Oncology Clinician Attitudes Regarding Sexual Minorities: A National Study of Anti-Gay Bias

Abstract

Background: Sexual and gender minorities experience health care access barriers, discrimination, and denial of care that result in poorer health outcomes. This is the first study to examine oncology provider anti-gay bias in a national sample in any country. Methods: U.S. cancer care professionals (n=404) were surveyed to determine whether level of cultural training had an impact on degree of anti-gay bias as measured through the Index of Attitudes on Homosexuality (IAH). Based on statistically significant independent variables, a 2x3 factorial between-groups ANOVA was conducted to examine mean differences between sex assigned at birth (male v. female) and level of cultural training (low v. medium v. high) on IAH composite and component (Avoidance, Approach, Acceptance) scores. Post-hoc tests examined all pairwise comparisons. Interaction effects were examined prior to main effects. Findings: Females reported less anti-gay bias than males as measured by IAH composite scores (F(1, 398)=25·256, p<0·001) as well as specifically on the Avoidance (F(1, 398)=39·780, p<0·001) and Approach (F(1, 398)=5·734, p=0·017) factors. High cultural training compared to low cultural training resulted in less reported bias for IAH composite (F(2, 398)=7·389, p=0·001), Avoidance (F(2, 398)=3·090, p=0·047), Approach (F(2, 398)=4·334, p=0·014), and Acceptance (F(2, 398)=8·164, p<0·001) scores. Cultural training appeared to moderate sex-based differences in the IAH overall (F(2,398)=.579, p=.561) driven by moderating the Approach factor (F(2,398)=.433, p=.649). Interpretation: Results indicate that cultural training is one strategy to potentially decrease anti-gay bias and may moderate differences by sex for Approach of oncology providers toward gay individuals; however, the small effect size (ɳp2=.021) suggests careful interpretation of findings. These data support investment in research to examine content and dosage of cultural training among diverse health care professionals. A limitation of this study is the small sample size for female physicians, male nurses, and sexual and gender minorities, and use of convenience sampling. Funding Statement: This study was made possible by the Pfizer Foundation. Opinions are those of the authors and not necessarily of Pfizer Foundation. Declaration of Interests: The authors declare no competing interests. Ethics Approval Statement: This study was approved by the Institutional Research Board at the George Washington University (#101646).