Levelling the odds of LGBTIQ+ asylum seekers: the interaction of legal representation and credibility in asylum appeals in Switzerland

Comparing Ways to Ask Patients about Sexual Orientation and Gender Identity in the Emergency Room—The EQUALITY Study

LGBTQ cultural competence for pharmacists

This study investigates the sexual and gender discrimination experienced by sexual orientation and gender identity (SOGI) asylum seekers in claiming refugee status in Canada. The author conducts a literature review of critiques of the refugee determination process in Canada, and reviews reports from service providers helping SOGI asylum seekers in Toronto. Historically, Canada has demonstrated an understanding that is ahead of the curve for LGBTQI refugees; however, much has changed under the current Conservative Government, led by Prime Minister Stephen Harper. Changes to the refugee determination system through the passing of Bill C-31 (2012) have made the situation for SOGI refugees particularly precarious. The designation of so-called “safe” countries of origin, as outlined in Bill C-31, shortens the time allotted to submit an application for asylum, making it more difficult to gather and prepare the documentation required for a successful case. The author pays particular attention to South Africa, as it is considered to be Africa’s gay haven. As a gender-queer person of colour pursuing hir Bachelor of Social Work at York University, the author describes the unique needs of lesbian, gay, bisexual, trans, queer, and intersexed (LGBTQI) refugee claimants. This study demonstrates the need for efficient and effective social services to meet the needs of SOGI claimants, needs that will surely increase due to changes to Canada’s Immigration and Refugee Act incurred with the passing of Bill C-31.

Improving Sexual Orientation and Gender Identity Documentation at an NCI-Designated Comprehensive Cancer Center

Changing language, changes lives: Learning the lexicon of LGBTQ+ health equity.

Wide-spread collection of sexual orientation and gender identity (SOGI) data has been a barrier to conduct of research to identify disparities and inequitable cancer care among sexual and gender minority (SGM) populations. Additionally, lack of SOGI data in electronic health records (EHR) renders clinical care teams unable to integrate such information into appropriate and tailored care and treatment plans and may delay the establishment of respectful, affirming, and knowledgeable relationships between patients and their cancer care teams, and the institutions in which they receive health care. The absence of SOGI data in EHRs also prevents the identification of individuals from SGM groups for inclusion into clinical trials to improve and strengthen the evidence-base for clinical treatment of cancer, from prevention through survivorship. Despite many organizations urging improvement in evidence-based cancer care for SGM populations, satisfactory progress has not yet been achieved in part attributed to the lack of widespread SOGI collection in medical records. As a first step in identifying and remedying real-world disparities and inequity among SGM populations, the H. Lee Moffitt Cancer Center & Research Institute (Tampa, FL) began collecting sexual orientation in 2016 and gender identity in 2017 as standard-of-care demographic items for all new patients. Moffitt Cancer Center is one of the first NCI-Designated Cancer Centers to collect SOGI as standard-of-care demographics for all patients. All new patients are required to complete the web-based electronic patient questionnaire prior (EPQ) to, or on the day of, their first visit. EPQ data are integrated into the EHR, and available at the point of care. To date, SOGI demographics have been collected on over 150,000 patients and ~3.5% of our patient population are self-identified as a SGM. Leveraging this valuable and largely unique data resource among NCI-Designated Cancer Centers, we have already identified real-world disparities and inequity among SGM persons with cancer. Additional research is underway to address issues related to intersectionality and to identify barriers to improve SOGI disclosure. In this session, we will present our approach to implement institutional-side SOGI collection and dispel myths about the difficulties and barriers to implementing SOGI data collection. Citation Format: Matthew B. Schabath. Sexual orientation and gender identity (SOGI) collection: Experiences at an NCI-Designated Cancer Center [abstract]. In: Proceedings of the 16th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2023 Sep 29-Oct 2;Orlando, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2023;32(12 Suppl):Abstract nr IA018.

170 Background: Despite recommendations from numerous clinical bodies (e.g., ASCO), less than 20% of NCORP-affiliated practices regularly collect SOGI data. This gap compromises the ability to identify and correct care inequities experienced by sexual and gender minority (SGM) individuals. Therefore, we evaluated provider- and clinic- level barriers and facilitators to SOGI collection at NCORP practices across the US. Methods: We conducted 14 interviews across seven NCORP oncology practices via Zoom. We purposefully sampled to ensure geographic, racial, and ethnic diversity of patient populations. We interviewed one clinician (oncologist, advanced practice provider) and one clinic staff member per practice. The Consolidated Framework for Implementation Research (CFIR) informed thematic analysis that identified barriers and facilitators to SOGI data collection. Interviews were recorded, transcribed, and coded by two coders who adjudicated any discordance. Analyses were conducted in NVivo. Results: Thematic saturation occurred after interviews at six practices, with interviews at the seventh practice confirming saturation. Participants represented five geographic regions and included three Minority Underserved practices and two rural practices. Several organizational context characteristics influenced SOGI data collection: access to knowledge, information technology infrastructure, staff processes, and perceived relative priority of SOGI for an oncology visit. All oncologists expressed a low relative priority of sexual orientation data for oncology care. Gender identity had higher priority because it influences how clinicians should address patients. At the clinic level, this low relative priority coincides with a lack of processes and policies for collecting SOGI from all patients. At the oncology care team level, perceived irrelevance to oncology care was related to discomfort in asking SOGI, fear of patient discomfort, and limited awareness of SOGI in electronic health records. Suggested solutions included: normalizing asking SOGI questions, giving patients privacy to complete SOGI, and clarifying relevance of SOGI for clinical purposes. Understanding how SOGI improves patient experiences was a facilitator for collection. Conclusions: Within this NCORP practice sample, SOGI data collection barriers included clinician-perceived low relative priority for collection, and perceptions that SOGI disclosure does not influence care quality, despite most interviewees expressing a strong desire to show respect to patients and provide high quality cancer care. Oncology teams may benefit from training on culturally sensitive SOGI collection, education on SOGI data relevance to oncology practices, and support for implementing SOGI data collection policies.

Background: Collection of reliable data on Sexual Orientation and Gender Identity (SOGI) is essential for improving cancer care for Sexual and Gender Minority (SGM) populations that experience health disparities. To address gaps in reliable SOGI data collection, the National Cancer Institute (NCI) funded a series of awards to enhance sexual orientation and gender identity (SOGI) data collection at cancer centers. In August 2022, we launched the “We Ask Because We Care: Enhancing Sexual Orientation and Gender Identity Data Collection in New Mexico Cancer Center” (Ask SOGI) research intervention at the University of New Mexico Comprehensive Cancer Center (UNMCCC). Methods: Our research team used a mixed methods framework that included a cancer center-wide readiness assessment survey and focus groups to: 1) identify potential barriers to the systematic collection of patient SOGI data, incorporate National Academy of Science Engineering Medicine (NASEM) recommended SOGI measures into the UNMCCC Electronic Health Records; 2) tailor future staff/provider-cultural competency/cultural humility educational interventions, and 3) design a patient-facing “We Ask Because We Care” campaign to encourage welcoming and comfortable care for SGM patients and their informal cancer caregivers. Results: Although the study is on-going, initial survey findings suggest that staff and provider concerns regarding the appropriate method and time for asking patients about their SOGI may inhibit data collection at the cancer center. Respondents desired cancer center led education and training for staff and faculty that would include appropriate points and methods for SOGI data collection, demonstrations of SOGI integration and utilization into the electronic health record, and strategies to encourage conversational confidence so staff and providers can engage patients and their caregivers in sensitive topics. Moreover, SGM patients and caregiver focus group participant reviewers of the emerging “We Ask Because We Care” campaign were positive about the visual images, and acknowledged the importance of such efforts for creating affirmative spaces for SGM persons experiencing cancer. Conclusion: Interventions that address multilevel staff and provider, as well as patient and caregiver concerns regarding discussions of sexual orientation and gender identity data collection may increase more consistent collection of SOGI data that can be used to enhance cancer care and health disparities research. Citation Format: Miria Kano, Dolores Guest, Amy Farnbach Pearson, Mikaela Kosich, Kendal A. Jacobson, Shiraz Mishra, Andrew Sussman, Bernard Tawfik, Zoneddy Dayao, NFN Scout, Cathleen Willging. Best practice strategies for SOGI data collection: Lessons learned from conducting and implementing the Ask SOGI study [abstract]. In: Proceedings of the 16th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2023 Sep 29-Oct 2;Orlando, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2023;32(12 Suppl):Abstract nr IA016.

Purpose This study investigated Korean healthcare providers’ attitudes toward sexual and gender minority (SGM) persons and their knowledge and behavior concerning the collection of data on sexual orientation and gender identity (SO/GI). Methods In this cross-sectional, descriptive study, 137 Korean healthcare providers were recruited through convenience sampling from internet communities for medical professionals. A structured questionnaire was created using Google Surveys. The Mann-Whitney U-test, Kruskal-Wallis test, and Spearman correlation analysis were performed.ResultsThe sample was mostly women (80.3%) and nurses (83.9%), who overall negative attitudes toward SGM persons and low levels of knowledge and behavior with regard to the collection of patients’ SO/GI data. Participants in their 20s, who were religious, and had clinical experiences in treating or providing nursing care for SGM persons had higher levels of knowledge about the collection of SO/GI data. The level of engagement in collecting SO/GI data was higher among women and in their 20s and 30s, unreligious participants, nurses, and those with less than 10 years of clinical experience. Positive attitudes toward SGM persons were associated with higher levels of knowledge, but lower levels of behavior, regarding the collection of SO/GI data.Conclusion It is important to recognize the diversity of patients’ SO/GI and to collect the corresponding information. To this end, it is necessary to develop and use a standardized SO/GI form. Healthcare providers should also receive education and training related to the health of SGM persons to resolve health problems that disproportionately affect SGM persons and related health disparities.

Introduction The inclusion of sexual orientation and gender identity measurements in national epidemiological surveys allows for the assessment of sleep disparities among sexual and gender minorities. Our objective is to establish the association of sexual orientation and gender identity with sleep duration. Methods We used 2020 Behavioral Risk Factor Surveillance System data from 33 states who included the sexual orientation and gender identity (SOGI) optional module in their questionnaires. The outcome variable is sleep duration (≤4 hours, 5, 6, 7, 8, 9, and ≥10 hours). Main predictors are sexual orientation (heterosexual, gay/lesbian, bisexual, and other) and gender identity (cisgender, trans woman, trans man, and trans gender non-conforming). We estimated multinomial logistic regression models due to the categorical nature of our outcome variable using Stata 17. We estimated models using sexual orientation alone as main predictor, gender identity alone, and then a combined model with both SOGI measures, and adjusted for sociodemographic characteristics and physical and mental health. Results Of the complete sample, 92% reported being heterosexual, 2% gay/lesbian, 3% bisexual, and 3% other sexual orientations. In addition, 99% reported being cisgender, and 0.2% reported being trans woman, trans man, and trans gender non-conforming, respectively. In the fully adjusted sexual orientation models, identifying as gay/lesbian was associated with a 27% increased likelihood of sleeping 8 hours and 71% increased likelihood of sleeping 10+ hours compared to heterosexuals. Self-identifying as bisexual and other orientations is associated with an 86% and 52% increased likelihood of sleeping 10+ hours, respectively. In the fully adjusted gender identity models, trans women were 115% more likely to report 8 hours of sleep, 122% more likely to report 9 hours of sleep, and 223% more likely to report 10+ hours of sleep. In the combined fully adjusted model, self-identifying as gay/lesbian, bisexual, or other orientations is associated with a 68%, 84%, and 63% increased likelihood of sleeping 10+ hours. Trans women are 149% more likely to report 10+ hours of sleep. Conclusion Based on our empirical analyses, being a sexual and/or gender minority is associated with a greater likelihood of reporting 10+ hours of sleep. Support (if any)

Using sexual orientation and gender identity data in electronic health records to assess for disparities in preventive health screening services

As healthcare settings are increasingly adding sexual orientation and gender identity (SO/GI) to routinely collected patient demographic information, it is important to understand how patients conceptualize and label these identities. This study explored university students' perspectives on and experiences with choosing SO/GI labels in the healthcare setting. We employed a mixed-method approach, collecting survey data on self-identified SO/GI labels across various contexts and conducting focus groups centered around experiences of SO/GI data collection and labeling in healthcare. Thirty-four graduate and undergraduate university students completed the survey and participated in six one-time focus groups. While many participants indicated that their self-identified SO/GI labels were consistent across contexts/relationships, 47% indicated that they used different labels to describe their SO or GI depending on the context. The focus group discussions revealed ways in which participants struggled to label their SO/GI on forms: They reported that (1) their authentic SO/GI labels were not among the commonly listed labels or (2) they felt that labeling their SO/GI identities was problematic. Participants reported that choosing a label that did not fit their lived experience was not only inaccurate, but could also feel painful and alienating. These findings hold implications for the collection and interpretation of patient SO/GI information, both for epidemiological purposes and for patient-centered care.

<p>目的</p> <p>探究病歷搜集性傾向與性別認同資料(sexual orientation and gender identity, SOGI)，在臺灣醫療場域的可接受性和可行性，與其對減低健康不平等和增進醫療品質的意義。</p> <p>材料與方法</p> <p>使用量性別結構式問卷，對醫學中心的門診300位病人進行SOGI問卷調查及分析。</p> <p>結果</p> <p>問卷信度Cronbach’α為0.835，具有高信度。病人與醫事人員對SOGI之接受度，包括：明白SOGI登錄的意義、理解題項的意思、填答意願、揭露SOGI的樂意度、醫院搜集SOGI執行容易度與病歷搜集SOGI對病人的重要性六方面。病人同意情形大致與醫事人員類似，落在80%至90%區間，唯樂意程度則有不同，病人與醫事人員分別為26.7%與4.1%。</p> <p>結論</p> <p>搜集病人SOGI資料具有可行性，且病人與醫事人員的看法一致。中文版SOGI量表能作為搜集、探究與擬定消弭性別不平等策略之工具。</p> <p> </p><p>Objective</p> <p>To explore the acceptability and feasibility of collecting sexual orientation and gender identity (SOGI) data in medical settings in Taiwan and evaluate the importance of these data in reducing health inequalities and enhancing medical quality.</p> <p>Materials and Methods</p> <p>A quantitative, structured SOGI survey was administered to 300 outpatients at a medical center in Taiwan.</p> <p>Results</p> <p>The questionnaire exhibited high reliability, with a Cronbach’s α of 0.835. The degree of acceptance of SOGI among patients, including the understanding of the meaning of SOGI medical records, the understanding of the questions, the willingness to complete the questionnaire, the readiness to disclose one’s own SOGI, the perceived ease of collecting SOGI data in hospitals, and the emphasis placed on the collection of SOGI data for doctors to understand their patients, was similar to that of medical staff, ranging from 80% to 90%. However, differences were observed in readiness, with 26.7% of the patients and only 4.1% of the medical staff being willing to disclose their SOGI.</p> <p>Conclusion</p> <p>Collecting SOGI data is viewed as a feasible approach by both patients and medical staff. The Chinese version of the SOGI scale can be used to collect data and formulate strategies aimed at eliminating gender inequalities.</p> <p> </p>

Although systematic collection of sexual orientation and gender identity (SOGI) data is essential for identifying and addressing disparities-and has been associated with improved survivorship outcomes-its implementation in oncology care remains limited. Recognizing clinic time and staff barriers, we piloted a multicomponent implementation strategy centered on collecting SOGI data through an online patient portal and evaluated its feasibility, acceptability, and effectiveness. This SOGI strategy, previously developed with input from national stakeholders, included (1) assignment of SOGI questions to all patients via MyChart, with follow-up in clinic as needed; (2) staff training for SOGI understanding, patient respect, and safety; (3) a script for asking patients about their SOGI; and (4) a clinic champion. We piloted the strategy at 3 outpatient adult cancer clinics for a total of 6 months. We conducted an evaluation that included preimplementation clinic staff surveys, patient surveys and interviews (after patients were asked about their SOGI), and postimplementation staff surveys and interviews. We evaluated SOGI collection rates for the study period using EPIC Clarity data. SOGI data were collected from 71% (n=1,410) of patients, and 94% of responses were collected on MyChart before clinic. The training helped 40% of surveyed staff (n=4) feel more comfortable asking about SOGI; however, staff interviewed (n=6) reported not attending the entire training. This likely contributed to their reported fear of patient reactions and lack of understanding that they were expected to ensure SOGI was documented for all patients. Of the 98 patient survey respondents (33% response rate), 69% reported that it was important for their provider to know their SOGI. In interviews (n=17), patients described MyChart as an acceptable and private method for collecting SOGI information. The MyChart-driven strategy for SOGI data collection was efficient, effective, feasible, and acceptable for collecting this information from most patients. Future work will focus on refining and reformatting staff training to ensure respectful SPGI data collection and on capturing information from patients who did not previously respond.

The federal government and other organizations have recommended that healthcare institutions collect and document patient sexual orientation and gender identity (SO/GI) information in order to advance the understanding of the health of sexual and gender minority populations and to combat existing health disparities. Little is known, however, about provider perception of the clinical relevance of, or how they might use, patient SO/GI information in individual care. To explore providers' perspectives on and experiences with collection of patient SO/GI information and how the knowledge of this information may impact clinical care. Qualitative study using in-depth individual interviews of healthcare providers. Twenty-five healthcare providers, including physicians, physician assistants, and nurse practitioners, from the fields of family medicine, internal medicine, gynecology, and urology within a single healthcare system in an east coast city. Interviews were recorded and transcribed verbatim. Transcripts were coded and analyzed using principles of grounded theory and thematic analysis to identify themes emerging from the data. Providers recognized the importance of collecting patient SO/GI information for understanding population-level public health concerns and disparities, as well as understanding and respecting the context of patients' lives. However, providers also emphasized the importance of knowing patients' sexual behaviors and physical anatomy for addressing health risk and preventive care needs-and noted the distinction between these characteristics and patient SO/GI. Providers cautioned that assumptions based on knowledge of patient SO/GI may unintentionally obscure accurate profiles of patient behavior and anatomy. Along with the potential benefits of routine collection of patient SO/GI, it is important that providers continue to inquire about patient behaviors and anatomy to inform individual risk and needs assessments. Findings from this study can inform the development of guidelines, trainings, and practices for incorporation of patient SO/GI along with existing assessment practices to improve individual and population health.