improve understanding about barriers that this community faces when seeking medical care.
 

How do I ensure I create an LGBTQIA+ friendly space in cancer care?

  • Introduce yourself with pronouns. This creates an open dialogue with patients and shows inclusivity. For example, you could say: “Hi, my name is Dr. Jones, and my pronouns are she/her.”
  • If using a virtual platform (like Zoom), change your name display to include pronouns.
  • Display visual indicators of inclusivity in your space, like pronoun pins, rainbow/queer flags, or LGBTQIA+ health information brochures.3
  • Advocate for correct language used for names, pronouns, and body parts with medical teams and electronic health records.
     

What are some ways I can ask about gender and sexuality?

  • Use gender-neutral language. For example, instead of asking a patient about his “wife,” you could ask about his “partner(s)” or “significant other(s).”
  • Mirror the same language the patient does when describing self, sexual partners, relationships (i.e., chosen family), and identity.4
  • Include pronouns and sexual and gender identity in intake paperwork. For example, use the term “relationship status” rather than “marital status”.4
  • Review all demographic characteristics with patients by confirming sexual orientation, gender identity, and legal vs. chosen name.
     

How do I talk to patients about how they refer to parts of their body?

  • Breast, prostate, uterine, and ovarian cancers are sex-based. For example, not everyone will want to refer to their “breasts” and may want to use the term “chest” instead. Ask patients what terms they use when referring to their reproductive organs.
  • Ask the patient to clarify any unfamiliar terms to enhance non-judgmental questions and communication.
  • Avoid assumptions based on patients’ sex. For example, not everyone will want breast reconstruction surgery after receiving a mastectomy.
     

Additional areas of consideration for LGBTQIA+ patients with cancer- legal documentation:

  • During the initial LGBTQIA+ patient encounter, discuss and formalize surrogate decision-making. This includes medical proxy documentation, formalizing custody of dependent children, and hospital visitation forms.5,6
  • It is your patient’s legal right to include family of choice in medical documentation and hospital visitation directives. When talking about surrogate medical decision-making with LGBTQIA+ patients, it is important that these discussions are reflective of rapidly changing laws, regulations, and accrediting standards at the national, state, and institutional levels.5,6
  • It is important to understand legislation impacting LGBTQIA+ people in the state(s) you practice in.
  • Advance directives, Durable Power of Attorney (DPoA) and Physician Orders for Life Sustaining Treatment (POLST) should follow LGBTQIA+ patients across all treatment facilities such as primary care, outpatient specialty care, and inpatient care.5
     

Additional resources:

    https://cancer-network.org/programs/support-groups-for-survivors/

    https://cancer-network.org/wp-content/uploads/2017/02/Trans_Access_to_Care_and_Cancer_Disparity_Fact_Sheet.pdf

    https://www.thehrcfoundation.org/professional-resources/healthcare-equality-index-2019

    Movement Advancement Project | Snapshot (lgbtmap.org)

 

References

  1. Quinn GP, Alpert AB, Sutter M, Schabath MB. What Oncologists Should Know About Treating Sexual and Gender Minority Patients With Cancer. JCO Oncol Pract. 2020;16(6):309-316. doi:10.1200/OP.20.00036
  2. Krehely J. How to Close the LGBT Health Disparities Gap. Cent Am Prog. Published online December 21, 2019:5.
  3. Creating an LGBTQ-friendly practice. American Medical Association. Accessed July 21, 2022. https://www.ama-assn.org/delivering-care/population-care/creating-lgbtq-friendly-practice
  4. Guidelines for Care of Lesbian, Gay, Bisexual, and Transgender Patients | National Prevention Information Network | Connecting public health professionals with trusted information and each other. Accessed July 21, 2022. https://npin.cdc.gov/publication/guidelines-care-lesbian-gay-bisexual-and-transgender-patients
  5. LGBT Best and Promising Practices Throughout the Cancer Continuum. National LGBT Cancer Network. Accessed July 21, 2022. https://cancer-network.org/lgbt-best-and-promising-practices-throughout-the-cancer-continuum/
  6. The Legal Documents Every LGBT Older Adult Needs. LGBTAgingCenter.org. Accessed July 26, 2022. https://lgbtagingcenter.org/resources/resource.cfm?r=3