Responding to narrowing discrimination protections: Can hospital policies protect transgender and gender diverse patients with cancer?

Abstract

e14126 Background: The U.S. Department of Health and Human Services recently proposed to eliminate federal protections against discrimination in healthcare on the basis of gender identity. This proposal seeks to alter the Patient Protection and Affordable Care Act Section 1557 Rule, which currently prohibits sex discrimination in any health program receiving federal financial assistance. The provisional change poses imminent threats to transgender and gender diverse (TGD) communities who face discrimination in healthcare, and in cancer care specifically. If current federal protections are eliminated, enacting local non-discrimination policies may safeguard TGD individuals’ rights to access safe equitable cancer care. To determine the need for local policy change, we sought to assess the current protections based on gender identity and expression for patients at National Cancer Institute (NCI)-Designated Cancer Centers. Methods: Publicly available hospital non-discrimination policies and Patients’ Bill of Rights were examined from the main affiliated hospitals of each of the 62 NCI-Designated Cancer Centers, excluding laboratories. The policies were classified as clearly including gender identity and expression or not. McNemar’s Test calculated differences between non-discrimination policies and Patient’ Bill of Rights. Results: Of 62 institutions, 30 (48.4%) clearly included gender identity and expression in their hospital non-discrimination policies, whereas 45 (72.6%) included gender identity and expression in their Patients’ Bill of Rights ( p= 0.014). Thirty-seven (59.7%) institutions included gender identity and expression in only one of the documents (Table). Conclusions: NCI-Designated Cancer Centers do not consistently include gender identity and expression in publicly available non-discrimination documents. The discrepancy between Patients’ Bill of Rights documents and hospital non-discrimination policies suggests a difference between what institutions outwardly convey to patients and what they operationalize in their legal documents. Paired outcomes from 62 independent NCI-Designated Cancer Centers. [Table: see text]