Jun 3, 2019

Significant unmet healthcare needs, discrimination, and disparity exists within the LGBTQIA+ community

When we begin to work in a new disease state, we usually start by identifying the unmet needs in that space. Often we find outdated guidelines or a complete lack of guidelines, gaps in an established standard of care or, maybe, no standard of care at all, where one is desperately needed.

While significant advances have been made in understanding population health and addressing healthcare disparities overall, the lesbian, gay, bisexual, transgender, queer/questioning, intersex, and asexual or allied (LGBTQIA+) community—which represents ~5% of the US adult population—has not been considered a key population, and thus continues to be underserved. This population also reports experiencing lower satisfaction with, and engagement in, healthcare, which has a significant health impact.1 Some of this dissatisfaction comes from discrimination and stigmatization, resulting in avoidance of or difficulty in seeking care.2,3

In fact, according to a recent poll by the Harvard Chan School, NPR, and the Robert Wood Johnson Foundation, which examined the experience of discrimination in several populations including LGBTQIA+ adults, one-sixth of LGBTQIA+ adults said they experienced discrimination at the doctor’s office or in another healthcare setting, while one-fifth said they have avoided seeking medical care out of fear of discrimination.4 Compounding the issue is a significant lack of understanding about the unique and specific healthcare needs of the LGBTQIA+ population among the medical community and the lack of consistent curriculum around this population in medical schools, resulting in healthcare systems unprepared to take appropriate care of LGBTQIA+ people.1,4,5

Further demonstration of the lack of awareness and understanding of the specific healthcare needs of the LGBTQIA+ patient population can be found in the results from a 2018 survey of 658 students at New England medical schools, in which 80% of respondents said they felt “not competent” or “somewhat not competent” or adequately trained with the medical treatment of gender and sexual minority patients.6 And in March 2019, Schabath et al published results from a national survey of 149 oncologists measuring attitude, knowledge, practice behavior, and demographic awareness of issues that are of particular importance to the LGBTQIA+ community. This included 2 pre- and post-surveys measuring physician confidence in managing LGBT healthcare.1

In the pre-assessment survey, more than 95% of oncologists felt comfortable treating lesbian, gay, or bisexual patients, but only 53% felt knowledgeable about the specific needs of this community. When asked about transgender patients, only 83% felt comfortable and 37% felt knowledgeable about the needs of transgender patients. Interestingly, the post-assessment survey showed a significant decline in the degree of confidence respondents had in their knowledge about the LGBTQIA+ community, compared with the pre-assessment survey.

The decrease in confidence suggests physician acknowledgement of the existing unmet healthcare needs among this patient group, as well as the need for more medical education. In fact, 70% of the oncologists surveyed expressed interest in receiving additional education about the unique healthcare needs for the LGBTQIA+ community, and many felt this training should be mandatory. Additionally, there is a growing base among medical students demanding more LGBTQIA+ health education and training to address disparities appropriately and confidently. Over the last 2 years New York Medical College, as a result of student advocacy, has increased its LGBT-focused content in the curriculum from 1-1/2 to 7 hours, and schools on the forefront of LGBT care curriculum such as UCSF and Harvard Medical School continue to assess and identify opportunities to better instruct on the health of sexual and gender minorities.6 So, while there is growing awareness, advocacy, and a push to improve the healthcare industry’s “cultural competence” and create a better understanding of the significant and unique healthcare challenges within the LGBTQIA+ patient population, the sense of urgency for, and need to establish, both culturally sensitive and clinically knowledgeable curriculum and guidelines for the appropriate healthcare of this community remains a critical and significant unmet need in population health.

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

Burkhalter JE, et al. The national LGBT action plan: a white paper of the 2014 National Summit on Cancer in the LGBT Communities. LGBT Health. 2016;3(1):19-31.

3

Kates J, et al. Health and access to care and convergence for lesbian, gay, bisexual, and transgender individuals in the US. Henry J Kaiser Family Foundation website. http://files.kff.org/attachment/Issue-Brief-Health-and-Access-to-Care-and-Coverage-for-LGBT-Individuals-in-the-US. Updated May 2018. Accessed May 22, 2019.

4

Sholes, S. The problems with LGBTQ healch care. Harvard Gazette website. https://news.harvard.edu/gazette/story/2018/03/health-care-providers-need-better-understanding-of-LGBTQIA+-patients-harvard-forum-says/. Updated March 23, 2018. Accessed May 30, 2019.

5

Sabin JA, Riskind RG, Nosek BA. Health care providers’ implicit and explicit attitudes toward lesbian women and gay men. Am J Public Health. 2015;105:1831-1841.

6

Cohen, RD. Medical students push for more LGBT health training to address disparities. NPR website. https://www.npr.org/sections/health-shots/2019/01/20/683216767/medical-students-push-for-more-lgbt-health-training-to-address-disparities. Updated January 20, 2019. Accessed May 30, 2019.