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Lesbian, Gay, Bisexual, Transgender, and Queer (LGBTQ) Communities

The American Society of Clinical Oncology (ASCO) states LGBTQ communities are disproportionately affected by seven types of cancer: anal, breast, cervical, colorectal, lung, prostate, and uterine. LGBTQ communities are at risk of poor access to cancer prevention, screening, care, cancer survivorship, quality of life, and cancer outcomes. Due to stigma and stress, LGBTQ people may be more hesitant to disclose their sexual orientation and gender identity to their health care providers, which may decrease their cancer survivorship outcome. The National LGBT Cancer Network provide the following strategies.

LGBTQ Patient-Centered Outcome Recommendations

Stigma

Providers and health care management should become educated about the stigma-related stress many LGBTQ people carry into the health care setting.

  • Provide cultural competency training for all staff
  • Include LGBTQ leaders on community advisory bodies

Health care environment

  • Health care institutions and offices should actively convey that LGBTQ-welcoming behavior is a core expectation of all staff
    • Include mandatory staff training
    • Reinforce such welcome through the actions of management and public relations staff. For example, an article could be written on LGBTQ diversity for an employee newsletter
    • Develop an LGBTQ study group
  • Health care institutions and offices should convey a zero-tolerance environment for any discriminatory behavior on the part of staff
    • Include scenarios and possible responses in annual staff trainings
  • Health care institutions and offices need to broadcast their LGBTQ-welcoming policies and training to potential and current patients
    • Include LGBTQ measures and nondiscrimination protections on intake forms
    • Prominently display LGBTQ protections/welcome on website and in waiting rooms
    • Partner with local LGBTQ community-based organizations for public events, in public materials
    • Tailor ads to LGBTQ media outlets
    • Participate in and display the results from the Human Rights Campaign Healthcare Equality Index report card
  • LGBTQ-welcoming policies and training should be broadcasted to the public in situations where there’s greater historic stigma, such as in religious institutions, or regions with no LGBTQ civil rights protections
  • Ensure LGBTQ employees can safely be out at the workplace
    • Sponsor an LGBTQ employee group
    • Include LGBTQ status on employee satisfaction surveys and ask about safety and being out at work

Disclosure and safety

Collect evidence to see if LGBTQ patients feel safe coming out at your institution and use evidence to increase safety.

  • Ask about LGBTQ status on patient satisfaction surveys
  • Ask about LGBTQ status on employee surveys and their relative safety
  • Convene LGBTQ employees as an advisory body, to suggest steps to increase patient safety
  • Include LGBTQ leaders on community advisory bodies to provide a constant source of feedback
  • Conduct an environmental scan of the facility to check how and when safety is conveyed to LGBTQ patients

Respect LGBTQ-patient support teams

Conduct a scan to see how the office/institution conveys welcome for alternative support teams. Use findings to augment the message to staff and patients alike.

  • Prominently display policies ensuring alternative families are respected during care
  • Train staff in the steps to comply with the early designation of health care proxy
  • Include designation of health care proxy materials in routine intake forms
  • Allow patient to designate important support team members as well as health care proxy on forms and/or patient records

Expectations of gender conformity

Conduct a scan to see when the office/institution presumes gender conformance in care. Use findings to build welcome for all gender nonconforming patients Due to the high chance of poor care, get input on the treatment of transgender patients and make changes to augment their welcome.

  • Review educational materials for gender presumptions
  • Offer LGBTQ-specific educational materials that avoid gender conformity expectations
  • Include training on gender assumptions in mandatory cultural competency care
  • Convene focus group of former transgender patients to get input on satisfaction and enhancements

Culturally appropriate support and information

  • Collect referral lists for LGBTQ-welcoming providers, including local mental health providers
    • Call referral sources in advance to ask if they are LGBTQ welcoming and follow up with the patient to ensure they were welcomed
    • Offer referrals to LGBTQ support groups or develop one if none exists
  • Review all educational materials to remove heterosexist language choices (e.g., “husband” “married,” etc.)
  • Ensure providers are educated in how to speak about sex and sexuality to LGBTQ patients