LGB Patients Research Articles

Disrespectful and inadequate palliative care to lesbian, gay, and bisexual patients.

The study aims to describe inadequate, disrespectful, and abusive palliative and hospice care received by lesbian, gay, and bisexual (LGB) patients and their spouses/partners due to their sexual orientation or gender identity. A national sample of 865 healthcare professionals recruited from palliative and hospice care professional organizations completed an online survey. Respondents were asked to describe their observations of inadequate, disrespectful, or abusive care to LGB patients and their spouses/partners. There were 15.6% who reported observing disrespectful care to LGB patients, 7.3% observed inadequate care, and 1.6% observed abusive care; 43% reported discriminatory care toward the spouses/partners. Disrespectful care to LGB patients included insensitive and judgmental attitudes and behaviors, gossip and ridicule, and disrespect of the spouse/partner. Inadequate care included denial of care; care that was delayed incomplete, or rushed; dismissive or antagonistic treatment; privacy and confidentiality violations; and dismissive treatment of the spouse/partner. These findings provide evidence of discrimination faced by LGB patients and partners while receiving care for serious illness. Hospice and palliative care programs should promote respectful, inclusive, and affirming care for the lesbian, gay, bisexual, transgender, and queer (LGBTQ) community, including policies and practices that are welcoming and supportive to both employees and patients. Staff at all levels should be trained to create safe and respectful environments for LGBTQ patients and their families.

Bisexual People Experience Worse Health Outcomes in England: Evidence from a Cross-Sectional Survey in Primary Care

ABSTRACT Persistent inequalities in relation to health outcomes continue to exist among patients identifying as lesbian, gay, and bisexual (LGB), and very little is known about outcomes specific to bisexual populations. This study’s aim was to compare the health of individuals identifying as LGB with heterosexual counterparts within primary care in England. Cross-sectional survey data from the year 10 (2015/2016) English General Practice Patient Survey (GPPS) dataset, which consisted of 836,312 responses (38.9% response rate), including 23,834 people who identified as gay, lesbian, bisexual or “other” was analyzed. Health outcomes were assessed through self-reported quality of life, physical and mental health, and confidence in managing own health. Multifactorial logistic regression (adjusting for age, ethnic group, working status, and socioeconomic status) were conducted. Long-term physical and mental health problems were more than twice as likely to be reported for people within LGB groups compared to the heterosexual group for both genders, except bisexual women where the odds were more than four times greater (OR = 4.275, 95% CI, 3.896, 4.691; p < .001). Bisexual women were half as likely to report the absence of a long-term health problem (OR = 0.452, 95% CI 0.419, 0.488; p < .001). LGB groups across both genders, reported a higher proportion of individuals that did not feel confident in managing their health and experienced significantly worse quality of life compared to heterosexuals. LGB patients consistently report poorer health outcomes than heterosexual patients. Bisexual people of both genders consistently experienced worse physical and mental health outcomes compared with the other recorded sexual orientations.

An Examination of Health Care Workers’ Education and Training on Their Basic Knowledge, Clinical Preparedness, and Attitudinal Awareness About LGBT Patients

ABSTRACT LGBT individuals experience discrimination in health care settings and report difficulty accessing clinically competent healthcare. This study examined the self-assessed knowledge, clinical preparedness, LGBT health focused education received and attitudinal awareness of health care workers (HCW) (n = 215) toward LGBT patients at an urban hospital in New York City. HCW completed a one-time survey, that included the Lesbian, Gay, Bisexual, and Transgender Development of Clinical Skills Scale. Forty percent of HCW treated LGB patients and 30% treated transgender patients, 11% and 18% reported they were unaware if their patients were LGB or transgender. Seventy-four percent of HCW received less than two hours of formal education in LGBT health. A slight majority of HCW (51%) reported not receiving adequate clinical training to work with transgender clients. Forty-six percent of HCW reported not receiving adequate clinical training to work with LGB clients. A significant difference in LGBT health knowledge, clinical preparedness, and attitudinal awareness was found by LGBT health education received. HCW that reported more LGBT focused health education reported higher basic LGBT health knowledge, felt more clinically prepared, and reported affirming attitudes regarding LGBT patients. This research suggests that more LGBT health focused education of HCW is needed.

Staff competence in caring for LGBTQ+ patients in the paediatric emergency department

ObjectiveThis study aimed to assess the competency of paediatric emergency department (PED) multidisciplinary staff in caring for LGBTQ+ (lesbian, gay, bisexual, transgender, queer/questioning, + inclusive of all identities) adolescents.DesignThis was...

A Quality Improvement Approach to Enhance LGBTQ+ Inclusivity in Pediatric Primary Care.

Lesbian, gay, bisexual, transgender, and queer (LGBTQ+) teens are at higher risk of illness as a result of bias but are less likely than peers to attend well visits. Medical organizations recommend improving care through staff education, visual cues, and routine inquiry of sexual orientation and gender identity (SO/GI) and pronouns. It is unknown how to do this confidentially in pediatrics. This quality improvement (QI) project aimed to confidentially collect and document SO/GI and pronouns early in at least 90% of teen acute care visits. A diverse, representative QI team in a resident primary care clinic conducted a series of staff and clinician trainings to improve knowledge, then displayed welcoming signage and offered staff pronoun and rainbow pins. Multiple Plan-Do-Study-Act cycles developed methods of routine and private collection of SO/GI and pronouns. Outcome measures included proportion of teen acute visits with such documentation collected via weekly chart reviews. Process measures included staff/clinician preparedness, assessed by surveys. SO/GI and pronouns were documented in 0% of teen acute visits at baseline, 70% after 6 months, and 90% during the 20-week sustainment measurement phase. The proportion of staff and clinicians who felt prepared to provide care for LGB and transgender patients increased (53% to 68% for LGB, P = .07; and 30% to 57% for transgender, P = .002). QI methods can create protocols for confidential, sustainable SO/GI and pronoun collection from teens early in acute visits. This allows clinicians and staff to address patients appropriately and for clinicians to better meet their needs.

Evaluating Medical Students' Views of the Complexity of Sexual Minority Patients and Implications for Care.

Purpose: Sexual and gender minority (SGM) people experience many health care disparities. We aimed to determine if medical students viewed sexual minority patients (lesbian, gay, or bisexual [LGB] men/women) as more complex than heterosexual patients, even when presenting with the same symptoms, and whether this perceived complexity affected confidence caring for LGB patients. Methods: A fictional patient with an upper respiratory infection was presented with systematic variation of the patient's sexual orientation across six experimental conditions in an online, vignette-based experimental study. Participants rated their perception of the medical, therapeutic, and social complexity of the patient, and completed a measure of stigma toward SGM people. Finally, participants indicated their confidence caring for the presented patient. Results: Overall, 665 students participated. Participants viewed the LGB patients as more complex across all domains, relative to heterosexual patients. Perceived medical and social complexity predicted lower confidence caring for the patient. Participants reported lower confidence caring for gay male patients with indirect effects of medical and social complexity. LGB identity was broadly and indirectly associated with lower confidence through social complexity. Conclusion: Our results suggest students view LGB patients as more complex compared with heterosexual patients. Medical education programs must provide training about the effects of social biases on clinical judgments and care for LGB patients, as well as build skills to ensure confidence caring for LGB patients.

Abstract PO-063: Medical students' knowledge and comfort in participating in cancer prevention for LGBTQ+ patients

Abstract Background: The majority of US medical schools have a required curriculum related to the care of LGBTQ+ people, which varies in length and content across schools. All medical specialties and sub-specialties have a component of need for cancer care; either in prevention, treatment, or care planning. As such, it is imperative that medical trainees receive relevant training in the care of LGBTQ+ populations, a community experiencing significant cancer health disparities. Assessing trainees' knowledge and confidence in providing care is an important aspect of preparing the next generation of physicians. Methods: This abstract reports on survey results from 3 US medical schools (New York University, University of Miami, University of Texas San Antonio) assessing the knowledge, attitudes and comfort in providing care for LGBTQ+ people. The survey was comprised of 54 Likert response (1=strongly disagree; 7=strongly agree) choice questions on: attitudes (30), knowledge (10), student demographics (13) and desire for additional LGBTQ+ education (1). Results were analyzed using descriptive and quantitative analyses. Results: A total of 360 medical students completed the survey and analyses revealed the majority of students had positive attitudes towards caring for LGBTQ+ patients, but lacked comfort in providing care for transgender/non binary patients (TNB) in general (p=0.05); specific cancer prevention care for TNB (p&amp;lt; 0.01); reproductive care for TNB (p&amp;lt; 0.01) and sexual heath (p=0.01). There was a significant correlation between high knowledge scores and comfort in asking a patient's pronouns (p&amp;lt;0.01). More than 80% felt comfortable discussing cancer prevention care with LGB patients and 75% believed it was important to know the sexual orientation of patient to provide the best care. Eighty percent agreed there should be mandatory LGBTQ+ education in medical school. As in our prior studies, total knowledge scores did not correlate with attitudes. Conclusions: Medical students feel comfortable and willing to provide cancer prevention care for LGB patients but may need more education and training in the unique needs of TNB patients. Medical schools should consider specific education in cancer prevention and treatment for TNB populations. Citation Format: Gwendolyn P. Quinn, Christina Tamargo, Devin Murphy, Megan Sutter, Lydia Fein, Fabio Ferrari, Amani Sampson, Mia Charifosn, Matthew B. Schabath. Medical students' knowledge and comfort in participating in cancer prevention for LGBTQ+ patients [abstract]. In: Proceedings of the AACR Virtual Conference: 14th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2021 Oct 6-8. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2022;31(1 Suppl):Abstract nr PO-063.

A Pilot Study of Latinx Lesbian, Gay, and Bisexual Adolescent Patients’ Goal Prioritizations in Patient-Provider Sexual Orientation and Health Disclosures

ABSTRACT This pilot study provides a theoretically-driven explanation of the dilemmas young Latinx LGB patients may experience surrounding disclosure of personal sexual orientation and sexual health information to a health care provider (HCP). The research team conducted face-to-face semi-structured interviews with LGB Latinx individuals (N= 29) ages 18–22 about their experiences, concerns, and preferences regarding divulging this type of information to an HCP. Interviews were thematically analyzed to identify (a) participants’ instrumental, identity, and relational goals during the potential and real disclosures and (b) patterns of how the participants prioritized their goals. Thematic analysis revealed four distinct goal prioritization patterns detailed in this study. Participants’ goals were shaped by (a) cultural upbringing, (b) beliefs about human sexuality, (c) perception of data leakage risk, (d) individual personality, (e) medical situation, and (f) the geographic location of clinic.

Culturally Competent Clinical Care for Older Sexual Minority Adults: A Scoping Review of the Literature

As recent efforts to improve culturally competent clinical care (CCCC) have largely overlooked older LGB adults, we conducted a scoping review of position statements, empirical, and non-empirical research and suggest action steps. We followed PRISMA Extension for Scoping Reviews Guidelines and searched for articles 1/1/11-3/14/19 (n = 1210) and other resources (n = 52), deduplicating, dually screening abstracts (n = 1,156), reviewing full-text (n = 107), and conducted a content analysis to identify distinct and cross-cutting domains (n = 44). Most research was based on simple pre/post-training differences in provider knowledge. A majority of sources were non-empirical. We identified three distinct domains (education & staffing, physical environment, and inclusive language & communication) and three cross-cutting domains (subgroup differences, research, and policy). Sparse empirical data that specify best approaches to improve CCCC exist; nevertheless, providers, in collaboration with researchers and policy makers, can initiate improved practices aimed at increasing CCCC for older LGB patients.

Experiences of LGBT Patients and Families With Hospice and Palliative Care: Perspectives of the Palliative Care Team

The lesbian, gay, bisexual, and transgender (LGBT) community experiences discrimination and stigma in accessing health care and social services – including palliative, hospice, and long-term care. Healthcare providers not recognize or address disparities in care. Providers and institutions may be uncomfortable with sexual orientation and gender identity and expression issues, and often don’t inquire about these. LGBT patients fear being open about their identities, not receiving equal or safe treatment, and having their family of choice and designated surrogates disrespected or ignored by healthcare staff. This study examines the degree to which hospice and palliative care providers report inadequate, disrespectful, or abusive care to LGBT patients and family members. A cross-sectional study using an online survey was completed by 865 providers, including social workers, physicians, nurses, and chaplains. Among respondents, 55% reported that LGB patients were more likely than non-LGB patients to experience discrimination at their institution; 24% observed discriminatory care; 65% reported that transgender patients were more likely than non-transgender patients to experience discrimination; 20% observed discrimination to transgender patients; 14% observed the spouse/partner of LGBT patients having their treatment decisions disregarded or minimized; and 13% observed the spouse/partner being treated disrespectfully. Qualitative data are presented to illustrate discomfort with LGBT patients and spouses/partners, disrespectful care, gossip and ridicule, inadequate care, and denial of care. Implications and suggestions for implementing non-discriminatory and respectful institutional and public policy, and for staff education and training to provide competent and respectiful care to this population are presented.

Disparities in the hospital cost of cardiometabolic diseases among lesbian, gay, and bisexual Canadians: a population-based cohort study using linked data.

Sexual identity has been recognized as a social determinant of health; however, evidence is limited on sexual minority status as a possible contributor to inequalities in cardiometabolic outcomes and the related hospital burden. This study aimed to investigate the association between sexual identity and hospital costs for cardiometabolic diseases among a cohort of Canadians using linked survey and administrative data. Data from the 2007-2011 Canadian Community Health Survey were linked to acute-care inpatient records from the 2005/2006-2012/2013 Discharge Abstract Database. Multiple linear regression was used to assess the association between self-reported sexual identity and inpatient resource use for cardiometabolic diseases. Among the population ages 18-59, 2.1% (95% CI 1.9-2.2) identified as lesbian, gay, or bisexual (LGB). LGB individuals more often reported having diabetes or heart disease compared with heterosexuals. The mean inflation-adjusted cost for cardiometabolic-related hospitalizations was found to be significantly higher among LGB patients (CAD$26,702; 95% CI 26,166-60,365) than among their heterosexual counterparts ($10,137; 95% CI 8,639-11,635), in part a reflection of longer hospital stays (13.6days versus 5.1days). Inpatient costs remained 54% (95% CI 8-119) higher among LGB patients after controlling for socio-demographics, health status, and health behaviours. This study revealed a disproportionate cost for potentially avoidable hospitalizations for cardiometabolic conditions among LGB patients, suggesting important unmet healthcare needs even in the Canadian context of universal coverage.

Experiences of LGBT Patients and Family Members with Hospice and Palliative Care (TH352)

•Describe institutional and provider policies regarding LGBT patients and family members in hospice and palliative care.•Describe the extent to which LGBT patients and their close family members and friends receive inadequate, disrespectful or abusive care due to their sexual minority status.•Discuss data-based recommendations for: provider education and practices; institutional and public policy; and future research. The lesbian, gay, bisexual, and transgender (LGBT) community experiences discrimination and stigma in accessing health care and social services – including palliative, hospice, and long-term care. Health care providers may fail to recognize or address disparities in care. Providers and institutions may be uncomfortable with sexual orientation and gender identity and expression issues, and often don't inquire about these. Research shows that LGBT patients fear being open about their identities, not receiving equal or safe treatment, and having their family of choice and designated surrogates disrespected or ignored by health care staff. There are approximately 2.7 million LGBT adults in the U.S. age 50+, with approximately 1.1 million age 65+. With the projected increased number of older adults and improved treatments that extend the life of seriously ill individuals, even more LGBT older adults, and their families, will require palliative and end-of-life care in coming years. This study examines inadequate, disrespectful, and abusive care to patients and family members due to their sexual orientation or gender identity. A cross-sectional study using an online survey was completed by 865 providers, including social workers, physicians, nurses, and chaplains. Among respondents, 55% reported that LGB patients were more likely to experience discrimination at their institution than non-LGB patients; 24% observed discriminatory care; 65% reported that transgender patients were more likely than non-transgender patients to experience discrimination; 20% observed discrimination to transgender patients; 14% observed the spouse/partner of LGBT patients having their treatment decisions disregarded or minimized; and 13% observed the spouse/partner or surrogate being treated disrespectfully. Findings reported also include: institutional non-discrimination policy, staff training, intake procedures, and comfort in assessing LGBT status. Implications for future research, institutional and public policy, and practice will be presented, including current policy barriers to respectful and non-discriminatory care, and the importance of staff training to address inadequate knowledge and discriminatory behaviors.

EXPERIENCE OF LGBT PATIENTS AND FAMILY WITH HOSPICE AND PALLIATIVE CARE

This study examines the degree to which hospice and palliative care staff observe or perceive inadequate, disrespectful, or abusive care to LGBT patients and family members. A cross-sectional study using an online survey completed by 865 providers, including social workers, physicians, nurses, and chaplains. Among respondents, 55% reported that LGB patients were more likely to experience discrimination at their institution than non-LGB patients; 24% observed discriminatory care; 65% reported that transgender patients were more likely than non-transgender patients to experience discrimination; 20% observed discrimination to transgender patients; 14% observed the spouse/partner of LGBT patients having their treatment decisions disregarded or minimized; and 13% observed the spouse/partner being treated disrespectfully. Findings reported also include: institutional non-discrimination policy, staff training, intake procedures, and comfort in assessing LGBT status. Implications for future research, policy, and practice will be presented.

National Survey of Oncologists at National Cancer Institute-Designated Comprehensive Cancer Centers: Attitudes, Knowledge, and Practice Behaviors About LGBTQ Patients With Cancer.

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 desire for future training and education. A random sample of 450 oncologists from 45 cancer centers was selected from the American Medical Association's Physician Masterfile to complete a survey measuring attitudes and knowledge about LGBTQ health and institutional practices. Results were quantified using descriptive and stratified analyses and by a novel attitude summary measure. Of the 149 respondents, there was high agreement (65.8%) regarding the importance of knowing the gender identity of patients, which was contrasted by low agreement (39.6%) regarding the importance of knowing sexual orientation. There was high interest in receiving education regarding the unique health needs of LGBTQ patients (70.4%), and knowledge questions yielded high percentages of "neutral" and "do not know or prefer not to answer" responses. After completing the survey, there was a significant decrease ( P < .001) in confidence in knowledge of health needs for LGB (53.1% agreed they were confident during survey assessment v 38.9% postsurvey) and transgender patients (36.9% v 19.5% postsurvey). Stratified analyses revealed some but limited influence on attitudes and knowledge by having LGBTQ friends and/or family members, political affiliation, oncology specialty, years since graduation, and respondents' region of the country. This was the first nationwide study, to our knowledge, of oncologists assessing attitudes, knowledge, and institutional practices of LGBTQ patients with cancer. Overall, there was limited knowledge about LGBTQ health and cancer needs but a high interest in receiving education regarding this community.

Abstract: Impact of Discrimination on Job Satisfaction in the LGBT Plastic Surgery Community

PURPOSE: Prior studies have demonstrated that underrepresented social groups often face increased overt and covert workplace discrimination, decreased professional success, and may find less overall workplace satisfaction. Despite increasing social acceptance and lessening social stigmatization, many individuals are uncomfortable working with lesbian, gay, bisexual, transgender (LGBT) peers. We sought to assess the existence and impact of overt and covert discrimination against LGBT members of the academic plastic surgery community and to determine if this resulted in a measurable impact on work satisfaction. METHODS: A link to an internet-based, anonymized survey was distributed to all plastic surgery program directors and resident coordinators with instructions to distribute to their respective attendings, fellows, and residents. Three reminder emails were sent, each at two-week intervals. Demographic information, career information, sexual orientation, and markers of both overt at covert discrimination were collected. A previously validated scale to assess work satisfaction was included as well. Responses of LGB trainees and LGB attendings were compared to their heterosexual counterparts using a two-tailed t-test and considered significant if p<0.05. RESULTS: 385 responses were recorded, 30 (8% who identify as LGB, none as transgender). 18% of this cohort report personally experiencing a direct homophobic remark by a resident, 27% report experiencing a direct homophobic mark by an attending. 5% of LGB respondents report that they believe they are treated differently by residents, 11% feel they are treated differently by attendings. LBG respondents report hearing general homophobic remarks from nurses, residents, and attendings at 62%, 38%, and 34% respectively. This is compared with 25%, 18%, and 17% in heterosexual peers. 19% of LGB respondents report witnessing discriminatory care of LGB patients or their partners, this is in contrast to 6% of their heterosexual peers. 100% percent of LGB respondents feel that nondiscrimination policies should include sexual orientation, only 91% of their heterosexual peers feel similarly. 0% of heterosexual respondents feel uncomfortable working with an LGB colleague, 0% feel sexual orientation affects job performance or would affect referral patterns. No significant difference exists in job satisfaction between LGB and heterosexual trainees or LGB and heterosexual attendings. CONCLUSION: While generally reassuring, the results of this study suggest that LGB plastic surgeons experience an undue amount of both covert and overt discrimination within the workplace. It is interesting to note that the LGB is, general, subject to more covert discriminatory practices as a smaller percentage of LGB respondents report experiencing a direct homophobic remark. This is further evidenced by the somewhat discouraging statistic that only 91% of heterosexual plastic surgeons feel that nondiscrimination policies ought to include sexual orientation. It is likely, however, that real progress has been made from a presumed historical baseline as no respondent reported to feel uncomfortable working with a LGB colleague. It is comforting to know, however, that despite the existence of discrimination, our LGB colleagues suffer no loss of job satisfaction.

Comprehensive Internal Medicine Residency Curriculum on Primary Care of Patients Who Identify as LGBT.

Graduate medical education curricula that provide training on LGBT healthcare are limited. The purpose of this study was to create and evaluate an LGBT curriculum for internal medicine (IM) residents. The implicit association test (IAT) measuring implicit bias toward gay individuals was administered as part of a needs assessment. The curriculum was developed by a multidisciplinary team, with objectives derived from the Association of American Medical Colleges' curricular recommendations and the Fenway Guide to Lesbian, Gay, Bisexual, and Transgender Health. Surveys assessed residents' perceptions of the importance of primary care for LGBT patients, and their knowledge of and confidence in providing primary care to LGBT patients. Faculty also rated the usability of the curricular materials. The IAT showed a slight preference for straight people compared with gay people, with an average "D score" of 0.27 ± 0.42. The importance of receiving education about the primary care of LGB patients was rated as high across the pre- to postsurveys. Knowledge improved with participation in the curriculum (average overall score: 42% pre- vs. 66% postsurvey, p < 0.0001). Participants' confidence in their ability to provide information to LGBT patients about resources for community engagement and to implement gender-neutral practices in their clinics increased significantly (p < 0.05). This curriculum pilot demonstrated an improvement in IM residents' knowledge of and confidence in providing care to LGBT patients. Our results suggest that curricular materials can be developed by experts in LGBT health and utilized effectively by nonexpert faculty to increase residents' knowledge and confidence regarding LGBT healthcare.

Waiting for the doctor to ask: influencers of lesbian, gay, and bisexual identity disclosure to healthcare providers

Lesbian, gay, and bisexual (LGB) individuals encounter multiple barriers in healthcare, resulting in problematic care. Many LGB patients wrestle with whether to disclose their sexuality to healthcare providers. This article explored what influences LGB patients’ decision to disclose their sexuality to healthcare providers. Guided by Communication Privacy Management theory, the authors conducted in-depth interviews with 20 LGB patients. LGB patients heavily relied on boundary management when negotiating the disclosure of their sexuality. The findings suggest several factors influence LGB patients’ disclosure of sexuality: i) experience with family; ii) fear of gossip and connections; iii) concern for provider care refusal; iv) religion; v) age; and vi) level of trust with providers. Boundary turbulence can be created between patient and provider when there is uncertainty about if and when sexuality is considered private information. Additionally, a site of tension for LGB patients was their concern about providers sharing private information outside the clinic setting.

Knowledge, Beliefs, and Communication Behavior of Oncology Health-care Providers (HCPs) regarding Lesbian, Gay, Bisexual, and Transgender (LGBT) Patient Health care

Delivery of culturally competent care toward lesbian, gay, bisexual, and transgender (LGBT) patients depends on how health-care providers (HCPs) communicate with them; however, research about knowledge, attitude, and behavior of HCPs toward LGBT patients is scant. The objectives of our study were to describe oncology HCPs’ knowledge and examine if beliefs about LGB and transgender patients mediate the effects of LGBT health-care knowledge on open communication behaviors with LGB and transgender patients, respectively. A total of 1253 HCPs (187 physicians, 153 advance practice professionals (APPs), 828 nurses, and 41 others) at a Comprehensive Cancer Center completed an online survey that included the following measures: LGBT health-care knowledge, beliefs, communication behaviors, willingness to treat LGBT patients, encouraging LGBT disclosure, and perceived importance of LGBT sensitivity training. Only 50 participants (5%) correctly answered all 7 knowledge items, and about half the respondents answered 3 (out of 7) items correctly. Favorable beliefs about LGBT health care mediated the effect of higher LGBT health-care knowledge on open communication behaviors with transgender patients, controlling for effects of type of profession, religious orientation, gender identity, sexual orientation, and having LGBT friends/family. The results of this study demonstrated an overall lack of medical knowledge and the need for more education about LGBT health care among oncology HCPs.

Observed Deficiencies in Medical Student Knowledge of Transgender and Intersex Health

Lesbian, gay, bisexual, transgender, and intersex (LGBTI) patients face many well-documented disparities in care which among transgender and intersex people can often be traced to providers' lack of knowledge. We administered surveys to examine the self-assessed knowledge and attitudes of all medical students at Boston University regarding different LGBTI subpopulations. Survey questions were based on a Likert scale from 1 to 5; analysis was conducted with Wilcoxon rank sum tests. Overall there was a response rate of 24%, with the number of responses varying by class. Three of the 4 surveyed classes reported lower knowledge about transgender health than LGB health. Every class reported significantly lower knowledge of intersex health in comparison to LGB. Comfort with transgender or with intersex patients was lower than with LGB patients for all surveyed classes. Students across all self-identified groups (LGBTI, ally, not an ally) reported significantly lower average responses for knowledge and comfort regarding transgender or intersex health in comparison to that of LGB. Students in their preclinical years reported lower levels of knowledge in comparison with students in their clinical years. Students who identified as LGBTI reported significantly higher knowledge and comfort with only LGB and transgender health when compared with students who didn't identify as LGBTI. Respondents more frequently requested additional learning opportunities in transgender and intersex health than in LGB health. Self-reported knowledge of transgender and intersex health lags behind knowledge of LGB health, though these deficits appear partially responsive to targeted educational intervention. BUSM = Boston University School of Medicine LGB = lesbian, gay, and bisexual LGBT = lesbian, gay, bisexual, and transgender LGBTI = lesbian, gay, bisexual, transgender, and intersex M1 = first-year medical student class M2 = second-year medical student class M3 = third-year medical student class M4 = fourth-year medical student class.

Genetics in LGB Assisted Reproduction: Two Flipped Classroom, Progressive Disclosure Cases.

There have been several educational reforms calling for increasing lesbian, gay, bisexual, and transgender (LGBT) education materials, application of basic sciences to clinical medicine, and active engagement of students. While the amount of educational materials for LGBT clinical cases is increasing, this session for preclinical medical students uniquely combines basic science population genetics, cisgender lesbian, gay, and bisexual (LGB) cultural issues and reproductive endocrinology in a 1.5-hour flipped classroom session. Students were assigned a prediscussion video and reading. Facilitators attended a 1.5-hour training session prior to discussion. Each classroom of 30 students with small groups of six was led by a third- or fourth-year medical student facilitator who taught from a PowerPoint that included discussion questions. An audience response system was used to show aggregated, real-time anonymous responses to case questions, a pre- and postsurvey was used to analyze changes in student attitudes and knowledge of assisted reproduction services for same-sex couples, and course evaluations captured overarching student impressions. All first-year students (N = 180) attended this mandatory session. Audience response questions showed a high level of knowledge of population genetics concepts. Voluntary surveys showed a higher number of assisted reproduction recommendations for LGB patients compared to heterosexual patients before discussion, with this difference disappearing after the discussion. This may indicate a shift in student attitudes and knowledge of LGB patient barriers and assisted reproduction. Course evaluations showed appreciation of LGB material integration within the course. Educators will be able to successfully integrate the application of population genetics, assisted reproduction cases, and an examination of cultural barriers in health care for LGB patients with this session.