LGBTQ Patients Research Articles

APA’s Government, Policy, and Advocacy Update

Back to table of contents Previous article Next article Government & LegalFull AccessAPA’s Government, Policy, and Advocacy UpdateSearch for more papers by this authorPublished Online:9 Feb 2021https://doi.org/10.1176/appi.pn.2021.2.40Biden Lifts Ban on Transgender People Enlisting in MilitaryAs one of his first acts in office, President Joe Biden signed an executive order that reversed the ban on transgender individuals enlisting in the military. When Trump issued a memo related to the ban in 2018, APA released a statement in which APA CEO and Medical Director Saul Levin, M.D., M.P.A., called the ban “a discriminatory action.” He continued: “This ban not only harms those who have chosen to serve our country, but it also casts a pall over all transgender Americans. This discrimination has a negative impact on the mental health of those targeted.”In his executive order, Biden revoked Trump’s 2018 memo, immediately prohibited involuntary discharges of transgender troops, and ordered the Pentagon to review the records of any service members who were previously forced out of the military on the basis of gender identity. The order also requires that a process be established by which transgender service members can transition while serving.“It is my conviction as commander in chief of the Armed Forces that gender identity should not be a bar to military service,” Biden’s order stated. “Therefore, it shall be the policy of the United States to ensure that all transgender individuals who wish to serve in the United States military and can meet the appropriate standards shall be able to do so openly and free from discrimination.”Executive Order Reinforces Discrimination Protections for LGBTQBiden also issued an executive order plainly stating that LGBTQ individuals are protected from discrimination in health care settings, schools, and workplaces.Last year, the Supreme Court ruled that Title VII of the Civil Rights Act of 1964 applies to LGBTQ individuals because it prohibits employee discrimination based on sex. (See Psychiatric News). Shortly before the ruling, the Trump administration had issued a rule that eliminated health care discrimination protections for LGBTQ patients, claiming that the term “sex” refers only to whether someone is male or female, as determined by biology. (See Psychiatric News). The rule was blocked by a federal judge.Biden’s order requires all federal agencies to review existing regulations and revise them to make it clear that the definition of “sex” includes gender identity and sexual orientation.“People should be able to access health care and secure a roof over their heads without being subjected to sex discrimination,” Biden’s order stated. “All persons should receive equal treatment under the law, no matter their gender identity or sexual orientation. ■ ISSUES NewArchived

Early Intervention for LGBTQ Health: A 10-Hour Curriculum for Preclinical Health Professions Students.

IntroductionIndividuals who identify as lesbian, gay, bisexual, transgender, or queer (LGBTQ) face significant health disparities and barriers to accessing care. Patients have reported provider lack of knowledge as one of the key barriers to culturally responsive, clinically competent care. Many US and Canadian medical schools still offer few curricular hours dedicated to LGBTQ-related topics, and medical students continue to feel unprepared to care for LGBTQ patients.MethodsWe developed a 10-hour LGBTQ health curriculum for preclinical medical and physician assistant students. The curriculum included lectures and case-based small-group discussions covering LGBTQ terminology, inclusive sexual history taking, primary care and health maintenance, and transition-related care. It also included a panel discussion with LGBTQ community members and a small-group practice session with standardized patients. Students were surveyed before and after completing the curriculum to assess for increases in confidence and knowledge related to LGBTQ-specific care.ResultsForty first- and second-year medical students completed the sessions and provided valid responses on pre- and postcourse surveys. Nearly all students initially felt unprepared to sensitively elicit information, summarize special health needs and primary care recommendations, and identify community resources for LGBTQ individuals. There was significant improvement in students' confidence in meeting these objectives after completion of the five sessions. Knowledge of LGBTQ health issues increased minimally, but there was a significant increase in knowledge of LGBTQ-related terminology.DiscussionOur 10-hour LGBTQ health curriculum was effective at improving medical students' self-confidence in working with LGBTQ patients but was less effective at increasing LGBTQ-related medical knowledge.

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Perspectives of LGBTQ Youth and Pediatricians in the Primary Care Setting: A Systematic Review.

Objectives:Conduct a systematic review designed to determine needs and experiences of LGBTQ adolescents in the pediatric primary care setting and to the ability of primary care practitioners to provide the most inclusive care to LGBTQ adolescents.Methods:PubMed, CINAHL, and Embase searches using the following keywords: LGBTQ, Adolescents, Pediatrics, Sexual-Minority, Gender-Identity, and primary care, to identify peer-reviewed publications from 1998 to 2017 that focused on stigma in the healthcare setting related to LGBTQ youth and the knowledge of healthcare providers on enhancing care for their sexual and gender minority patients. Article inclusion criteria include: primary research studies conducted in a pediatric primary care describing LGBTQ patients, pediatric patients as described by the American Academy of Pediatrics (AAP), and written in the English language. Articles were excluded if they used inaccurate definitions for LGBTQ identity, inappropriate patient ages outside of those defined by the AAP, and studies not in a pediatric primary care setting.Results:Four articles were identified for the review. Of the included articles, the majority of LGBTQ adolescents experience stigma in the healthcare setting. A limited number of physicians providing care to LGBTQ adolescents felt equipped to care for their sexual-minority patients due to lack of education and resources.Conclusions:The education of physicians should include a more detailed approach to providing care to the LGBTQ population, particularly to those training to become pediatricians. A standard guide to treating LGBTQ adolescents could eliminate stigma in the healthcare setting.

"Fat broken arm syndrome": Negotiating risk, stigma, and weight bias in LGBTQ healthcare.

In the U.S., the weight of LGBTQ people-and sexual minority women in particular-is a key focus for those addressing sexual and gender minority health disparities. Sociomedical stigma related to both fat and sexuality, however, complicates patient-provider perceptions and discussions about weight and health. I analyzed data from interviews with LGBTQ patients, healthcare employees, and observations at a LGBTQ healthcare organization to reveal how weight bias becomes a barrier to care for LBQ cisgender women, transgender men, and nonbinary people assigned female. Understood by patients as similar to "trans broken arm syndrome,"-wherein providers attribute health concerns of trans people to minority gender identities and gender affirming care-patients report "fat broken arm syndrome," wherein providers are perceived to attribute patient health concerns to weight. Patients interpret weight bias as intersectional stigma-related to multiple marginalized identities and embodiments-that puts their health at risk. Healthcare professionals make sense of risk, however, through competing fat frames. Although patient narratives suggest the promise of utilizing stigma-reduction approaches, many providers-typically those who do not share patient standpoints-emphasize the importance of framing fat as an urgent health risk in order to "do no harm." This case advances knowledge by demonstrating the relational process through which interventions designed to ameliorate health disparities may inadvertently discourage marginalized, "at-risk" patients from healthcare access and adherence.

Exploring the Relationships between Sexual Orientation and Gender Identity and Youth Synthetic Cannabinoid Use

Purpose: Existing studies have identified sexual minorities as being at enhanced risk for reporting synthetic cannabinoid (SC) use. It is unclear whether this association is the result of those that identify as a minority due to sexual orientation being more likely to use SCs, due to those that identify as transgender using SCs more, or both. Deconstructing this relationship will allow for targeted clinical advice and public health campaigns. Methods: Data from the 2015 and 2017 Youth Risk Behavior Study are utilized. In total, 31,279 youth were asked about their gender identity, sexual orientation, and SC use history. Bivariate analyses and logistic regression models were completed to explore relevant associations. Results: Identifying as lesbian, gay, bisexual, or questioning was linked to SC use and continuing SC use. Similarly, identifying as transgender was linked to SC use and continuing use. Regression analyses showed no significant interactive effect; identifying as both LGBQ and transgender does not have a compounding effect on use likelihood. Conclusions: Both sexual orientation and gender identity contribute to the relationship between sexual minority status and SC use noted in extant literature. This relationship is hypothesized to be tied to increased exposure to discrimination, victimization, and social isolation. Thus, efforts to directly counsel LGBTQ patients about the dangers associated with SC use are warranted as well as social policy reforms to better protect and support members of the LGBTQ community.

Abstract PO-067: LGBTQ patients and cancer care: A scoping review of U.S. physician attitudes, biases, and interactions

Abstract As lesbian, gay, bisexual, transgender, and queer (LGBTQ) people gain increasing acceptance in U.S. society, physicians are at an important turning point. Older physicians who entered medicine when homophobia was still the norm are interacting with new generations of physicians who have emerged through the cultural debates, and increased acceptance, of LGBTQ people in our society. This dichotomous acceptance of LGBTQ people by physicians makes it unclear the extent and types of biases that remain in medical settings that negatively impact both LGBTQ patients and physicians. In cancer care, data indicate that LGBTQ patients have less timely screenings as compared with the general population, as well as negative beliefs about care and perceptions of heterosexism and homophobia among providers, among other factors. Thus, the effects of perceived homophobia by physicians can cause health disparities and inequity for LGBTQ populations. Identifying and understanding the scope of LGBTQ biases within medicine, especially in cancer care, will allow us to work at dismantling these biases. This scoping review explores existing literature outlining the types and extent of biased attitudes of physicians within the U.S. towards LGBTQ patients seeking cancer care. Citation Format: Kristi Tredway, Stephanie J. Cork, Melissa S. Camp, Tonia Poteat, Lorraine T. Dean. LGBTQ patients and cancer care: A scoping review of U.S. physician attitudes, biases, and interactions [abstract]. In: Proceedings of the AACR Virtual Conference: Thirteenth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2020 Oct 2-4. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(12 Suppl):Abstract nr PO-067.

Abstract PO-068: Survey of healthcare providers in the ECOG-ACRIN cancer research group: Attitudes, knowledge, and practice behaviors about LGBTQ patients with cancer

Abstract INTRODUCTION: The lesbian, gay, bisexual, transgender, and queer/questioning (LGBTQ) community is a medically underserved population that suffers from cancer disparities. To identify potential gaps in attitudes, knowledge, and institutional practices toward LGBTQ patients, we conducted a mixed-methods survey of healthcare providers in the ECOG-ACRIN Cancer Research Group. METHODS: A validated, web-based survey was administered to members of the ECOG-ACRIN Cancer Research Group in late 2019. The survey was completed by 490 healthcare providers measuring attitudes and knowledge about LGBTQ health and institutional practices regarding collection of sexual orientation and gender identity data. Results were quantified using descriptive and stratified analyses. RESULTS: Among the 490 healthcare providers that completed the survey, 77% were White, 86% were non- Hispanic, 75% were female, 81% were heterosexual, and the mean age was 46 years. Approximately 47% of the respondents were medical oncologists, 39% practiced in academic medical centers (AMCs), and 49% were from the Midwest/Northeast. As reported by prior institutional and national survey studies, there was high interest (77%) in receiving education regarding the unique health needs of LGBTQ patients, an overall limited knowledge about LGBTQ health and cancer needs, and a significant decrease from survey assessment to postsurvey assessment for confidence in knowledge for LGBT health needs. There was high agreement (71%) regarding the importance of knowing gender identity, which was contrasted with a low agreement (48%) regarding the importance of knowing sexual orientation. Stratified analyses revealed significant differences of some attitude and knowledge items. For example, when stratified by licensure/terminal degree, MD/DO vs. RN/NP/PA were significantly more willing to be listed as a LGBTQ-friendly provider (81% vs. 50%) and reported to be knowledgeable about LGB health needs (69% vs. 53%). Providers at AMCs were significantly more willing to be listed as a LGBTQ-friendly provider (71% vs.53%) believe there should be mandatory education (72% vs. 60%) regarding care of LGBQ patients versus those at non-AMCs. Having family and/or friends who are LGBTQ (vs. none) and political affiliation (conservative vs. liberal) were strong effect modifiers resulting in significant differences for 9 and 8 items, respectively. CONCLUSION: To our knowledge, this was the first study of cancer care providers in a large cancer clinical trials research group that assessed attitudes, knowledge, and institutional practices of LGBTQ patients with cancer. Consistent with prior studies, there was limited knowledge about LGBTQ health and cancer needs, but high interest in receiving education regarding this community. New and intriguing differences for many attitude and knowledge items were revealed when we stratified the responses by licensure/terminal degree, practice setting, LGBTQ friends and/or family members, and political affiliation. Citation Format: Matthew B. Schabath, Jaileene Perez-Morales, Megan Sutter, Lynne Wagner, Melissa Simon, Ruth C. Carlos, Bruce J. Giantonio, Gwendolyn P. Quinn, Edith P. Mitchell. Survey of healthcare providers in the ECOG-ACRIN cancer research group: Attitudes, knowledge, and practice behaviors about LGBTQ patients with cancer [abstract]. In: Proceedings of the AACR Virtual Conference: Thirteenth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2020 Oct 2-4. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(12 Suppl):Abstract nr PO-068.

Human papillomavirus vaccination in lgbtq patients: the need for dermatologists on the front lines.

Human papillomavirus vaccination in lgbtq patients: the need for dermatologists on the front lines.

Oncologists’ experiences caring for LGBTQ patients with cancer: Qualitative analysis of items on a national survey

ObjectivesSexual and gender minority (SGM) individuals experience cancer-related health disparities and reduced quality of cancer care compared to the general population in part due to a lack of knowledgeable providers. This study explored oncologists’ experiences and perspectives in providing patient-centered care for SGM individuals with cancer. MethodsWe conducted a qualitative analysis of oncologists’ responses to four open-ended items on a national survey eliciting their experiences, reservations, and suggestions in treating SGM patients. ResultsOver 50 % of the 149 respondents of the national survey responded to at least one open-ended item. Many oncologists reported positive experiences reflecting personal growth and affirmative care practices, such as open, non-judgmental communication, compassion, competence, and supporting patients’ identity. There was a notable lack of experience with transgender patients in particular. Lack of knowledge, interpersonal communication concerns (e.g., fear of offending patients), and microaggressions (“don’t ask, don’t tell”) were identified as barriers to providing affirming care. ConclusionsOncologists recognize their knowledge deficits and need strategies to overcome communication barriers and microaggressions among the cancer care team to provide SGM-affirming care. Practice implicationsCurricula are needed to train oncologists in SGM healthcare needs and affirming communication skills to facilitate patient-centered care for SGM individuals with cancer.

Judge Blocks HHS Rule Permitting Discrimination Against LGBTQ Patients

Judge Blocks HHS Rule Permitting Discrimination Against LGBTQ Patients

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

BackgroundLesbian, gay, bisexual, transgender, and queer (LGBTQ) populations have an increased risk of multiple adverse health outcomes. Capturing patient data on sexual orientation and gender identity (SOGI) in the electronic health record (EHR) can enable healthcare organizations to identify inequities in the provision of preventive health screenings and other quality of care services to their LGBTQ patients. However, organizations may not be familiar with methods for analyzing and interpreting SOGI data to detect health disparities. PurposeTo assess an approach for using SOGI EHR data to identify potential screening disparities of LGBTQ patients within distinct healthcare organizations. MethodsFive US federally qualified health centers (FQHCs) retrospectively extracted three consecutive months of EHR patient data on SOGI and routine screening for cervical cancer, tobacco use, and clinical depression. The screening data were stratified across SOGI categories. Chi-Square and Fisher’s Exact test were used to identify statistically significant differences in screening compliance across SOGI categories within each FQHC. ResultsIn all FQHCs, cervical cancer screening percentages were lower among lesbian/gay patients than among bisexual and straight/heterosexual patients. In three FQHCs, cervical cancer screening percentages were lower for transgender men than for cisgender (i.e., not transgender) women. Within each FQHC, we observed statistically significant associations (P < 0.05) between SOGI categories and at least one screening measure. The small number of transgender patients, and limitations in EHR functionality, created challenges in interpretation of SOGI data. ConclusionsTo our knowledge, this is the first published report of using SOGI data from EHRs to detect potential disparities in healthcare services to LGBTQ patients. Our finding that lesbian/gay and transgender male patients had lower cervical cancer screening rates compared to heterosexual, bisexual, and cisgender women, is consistent with the research literature and suggests that using SOGI EHR data to detect preventive screening disparities has value. EHR functionality should allow for cross-checking gender identity with sex assigned at birth to reduce errors in data interpretation. Additional functionality, like clinical decision support based on anatomical inventories rather than gender identity, is needed to more accurately identify services that transgender patients need.

Investigation of Geographic and Macrolevel Variations in LGBTQ Patient Experiences: Longitudinal Social Media Analysis.

BackgroundDiscrimination in the health care system contributes to worse health outcomes among lesbian, gay, bisexual, transgender, and queer (LGBTQ) patients.ObjectiveThe aim of this study is to examine disparities in patient experience among LGBTQ persons using social media data.MethodsWe collected patient experience data from Twitter from February 2013 to February 2017 in the United States. We compared the sentiment of patient experience tweets between Twitter users who self-identified as LGBTQ and non-LGBTQ. The effect of state-level partisan identity on patient experience sentiment and differences between LGBTQ users and non-LGBTQ users were analyzed.ResultsWe observed lower (more negative) patient experience sentiment among 13,689 LGBTQ users compared to 1,362,395 non-LGBTQ users. Increasing state-level liberal political identification was associated with higher patient experience sentiment among all users but had stronger effects for LGBTQ users.ConclusionsOur findings highlight that social media data can yield insights about patient experience for LGBTQ persons and suggest that a state-level sociopolitical environment influences patient experience for this group. Efforts are needed to reduce disparities in patient care for LGBTQ persons while taking into context the effect of the political climate on these inequities.

Moving Toward Equitable Health Care for Lesbian, Gay, Bisexual, Transgender, and Queer Patients: Education and Training in Physical Therapy Education

Introduction. Disparities in health and health care experienced by sexual and gender minorities in the United States (US) are well documented, and physical therapists (PTs) play a role in perpetuating them. This study aimed to determine to what degree lesbian, gay, bisexual, transgender, and queer (LGBTQ) health education and training is integrated into physical therapy education curricula. Studies in medicine and nursing have led to increased curricular attention to LGBTQ health topics; yet, similar physical therapy education research has not been published. Methods. A link to an anonymous Google Forms survey was emailed to Program Directors (PDs) of US physical therapist education programs accredited by the Commission on Accreditation in Physical Therapy Education for the academic years of 2015–2017. The survey gathered information on the current and optimal number of curricular hours spent on equitable care for LGBTQ patients and perceived barriers to inclusion of LGBTQ curriculum. Results. Seventy-two of 229 (31%) programs responded to the survey. Half of the respondents reported inclusion of LGBTQ-related topics in the curriculum. The average number of current hours was 1.43 per year. The average number of optimal hours was 2.82 per year. Eighty-nine percent reported that one or more curricular hours per year should be included. Barriers to LGBTQ health education and training include perceived lack of time and adequate faculty training. Discussion. Most PDs believe that more hours should be dedicated to LGBTQ health topics. Open-ended question responses reflect various perspectives held by PDs regarding the importance of including LGBTQ health topics and barriers to inclusion. The development of core competencies may facilitate the inclusion of LGBTQ-specific health education in Doctor of Physical Therapy program curricula. Conclusion. Resources to educate faculty and students on LGBTQ health topics are readily available. These topics may be effectively woven into existing curricula, making it an attainable goal to increase the competency of entry-level PTs to assist in meeting the American Physical Therapy Association's mandate to provide nondiscriminatory care.

Care Considerations for LGBTQ Patients in Acute Psychiatric Settings.

Caring for any patient in psychiatric crisis in an acute care setting requires a keen understanding of risk assessment as well as creation and maintenance of a safe and therapeutic treatment environment. The long-term success of acute psychiatric care is also dependent on competent discharge planning. Yet, current psychiatric practices in acute care settings often fail to account for the unique barriers faced by lesbian, gay, bisexual, transgender, and queer (LGBTQ) patients, starting from the moment of arrival in the emergency room and continuing through discharge from the hospital. This article highlights best practices to address the needs of LGBTQ patients in acute psychiatric settings, including inclusive and affirming communication and culturally competent history taking, risk assessment, treatment environments, and discharge considerations.

The Pharmacist as an LGBTQ Ally

An ally is defined as one who is associated with another as a helper that provides support and assistance in an ongoing struggle or effort. Pharmacists should be allies to their patients by ensuring optimal health outcomes and by helping their patients achieve therapeutic objectives and goals. However, most colleges of pharmacy are currently not well equipped to train future pharmacists to counsel lesbian, gay, bisexual, transgender, and questioning/queer (LGBTQ) patients. This commentary explores reasons for discrepancies in health care access for LGBTQ patients and how efforts can be advanced to meet the needs of this minority group. Pharmacists require adequate training to provide optimal care for a more diverse patient population and to be both an ally in health and a reassuring supporter for members of the LGBTQ community.

Tu1116 DISPARITIES IN HEALTH: LOWER COLORECTAL CANCER SCREENING RATES AMONG LGBTQ PATIENTS

Colorectal cancer (CRC) screening via colonoscopy can prevent CRC. Socially neglected populations such as ethnic and racial minorities have consistently lower CRC screening rates when compared to the general population. While lesbian, gay, bisexual, transgender, and queer (LGBTQ) patients represent a population who are at risk for CRC screening disparities, an estimate of the existence and magnitude of the disparity remains unknown. The aim of this study is to analyze the rate of CRC screening between the LGBTQ population and the general population to determine if a disparity exists along with the possible magnitude. Data was extracted from our tertiary care medical center’s de-identified patient database (SD) between 2014 and 2018. Search terms for the LGBTQ population included self-identification in the EMR as “lesbian”, “gay”, “bisexual”, “transgender”, “transsexual”, “queer”, “questioning”, or “intersex” or had an associated ICD 9 or 10 code. The 2008 USPSTF criteria for CRC screening were utilized for identification of patients eligible for screening. Search terms for average risk CRC screening included “colonoscopy”, “FOBT”, “FIT”, “flexible sigmoidoscopy”, and ICD 9/10 codes v76.51, v76.41, z12.11, and z12.12. Patients considered as increased risk for CRC were excluded (family history of CRC or advanced polyp; personal history of IBD). Based on the magnitude of data for the general population, the Center for Disease Control (CDC) and Prevention database for our state was utilized in publication years to calculate the CRC screening rate of the state-wide population. Students t-test for was utilized to assess for differences between the groups. A total of 117 LGBTQ patients were found in the SD. 15% were lesbian, 44% gay, 18% bisexual, 23% transgender, and 0% queer/questioning or intersex with a mean age of 58 [50-76] years-old. 85% were Caucasian (90% non-Hispanic; 3% Hispanic; 7% not identified), 11% African-American, 0% Asian, and 4% unknown. Of the LGBTQ patients identified, 35 met 2008 USPSTF eligibility criteria for average risk CRC screening. The LGBTQ CRC screening rate compared to the state population rate was 29.3% v. 64.9% (p<0.01) in 2014, 34.8% v. 66.4% (p<0.01) in 2016, and 29.9% v. 69.1% (p<0.01) in 2018. Despite increased CRC screening rates for the state population over the years of the study, the rate among the LGBTQ population remained low. Although this is a single center study, our data may serve to highlight low CRC screening rates among the LGBTQ population. Future studies to evaluate the etiology of the low rate, barriers to screening in this marginalized population, and implementation of strategies to improve screening rates are underway.

Giving Safe, Sensitive Care to LGBTQ Patients and Families

The conversation should not be different from one with any other nurse, but the delivery may need to be different. Millennials like to use technology to learn, so they may benefit from self-paced video learning modules, such as this webinar from the American Association of Critical-Care Nurses. An abundance of interactive video education is available free online from the Fenway Institute (fenwayhealth.org/the-fenway-institute) and the Gay and Lesbian Medical Association (www.glma.org).The “Q” can stand for “questioning” and “queer.” Questioning refers to individuals who are unsure of their sexual orientation and/or gender identity. Queer is an umbrella term encompassing a variety of sexual orientations and gender identities, excluding heterosexuality. The term was originally used as a slur but has been reclaimed by younger generations to also refer to political ideologies not adhering to heteronormativity or gender binary. To avoid offense, it is best to avoid this term unless the person introduces it.The LGBTQ population has faced continual discrimination. Health disparities have developed over time because of the reluctance of this population to seek medical attention with providers who, often, mistreat them, discriminate against them, or even refuse to treat them. Factors theorized to contribute to this population’s higher rates of suicide and depression include internalized homophobia, societal stigma, lack of support by those who are important to them, and discrimination.The Joint Commission recommends placing transgender patients in the room that corresponds with their identified gender. However, in practice this may result in a situation in which transgender patients are placed in the first available private room to ensure respect for them and their identified gender.In addition to the tools and resources provided in this webinar, The Joint Commission has a field guide with a wealth of information in the form of a “road map.” The Fenway Institute also has free training modules, as well as a video series, addressing an array of LGBTQ training issues. Another resource is the Gay and Lesbian Medical Association.

PrEP (Pre-Exposure Prophylaxis) Education for Clinicians: Caring for an MSM Patient.

IntroductionGaps exist in educational materials addressing LGBTQ patient care and LGBTQ health. One such area is prescribing HIV pre-exposure prophylaxis (PrEP) for men who have sex with men (MSM). PrEP awareness, familiarity, and comfort in prescribing are very important in the rollout and success of PrEP as a preventative measure. Our needs assessments showed a lack of familiarity and comfort among clinicians/medical students in prescribing PrEP. Furthermore, studies have shown that since its launch as an effective prevention method of HIV transmission, PrEP has not been widely prescribed to at-risk populations. Educating clinicians about PrEP may increase its use among high-risk MSM populations and reduce the incidence of HIV infections.MethodsFor medical students, we developed a didactic presentation and video recording discussing (1) a brief history of HIV prevention, (2) indications for PrEP prescription, (3) medical testing for PrEP onboarding, (4) common PrEP side effects, and (5) appropriate follow-up and testing for PrEP maintenance and discontinuation. We also developed a videotaped clinical encounter demonstrating communication skills used in PrEP counseling. Pre- and postworkshop surveys assessed participants’ PrEP attitudes and knowledge.ResultsAll 43 survey respondents were second- through fourth-year medical students. Pre- and postpresentation evaluation of questions assessing comfort demonstrated a statistically significant improvement in level of comfort with understanding when to prescribe PrEP and in level of knowledge in prescribing PrEP.DiscussionWorkshop participants acknowledged their training gaps in PrEP prescribing and acquired knowledge and comfort with prescribing PrEP for at-risk populations.

A knowledge, attitudes and practices survey for medical trainees about cancer in the LGBTQ community.

e19073 Background: The purpose of our study was to assess the extent of knowledge, attitudes and practices regarding cancer in the LGBTQ community among medical students and resident physicians at the Detroit Medical Centre/Wayne State University program. Methods: A 15 question validated survey was electronically provided to medical students and resident physicians. The survey included questions that assessed the knowledge, attitudes and practices regarding cancer in the LGBTQ community. Respondents selected a choice based on a 5 item rating scale that ranged from "strongly agree" to "strongly disagree." In addition, participant demographics including training level and gender/sexual identity were collected. Descriptive statistics (counts and percentages) were used to quantify survey responses. Results: A total of 110 responses were received. The respondents consisted of 77% medical students as well as 8.2% interns and 13.7% senior residents in the department of internal medicine. Five percent of the responders reported having rotations in Corktown Health Center, which is an LGBTQ clinic. Majority (82.7%) reported that they were heterosexual while the rest were homosexual, bisexual, pansexual or preferred not to say. In terms of knowledge, one third of the responders reported being well informed on the health needs of LGBTQ patients. While majority (82.1%) believed that LGBTQ patients avoid accessing healthcare, 7% of the respondents disagreed that transgender individuals are less likely to have health insurance. In terms of attitudes, majority (97%) agreed that the LGBTQ population has unique health risks. 82% of the responders believe that it is important to know the gender identity and the sexual orientation of the patients to provide the best care, however only 30% practiced actively inquiring about a patient’s sexual orientation when taking a history. One third of the responders assume that the patient is heterosexual upon first encounter. Ninety five percent of medical trainees agreed that formal education needs to be provided in medical school or as part of residency curriculum on LGBTQ health needs. Conclusions: Our survey shows that there is a gap in knowledge and practices of medical trainees about health needs of the LGBTQ population. Majority of the respondents believe that training about cancer in the LGBTQ population needs to be integrated into medical school or residency curriculum. Exclusion of LGBTQ- specific health needs from medical school and residency curricula contributes to cancer related health inequities faced by this population.