Optimizing patient-centered, inclusive care in oncology: Healthcare professionals' knowledge, attitudes, and practices in caring for LGBTQ2+ individuals

Abstract

Background The sexual and gender diverse community of lesbian, gay, bisexual, transgender, queer/questioning, two-Spirit, plus (LGBTQ2+) patients experience cancer-related health disparities and inequities compared to heterosexual and cisgender patients. Our objective was to examine healthcare professional (HCP) knowledge, attitudes, practices, and education interest when caring for LGBTQ2+ patients with cancer, and identify gaps and opportunities to improve care. Methods A 38-item online survey was sent to all Gynecologic oncology staff (n=92) within a tertiary care cancer centre in Toronto. Items included respondent demographics (n=7), and LGBTQ2+ knowledge (n=7), attitudes (n=15), practice behaviours (n=5), education interest (n=1), and open comments (n=3). Descriptive statistics summarized survey responses. Fisher's exact test was used to assess interactions between demographics and survey responses. Thematic analysis was used to analyze open-ended questions. Results 75/92 (82%) HCPs completed the survey. Although most respondents felt comfortable (96% strongly agree/agree) treating LGBQ2+ patients, only 45% felt knowledgeable about their specific health needs. In comparison, staff reported less comfort (87%) and knowledge (27%) caring for transgender patients. Respondents believed it is important to know a patient's sexual orientation (58%) and gender identity (41%); however, significantly less felt comfortable inquiring (sexual orientation 41%, p=0.023 and gender identity 36%, p<0.001). LGBTQ2+ health-related knowledge items yielded responses of "neutral" and "not sure" ranging from 19-73% and most were "not sure" about institutional practices regarding collecting patient sexual orientation (61%), sex assigned at birth (52%) and gender identity (60%). Almost all (96% strongly agreed/agreed) were interested in receiving LGBTQ2+ specific education. Age, having friends/family who identify as LGBTQ2+ and non-white race were found to have some influence on attitudes. Thematic analysis of open-comments identified two main themes: (i) HCPs are concerned of offending LGBTQ2+ individuals because of their lack of knowledge and experience, and (ii) HCPs desire LGBTQ2+-specific health training and the creation of inclusive environments. Conclusions Although HCPs report feeling comfortable caring for LGBTQ2+ individuals, most report a lack of knowledge and awareness in caring for this population. We recommend institutions implement cultural competency training for HCPs to improve high quality and inclusive patient-centered care for LGBTQ2+ patients and their caregivers. The sexual and gender diverse community of lesbian, gay, bisexual, transgender, queer/questioning, two-Spirit, plus (LGBTQ2+) patients experience cancer-related health disparities and inequities compared to heterosexual and cisgender patients. Our objective was to examine healthcare professional (HCP) knowledge, attitudes, practices, and education interest when caring for LGBTQ2+ patients with cancer, and identify gaps and opportunities to improve care. A 38-item online survey was sent to all Gynecologic oncology staff (n=92) within a tertiary care cancer centre in Toronto. Items included respondent demographics (n=7), and LGBTQ2+ knowledge (n=7), attitudes (n=15), practice behaviours (n=5), education interest (n=1), and open comments (n=3). Descriptive statistics summarized survey responses. Fisher's exact test was used to assess interactions between demographics and survey responses. Thematic analysis was used to analyze open-ended questions. 75/92 (82%) HCPs completed the survey. Although most respondents felt comfortable (96% strongly agree/agree) treating LGBQ2+ patients, only 45% felt knowledgeable about their specific health needs. In comparison, staff reported less comfort (87%) and knowledge (27%) caring for transgender patients. Respondents believed it is important to know a patient's sexual orientation (58%) and gender identity (41%); however, significantly less felt comfortable inquiring (sexual orientation 41%, p=0.023 and gender identity 36%, p<0.001). LGBTQ2+ health-related knowledge items yielded responses of "neutral" and "not sure" ranging from 19-73% and most were "not sure" about institutional practices regarding collecting patient sexual orientation (61%), sex assigned at birth (52%) and gender identity (60%). Almost all (96% strongly agreed/agreed) were interested in receiving LGBTQ2+ specific education. Age, having friends/family who identify as LGBTQ2+ and non-white race were found to have some influence on attitudes. Thematic analysis of open-comments identified two main themes: (i) HCPs are concerned of offending LGBTQ2+ individuals because of their lack of knowledge and experience, and (ii) HCPs desire LGBTQ2+-specific health training and the creation of inclusive environments. Although HCPs report feeling comfortable caring for LGBTQ2+ individuals, most report a lack of knowledge and awareness in caring for this population. We recommend institutions implement cultural competency training for HCPs to improve high quality and inclusive patient-centered care for LGBTQ2+ patients and their caregivers.