Jun 17, 2019

Conflicting data on oncologist comfort and confidence/knowledge in treating LGBTQIA+ patients widens the communication gap

Conflicting survey data exemplifies disparities in oncologist comfort and confidence/knowledge in treating those in the LGBTQIA community. What’s the key to closing the gap and creating informative provider/patient conversations?

As established in our previous posts, critical health disparities in the LGBTQIA+ population are perpetuated by gaps in understanding, confidence, and knowledge from the medical professionals treating this unique population.1

Unfortunately, these gaps, often compounded by physicians’ personal biases, create a significant communication disconnect between physicians and patients, fueling inadequate standard of care for LGBTQIA+ patients and perpetuating a perceived lack of sensitivity and social stigma felt by this patient demographic.2

This lack of open communication between oncologists and patients presents yet another critical disparity. Revisiting the March 2019 Schabath study, oncologists reported a high percentage of comfort with treating the LGBTQIA+ population but, in contrast, low numbers in confidence and/or knowledge of the healthcare needs of this specific patient population.1

So, why does the disparity exist?

As previously noted, guidelines are lacking and there is a significant lack of accurate data due to deficient collection of SOGI information.1 But, if the comfort level with treating LGBTQIA+ patients is high, wouldn’t this lack of form data actually prompt necessary questions, driving the open and holistic physician-patient dialogue critical to positive outcomes? Or, does this lack of form data facilitate the skirting of what is perhaps an uncomfortable subject, therefore limiting adequate, informed, and comprehensive care?

For participants in the Schabath study, familiarity with the LGBTQIA+ community through friends or family had some influence on their attitudes and knowledge of the population as a whole, but it also revealed limited acknowledgement of the unique healthcare needs of the LGBTQIA+ population.1 While 65.8% agreed it was important to know the gender identity of a patient, only 39.6% agreed it was important to know sexual orientation.1 This parallels a report by the American Association of Medical Colleges which found that the majority of providers and medical students do not believe they need to know the sexual orientation of patients.1 Similarly, a 2015 Canadian study reported that healthcare professionals suggested there are no significant differences between primary care for LGBTQ women and care for any other patients and that, except for specific health issues, everyone is an individual.3

The foundation for an open dialogue is not present and, as a result, oncologists remain naive to LGBTQIA+ lifestyle choices and dynamics that have direct, negative health consequences. Relevant information specific to the LGBTQIA+ population and directly correlated with health is not being addressed. For example, the LGBTQIA+ population is more likely to spend time in the sun, use tobacco, and/or have substance abuse issues.1,4 Lesbian and bisexual women are more likely to be overweight than straight women, and lesbian women are 4 times less likely to engage in routine mammograms. Transgender women have 34 times the odds of having HIV versus the adult population and 41% of transgender people have attempted suicide compared to 1.6% of the general population.5 Unfortunately, these types of data points result in an increased risk of adverse health outcomes for the LGBTQIA+ population at 2 to 5 times that of the general population, according to the NIH.6

So, beyond improvements to the capturing of SOGI data, growing awareness of the need for established standards of care, and increased educational content on the unique health needs of LGBTQIA+ people, what else needs to happen to ensure that the medical and social needs of this community are met?

The very real human element adding to the dynamic that must be considered and explored a little more closely is that of true, individual comfort… or discomfort, rather. Which is it? Could this lack of general understanding, regard, and overall lack of engagement actually be born from a subjective lack of comfort?

Contrary to the findings of Schabath et al, another survey reported that providers are often reluctant to ask patients questions about sexual preference for fear of embarrassing them7, among other cited barriers. Reasons for not addressing or taking a sexual history include fear of being intrusive, being unsure of proper terminology and cultural differences, as well as a lack of ease with how to ask questions or respond to patients.5 On the flip side, another recent survey of patients said that 90% do not share that fear and there are high levels of patient acceptability of routine collection of SOGI data.6,8

Along with the push to improve the healthcare industry’s preparedness and standards for providing comprehensive and adequate care for this community, oncologists must proactively find and use the resources available to take the lead in learning about the healthcare and social needs of the LGBTQIA+ patient population. Additionally, in order to create the inclusive, inviting, and holistic clinical environment vital to providing patient-centered care, there must be a greater push to increase the comfort level between oncologist and patient, thus closing the communication gap and facilitating the open and honest exchange that is critical to positive clinical and patient outcomes.

 

References:

1.

Schabath MB, et al. National survey of oncologists at National Cancer Institute—designated Comprehensive Cancer Centers: attitudes, knowledge, and practice behaviors about LGBTQ patients with cancer. J Clin Oncol. 2019;37(7):epub.

2.

Bridging the LGBT health care gap. USC Suzanne Dworak-Peck Website. https://dworakpeck.usc.edu/news/bridging-the-lgbt-health-care-gap. Accessed June 12, 2019.

3.

Beagan B, et al. Family physician perceptions of working with LGBTQ patients: physician training needs. Can Med Educ J. 2015;6(1):e14-e22.

4.

Jabson M, et al. Health behaviors and self-reported health among cancer survivors by sexual orientation. LGBT Health. 2015;2(1):41-47.

5.

Sexual and gender minorities in medicine. Stanford University School of Medicine website. https://med.stanford.edu/content/dam/sm/faculty-diversity/documents/SGM%20In%20Medicine_051315.pdf. May 12, 2015. Accessed June 12, 2019.

6.

The problems with LGBTQ health care. The Harvard Gazette Website. https://news.harvard.edu/gazette/story/2018/03/health-care-providers-need-better-understanding-of-lgbtq-patients-harvard-forum-says/. Accessed June 12, 2019.

7.

Verhoeven V, et al. Collecting data for sexually transmitted infections (STI) surveillance: what do patients prefer in Flanders? BMC Health Serv Res. 2007;7:149.

8.

Cahill S, et al. Do ask, do tell: high levels of acceptability by patients of routine collection of sexual orientation and gender identity data in four diverse American community health centers. PLoS One. 2014;9(9):e107104.