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Attitude items beginning and end of survey. Responses less than 5% are not labeled on the figure. All numbers and percentages are presented in
Source publication
Purpose:
To identify potential gaps in attitudes, knowledge, and institutional practices toward lesbian, gay, bisexual, transgender, and queer/questioning (LGBTQ) patients, a national survey of oncologists at National Cancer Institute-Designated Comprehensive Cancer Centers was conducted to measure these attributes related to LGBTQ patients and de...
Context in source publication
Context 1
... the survey assessment, 53.1% (mean, 3.12; SD, 0.87) were confident (strongly agree and agree) in their knowl- edge of health care needs among LGB patients (Fig 3), which decreased to 38.9% (mean, 3.56; SD, 0.91; P , .001 for paired differences). Similarly, 36.9% (mean, 3.18; SD, 0.97) were confident in their knowledge of health care needs among transgender patients in the survey assess- ment, which decreased to 19.5% (mean, 2.71; SD, 0.88; P , .001). ...
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Objectives
Orthopaedic surgeons have a responsibility to minimise risks of ionising radiation to patients, themselves and staff. This study aims to establish the understanding of radiation practice, legislation and risk by orthopaedic surgeons.
Methods
A nationwide online survey of UK-based orthopaedic surgeons was conducted. Participants answered...
Citations
... LGBTQIA + health, and in using online educational formats for this purpose. 21,[34][35][36] Overall, we found that users accessed resources focused on introductory concepts more frequently than other topics. This usage pattern suggests a continued need for CE programs to develop and disseminate resources that build foundational knowledge and skills in LGBTQIA + health that apply to all healthcare staff, and not just specialized areas of care. ...
OBJECTIVES
To reduce health inequities for lesbian, gay, bisexual, transgender, queer, intersex, asexual, and all sexually and gender diverse (LGBTQIA+) people, healthcare professionals need increased access to education and training resources on LGBTQIA + health. Web-based, asynchronous, electronic learning (e-learning) resources are critical for expanding the availability of LGBTQIA + health programs. This article presents the design and utilization outcomes of a novel e-learning platform for engaging healthcare professionals in LGBTQIA + health online continuing education.
METHODS
As of December 2022, the e-learning platform consisted of 293 resources within 17 topic domains. Modalities included: learning modules, recorded webinars, publications, videos, and toolkits. We conducted a descriptive analysis of the e-learning platform's website traffic and user engagement data. Google Universal Analytics and event tracking were used to measure website traffic, user locations, and publication downloads. Learning module and webinar completions were exported from the learning management system and run as frequencies.
RESULTS
Between January 1, 2020, and December 31, 2022, over 650,000 people from all U.S. states, 182 countries, and 31 territories visited the website. Platform users downloaded publications 66,225 times, and completed 29,351 learning modules and 24,654 webinars.
CONCLUSION
The broad reach and high user engagement of the e-learning platform indicate acceptability of web-based, asynchronous online continuing education in LGBTQIA + health, and suggest that this platform is filling a need in health professional education. Remote, online learning opportunities may be especially important in jurisdictions with bans on medical care for transgender and gender diverse youth. Future growth of the platform, paired with in-person and other online learning opportunities, has the potential to reduce gaps in LGBTQIA + health training, and mitigate LGBTQIA + health inequities.
... 4 Finally, widely insufficient knowledge of TGD health issues among healthcare providers has been demonstrated. [5][6][7][8] These factors lead to worse clinical outcomes in terms of cancer diagnosis and mortality. 9 TGD individuals may decide to undergo feminising or masculinising gender-affirming hormone therapy (GAHT), which is variably consisting of exogenous oestrogens, antiandrogens, androgens and gonadotropinreleasing hormone agonists. ...
Transgender and gender-diverse (TGD) individuals face an elevated risk of cancer in comparison with the general population. This increased risk is primarily attributed to an imbalanced exposure to modifiable risk factors and a limited adherence to cancer screening programmes, stemming from historical social and economic marginalisation. Consequently, these factors contribute to poorer clinical outcomes in terms of cancer diagnosis and mortality. A focal point of interest is the potential carcinogenic effect of gender-affirming hormone therapy (GAHT). It is crucial to recognise that GAHT serves as an essential, life-saving treatment for TGD individuals. Therefore, if a demonstrated direct correlation between GAHT and elevated cancer risk emerges, essential shared decision-making discussions should occur between oncology practitioners and patients. This narrative review aims to collect and discuss evidence regarding potential correlations between GAHT and the most prevalent tumours known to be influenced by sex hormones. The objective is to comprehend how these potential carcinogenic effects impact health and inform health interventions for TGD individuals. Unfortunately, the scarcity of epidemiological data on cancer incidence in the TGD population persists due to the absence of sexual orientation and gender identity data collection in cancer centres. Consequently, in most cases, establishing a positive or negative correlation between GAHT and cancer risk remains speculative. There is an urgent need for concerted efforts from researchers and clinicians worldwide to overcome barriers and enhance cancer prevention and care in this specific population.
... Our results also show the complete lack of representation of gender minorities (transgender and gender diverse subjects) within BC pivotal clinical trials, thus making these subpopulations unacceptably neglected entities within the contemporary landscape. Available evidence suggests that transgender and gender diverse people's needs are under-estimated and under/mis-addressed in terms of primary and secondary prevention, and that sex and gender minorities typically experience disparities in the oncological care [13,69,70], driving poorer BC-related outcome. Our study perfectly fits within this framework, providing another important piece of the puzzle and arising important therapeutic considerations when dealing with gender minorities, including men and transgender and gender diverse people. ...
Background
The last years have seen unprecedented improvement in breast cancer (BC) survival rates. However, this entirely apply to female BC patients, since gender minorities (male, transgender/gender-diverse) are neglected in BC phase III registration clinical trials.
Methods
We conducted a scoping review of phase III clinical trials of agents with a current positioning within the therapeutic algorithms of BC.
Results
We selected 51 phase III trials. Men enrollment was allowed in 35.3% of trials. In none of the trial inclusion/exclusion criteria referred to transgender/gender-diverse people. A numerical higher rate of enrolled men was observed in the contemporary as compared to historical group.
We found a statistically significant association between the drug class and the possibility of including men: 100%, 80%, 50%, 33.3%, 25%, 10% and 9.1% of trials testing ICI/PARP-i, ADCs, PI3K/AKT/mTOR-i, anti-HER2 therapy, CDK4/6-i, ET alone, and CT alone.
Overall, 77409 patients were enrolled, including 112 men (0.2%). None of the trial reported transgender/gender-diverse people proportion. Studies investigating PARP-i were significantly associated with the highest rate of enrolled men (1.42%), while the lowest rates were observed for trials of CT (0.13%), ET alone (0.10%), and CDK 4/6-I (0.08%), p < 0.001.
Conclusions
We confirmed that gender minorities are severely underrepresented among BC registration trials. We observed a lower rate of men in trials envisaging endocrine manipulation or in less contemporary trials. This work sought to urge the scientific community to increase the awareness level towards the issue of gender minorities and to endorse more inclusive criteria in clinical trials.
... While prior research in knowledge, attitudes, and practice behaviors focused solely on clinicians, nonclinicians (administrative staff, medical assistants, and other nonmedical staff) make a significant contribution to a patient's overall health care experience. [20][21][22] This study analyzed differences in survey responses across all clinicians and nonclinicians in radiation oncology to identify gaps in knowledge, attitudes, and practice behaviors in the context of role groups. ...
... The survey was developed from validated survey instruments and was divided into 4 sections: demographics (16 questions), attitudes (14 questions), knowledge (5 questions), and open comments (3 questions). [20][21][22] The survey is included in Appendix E1. The Human Rights Campaign glossary of terms was used as reference for the most inclusive language. ...
... All survey items were taken from published surveys as well as articles on LGBTQ+ health 20,21 and reviewed by the diversity, inclusion, and equity committee in the department. ...
Purpose
Sexual and gender minority (SGM) individuals have an increased risk of poor health outcomes, in part due to knowledge and training gaps in health care education. This study sought to evaluate the knowledge, attitudes, and practice behaviors of various health care role groups within radiation oncology toward SGM patients.
Methods and Materials
A 38-item web-based survey was emailed to 1045 staff across 2 large radiation oncology departments. The survey assessed demographics, attitudes, knowledge, and practice behaviors. χ² tests were performed to explore differences in survey responses by age, political affiliation, religious identity, year since graduation, and role groups. One-way analysis of variance tests were conducted to determine differences between respondents’ confidence in knowledge and performance on the knowledge section of the survey. Thematic analysis was applied to the open discussion section.
Results
Of the 223 respondents, 103 clinicians (physicians/advanced practice providers/nurses) and 120 nonclinicians (administrative staff, medical assistants, and other nonmedical staff) participated in the survey (21.3% response rate): 72.6% answered the knowledge questions; 93.5% stated they were comfortable treating sexual minorities, or lesbian, gay, bisexual, and queer + patients; 88% indicated comfort in treating transgender patients; 36.6% stated they were confident in their knowledge of the health needs of transgender patients; and 50.3% expressed confidence in treating lesbian, gay, bisexual, and queer + patients. Fewer nonclinicians than clinicians thought that gender identity, sexual orientation, and sex assigned at birth were important to provide the best care (P < .05). The open comments section identified key themes, including the belief that current educational tools are not helpful, desire for more educational formats (lectures, case-based learning, seminars), and an overall interest in SGM health education.
Conclusions
Most staff feel comfortable in treating SGM patients but are less confident in the distinct needs of this population. Knowledge gaps persist for both clinicians and nonclinicians, indicating a need for further training specific to oncology care.
... 17 This disparity may be due in part to a lack of knowledge, skill, and overall competence on the part of cancer care providers to work with SGM populations. 18 The majority of oncologists report that they lack sufficient knowledge to treat SGM patients competently, and this lack of knowledge is especially pronounced for gender minority and transgender patients. 19,20 In addition, both patient and physician attitudes can impact the quality of care received by SGM cancer patients. ...
Background
Few studies have attempted to characterize the cancer care experiences and outcomes of sexual and gender minority (SGM) patients with cancer, despite indications that this population experiences disparities across the cancer continuum. The current study used descriptive and exploratory methods to assess factors related to SGM cancer patients’ satisfaction with cancer care and self‐reported physical and mental health.
Methods
The authors designed a cross‐sectional self‐report online survey and recruited 3750 SGM cancer patient participants (mixed cancers; 85.6% White; 57% gay, 24% lesbian, 6.7% bisexual, and 6.2% transgender/gender nonbinary) using social media posts, partner organizations, and paid advertisements. They analyzed data using descriptive approaches and exploratory multivariate logistic regression models.
Results
Overall, 70.6% of participants reported feeling satisfied with the cancer care they received, 70% rated their physical health as very good or excellent, and 46% reported experiencing less than 5 days of poor mental health in the last month. In models including all participants, complete cases, and Black, Indigenous, and people of color (BIPOC), satisfaction with care was consistently associated with receiving treatment in an SGM welcoming environment. Physical health was consistently associated with having strong social support after cancer. Mental health was consistently associated with feeling safe disclosing SGM identities.
Conclusions
SGM cancer patients treated in SGM‐welcoming environments were over six times more likely to be satisfied with the care they received than those treated in nonwelcoming environments; this and other modifiable factors could be the target of further study and intervention.
... Disparities in SGM health outcomes are due in part to inadequate training [9][10][11][12] and thus inadequate competence of physicians in SGM health topics [3,[13][14][15]. The competence of healthcare providers to provide care to SGM patients has been studied, with healthcare providers self-reporting competence ranging from 19.8-94% [10,14,[16][17][18][19][20] and assessments demonstrating competence ranging from 24-67% [17,[20][21][22][23]. Several studies found that physicians do not routinely assess sexual history during general patient encounters, [19] in part due to fear of offending their patients, [24] and as a result, questions related to gender identity, sexual orientation, and sexual behavior are often left unaddressed [19,25] Transgender patients in particular report that the largest barrier to healthcare access is a shortage of healthcare providers who are knowledgeable about transgender medicine [26,27]. In addition to lack of preparation to care for SGM patients, [22,28,29] many physicians also exhibit beliefs and behaviors that stigmatize SGM individuals [30,31]. ...
... Disparities in SGM health outcomes are due in part to inadequate training [9][10][11][12] and thus inadequate competence of physicians in SGM health topics [3,[13][14][15]. The competence of healthcare providers to provide care to SGM patients has been studied, with healthcare providers self-reporting competence ranging from 19.8-94% [10,14,[16][17][18][19][20] and assessments demonstrating competence ranging from 24-67% [17,[20][21][22][23]. Several studies found that physicians do not routinely assess sexual history during general patient encounters, [19] in part due to fear of offending their patients, [24] and as a result, questions related to gender identity, sexual orientation, and sexual behavior are often left unaddressed [19,25] Transgender patients in particular report that the largest barrier to healthcare access is a shortage of healthcare providers who are knowledgeable about transgender medicine [26,27]. ...
Background
Despite changes in social attitudes in the United States over the last decade, sexual and gender minority (SGM) individuals continue to face significant health disparities, driven partly by disproportionately higher rates of self-reported discrimination and harassment when seeking healthcare. Historically, physicians have received little to no required training on how to provide sensitive, competent care to SGM patients, and continue to demonstrate poor competency with SGM topics despite calls for increased education and published guidelines to promote competency. The present study aimed to investigate competency with SGM topics among both faculty and medical students at one institution.
Methods
The authors distributed an anonymous online survey (2020–2021) to medical students and student-facing faculty at one allopathic medical school in the United States. The objective of the study was to evaluate knowledge, clinical skills, and self-reported competence with SGM topics.
Results
Of survey respondents, 223 medical students and 111 faculty were included in final analysis. On average, medical students were significantly more likely to answer General Knowledge questions correctly (97.2%) compared to faculty (89.9%). There were no significant differences in responses to Clinical Knowledge questions between medical students and faculty. however medical students were significantly more likely to report competence with eliciting a thorough sexual history, and faculty were significantly more likely to report receiving adequate clinical training and supervision to work with lesbian, gay, and bisexual patients.
Conclusions
Medical students demonstrated significantly higher general knowledge about SGM topics compared to faculty. Medical students and faculty demonstrated similarly low average clinical knowledge, with percent correct 65.6% for students and 62.7% for faculty. Despite significant differences in general knowledge and low clinical knowledge, medical students and faculty self-reported similar levels of competence with these topics. This indicates insufficient curricular preparation to achieve the AAMC competencies necessary to care for SGM patients.
... There are a number of reasons for disparities across both sexual orientation and gender identity. SGM individuals may fear accessing care due to previous discriminatory experiences in healthcare settings [1,14,15] and a lack of available SGM-knowledgeable and/or affirming providers [1,6,[16][17][18]. In addition, not disclosing one's identity to primary care providers is associated with reduced screening uptake [19] and delayed care [20]. ...
The purpose of this study was to explore healthcare experiences of Black and White sexual and gender minority (SGM) cancer survivors across the cancer care continuum.
This was a qualitative analysis of two focus groups and eight individual interviews completed as part of a larger initiative using a community-engaged research approach to reduce cancer disparities in marginalized communities. There was a total of 16 participants in the study (9 were White, 7 were Black) and data were collected between 2019 and 2020.
Three main themes emerged from the thematic analysis: strategically coming out, provider preferences, and health system challenges. Participants noted that they often came out through their support system, decided to come out based on the relevance of their SGM identity that they perceived, and expressed a desire for privacy. Lack of an accessible and competent PCP was tied to delayed cancer diagnosis and many participants voiced a preference for consistency when they found a provider they liked.
Providers across specialties can address barriers for SGM patients by not making assumptions about patient sexual orientation or gender identity. Institutions should systematically collect sexual orientation and gender identity information. Primary care providers should be aware that due to resistance to switching from trusted providers, they may need to take greater initiative to facilitate cancer screenings for their patients when appropriate or take special care when making referrals to ensure they are using SGM-affirming providers.
SGM cancer survivors often benefit from a cultivating relationship with a trusted PCP or other provider.
... Health professionals desire more training to address the distinct needs of LGBTQ + individuals, with most concurring that such training must be mandatory [21][22][23][24]. However, content and competencies in LGBTQ + health and well-being have not been broadly integrated in health science curricula [25][26][27], even though national health professional associations, including the American Medical Association [28] and American Nurses Association [29] have advocated for improved training for health professionals to ensure clinically and culturally appropriate care for LGBTQ + patients. ...
Background:
Health disparities experienced by LGBTQ + individuals have been partially attributed to health professionals’ lack of cultural competence to work with them. Cultural competence, the intricate integration of knowledge, skills, attitudes, and behaviors that improve cross-cultural communication and interpersonal relationships, has been used as a training framework to enhance interactions between LGBTQ + patients and health professionals. Despite multiple published LGBTQ + cultural competency trainings, there has been no quantitative appraisal and synthesis of them. This systematic review assessed articles evaluating the design and effectiveness of these trainings and examined the magnitude of their effect on cultural competence outcomes.
Methods:
Included studies quantitatively examined the effectiveness of LGBTQ + cultural competency trainings for health professionals across all disciplines in various healthcare settings. 2,069 citations were retrieved from five electronic databases with 44 articles meeting inclusion criteria. The risk of bias in the included studies was assessed by two authors utilizing the Joanna Briggs Institute critical appraisal checklists. Data extracted included study design, country/region, sample characteristic, training setting, theoretical framework, training topic, modality, duration, trainer, training target, measurement instrument, effect size and key findings. This review followed the PRISMA statement and checklist to ensure proper reporting.
Results:
75% of the studies were published between 2017 and 2023. Four study designs were used: randomized controlled trial (n = 1), quasi-experimental pretest–posttest without control (n = 39), posttest only with control (n = 1) and posttest only without control (n = 3). Training modalities were multiple modalities with (n = 9) and without simulation (n = 25); single modality with simulation (n = 1); and with didactic lectures (n = 9). Trainings averaged 3.2 h. Ten studies employed LGBTQ + trainers. The training sessions resulted in statistically significant improvements in the following cultural competence constructs: (1) knowledge of LGBTQ + culture and health (n = 28, effect size range = 0.28 – 1.49), (2) skills to work with LGBTQ + clients (n = 8, effect size range = 0.12 – 1.12), (3) attitudes toward LGBTQ + individuals (n = 14, effect size range = 0.19 – 1.03), and (4) behaviors toward LGBTQ + affirming practices (n = 7, effect size range = 0.51 – 1.11).
Conclusions:
The findings of this review highlight the potential of LGBTQ + cultural competency training to enhance cultural competence constructs, including (1) knowledge of LGBTQ + culture and health, (2) skills to work with LGBTQ + clients, (3) attitudes toward LGBTQ + individuals, and (4) behaviors toward LGBTQ + affirming practices, through an interdisciplinary and multi-modal approach. Despite the promising results of LGBTQ + cultural competency training in improving health professionals’ cultural competence, there are limitations in study designs, sample sizes, theoretical framing, and the absence of longitudinal assessments and patient-reported outcomes, which call for more rigorous research. Moreover, the increasing number of state and federal policies that restrict LGBTQ + health services highlight the urgency of equipping health professionals with culturally responsive training. Organizations and health systems must prioritize organizational-level changes that support LGBTQ + inclusive practices to provide access to safe and affirming healthcare services for LGBTQ + individuals.
... 28,29 Survey items were modified from the National Oncologists Survey conducted by our group. [30][31][32] As participants were medical students, wording was changed to "participate in the care of" versus "provide care for" patients. Some questions were asked for each specific LGBTQ population. ...
... Using similar metrics, prior studies from our group conducted with oncologists and advanced practice professionals (APPs) also found a generally positive attitude toward LGBTQ persons. 30,31 Although analyses were not conducted comparing these groups with students, it is worth noting that students indicated higher comfort with LGBTQ persons than other healthcare professionals. 30,34,35 An important difference to note from our previous work is that this study separated the identities within the LGBTQ community into different questions, providing a more detailed assessment of respondents' comfort levels caring for subpopulations. ...
... 30,34,35 An important difference to note from our previous work is that this study separated the identities within the LGBTQ community into different questions, providing a more detailed assessment of respondents' comfort levels caring for subpopulations. [30][31][32] Fewer students expressed comfort for all questions involving transgender and non-binary patients. Although most students agreed with general statements concerning their comfort in treating LGBTQ persons, when asked specifically about comfort in discussing preventative, sexual, reproductive, and gender affirming health needs, fewer students agreed with the statements. ...
Background:
The lesbian, gay, bisexual, transgender, and queer/questioning (LGBTQ) community experiences health disparities. It is thus imperative that medical trainees receive training in the care of LGBTQ community. The objective of this study was to identify gaps in knowledge and comfort among medical school students in providing care for the LGBTQ community.
Methods:
An online survey was administered to medical students at 3 institutions in the United States from December 2020 to March 2021. Using a Likert scale, the survey assessed attitudes, comfort, and knowledge in providing care for the LGBTQ community. The survey included questions for each specific LGBTQ population. Results were quantified using descriptive and stratified analyses, and an exploratory factor analysis was used to calculate attitude summary measure (ASM) scores. A total knowledge score was calculated, with higher values indicating greater knowledge.
Results:
Among the 300 medical students who completed the survey, the majority were female (55.7%), White (54.7%), and heterosexual (64.3%). The majority of medical students felt comfortable (strongly agree/agree) participating in the care of lesbian (94.3%), gay (96.0%), and bisexual (96.3%) patients; this percentage dropped to 82.3% for non-binary and 71.3% for transgender patients. Only 27.0% of medical students reported confidence in their knowledge of health needs of transgender patients. LGBTQ self-identification, percent of core rotations completed in school, region of country, and friends and/or family who are part of the LGBTQ community were significantly associated with various ASM scores. Knowledge questions yielded high percentages of "neutral" responses, and medical students who identified as LGBTQ had significantly higher total knowledge scores.
Conclusions:
Overall, the surveyed medical students feel comfortable and willing to provide care for LGBTQ persons. But, there is limited knowledge about specific LGBTQ health needs. More education and training in the needs of transgender and non-binary patients, in particular, is indicated.
... It involves pleasurable tactile sensations, affection, and love arising from marital, fraternal, or friendly relationships. Sexuality is expressed according to historical, sociocultural, familial, and subjective contexts [19,25,26]. ...
... LGBT cultural competence requires dynamics and multilevel systemic change that includes provider education, physical body care, environment, administration acceptance, and inclusion of LGBT community voices through outreach and with a diverse team Schabath et al., 2019 USA [25] Health professionals with specific knowledge on understanding LGBTQIA + issues improve the quality of care. As noted in this study, there was great interest in receiving education about LGBTQIA + health needs and greater confidence in the ability of well-trained providers to treat these patients Shetty et al., 2016. ...
Background
When individuals in the SGM group are diagnosed with cancer and undergo treatment, they experience changes in physical, mental, sexual and spiritual dimensions, which can negatively impact sexual desire, as well as satisfaction and sexual health as a whole. This study aims to examine the existing scientific literature on how healthcare professionals approach sexuality in cancer patients who belong to the SGM group. The SGM group is particularly vulnerable, and the challenges they face in terms of psychosocial and emotional health are further exacerbated by the oncological treatment they receive. Therefore, specialized attention and support are necessary to address their unique needs.
Method
To conduct this study, a scoping review was performed following the guidelines established by the Joanna Briggs Institute. By synthesizing the available evidence, this study aims to provide insights and recommendations for healthcare professionals to improve the care and support provided to SGM individuals with cancer. Guiding question: “how do health professionals approach sexuality in cancer patients in a minority group?”. The search was carried out in PubMed, Science Direct, Scopus, Web of Science, Virtual Health Library, Embase databases and Google Scholar in addition. Specific criteria were used for Evidence source selection, Data mapping, assurance, analysis, and presentation.
Results
Fourteen publications were included in this review for the final synthesis, which indicated that the approach to the sexuality of sexual and gender minority groups is based on research whose character is limited in terms of producing care and health care that is congruent in gender and sexuality. The analysis of scientific articles showed that one of the biggest challenges and priorities of health services today is to reduce disparities and promote equity in health for SGM people.
Conclusions
This study reveals a significant gap in addressing the sexuality of SGM groups within cancer care. Inadequate research impedes the provision of consistent and inclusive care for SGM individuals, which has a negative impact on their overall wellbeing. Reducing disparities and promoting healthcare equity for SGM individuals must be a top priority for health services.
