Sexual Orientation Gender Identity Research Articles

Beyond the binary: A transformative implementation science initiative to improve LGBTQ+ cancer care.

11010 Background: Patient, provider, and system-level barriers contribute to significant disparities in care of LGBTQ+ persons, including delays in screening and diagnosis, and poorer outcomes. This implementation science initiative was designed to identify and address root causes of disparities in care for LGBTQ+ patients (pts) and drive sustainable change to improve health equity in LGBTQ+ cancer care. Methods: In 2023, a steering committee of 3 expert oncologists and 5 LGBTQ+ cancer pts convened to develop survey instruments and a point-of-care LGBTQ+ Cancer Care Toolkit. Next, LGBTQ+ pts with cancer (N = 817) and oncology providers (OPs) from 2 academic and 5 community-based practices (N = 115) completed surveys to reveal alignments and discordances in beliefs, perceptions, and practices regarding cancer care. OPs participated in audit-feedback (AF) sessions to critically assess system-specific practice gaps, prioritize areas for improvement, and develop action plans for improving LGBTQ+ cancer care. Results: Provider-reported top challenges in care included: unsure how sexual orientation/gender identity (SOGI) affect treatment considerations (35%), unsure how to discuss SOGI (30%),and systemic barriers that limit inclusion (29%). While most providers (84%) were at least moderately comfortable treating LGBTQ+ pts, these data suggest they overestimated the level of comfort of their pts. For example, only 24% of pts reported feeling safe disclosing their LGBTQ+ identity, while 65% of providers thought pts felt safe. Additionally, while most providers (73%) thought it was important to know a pt’s gender identity, only 46% thought it was important to know sexual orientation, and only 3% of providers reported routinely discussing SOGI with new pts. Patients and providers were not concordant in several other key areas, including the experience of pts’ partners, measures of inclusivity, and supportive care services offered, such as fertility preservation. Survey data also revealed systemic barriers to equitable care, such as EMR documentation of SOGI. In AF sessions, teams reviewed survey outcomes, and developed action plans for improvement, including integrating the toolkit, updating EMR documentation, developing LGBTQ+ education, and adopting measures of inclusivity. Notably, following the intervention, there were considerable gains in provider confidence and knowledge, and ~70% of providers committed to discussing SOGI with their pts at first introduction. Conclusions: Through this QI initiative, teams identified patient-, provider-, and systemic-level barriers that affect LGBTQ+ cancer care in their own practices and implemented action plans to address key challenges. The sustainable changes implemented in this QI initiative represent key opportunities for improvement that can be implemented in clinics across the country to improve equitable LGBTQ+ cancer care.

Impact of Multiple Minority Statuses: An Examination of Violent Victimization, Police Reporting and Perception of Police Bias

Individuals who identify as belonging to multiple marginalized groups experience disproportionate violent victimization yet are reluctant to inform the police following an incident. Perceptions of the police as biased may influence whether victims report. This study examines low socio-economic and sexual orientation/gender-identity (SOGI) minority statuses on experiencing violent victimization, reporting to the police and perceived police bias as a reason for not reporting. Multivariate logistic regressions were applied to National Crime Victimization Survey data. Low-income, SOGI respondents reported greater odds of experiencing violent victimization but lower odds of reporting to the police. An increase in the odds of perceiving the police as biased was found among victims who did not report. Results suggest greater work to improve the strained relationships between the police and minority communities.

Cognitive Impairment in Sexual and Gender Minority Groups: A Scoping Review of the Literature.

Purpose: The purpose of this review was to synthesize evidence on differences in cognitive impairment by sexual orientation/gender identity (SOGI) status. Methods: A scoping review of the literature was conducted. Five databases (PubMed/Medline, Cumulated Index to Nursing and Allied Health Literature, Web of Science, PsycInfo, and Embase) were searched for primary articles comparing incidence or prevalence of cognitive impairment among sexual and gender minority (SGM) groups versus non-SGM groups. Two reviewers independently screened articles and conducted risk-of-bias assessment on eligible articles. Results: Fifteen primary studies were eligible. Most studies (n = 13) were cross-sectional, with moderate to critical risk of bias. Among eight studies examining self-reported cognitive impairment, seven reported a higher prevalence among some SGM groups versus non-SGM groups. Among seven studies using objective measures of cognitive impairment, three examined prevalence of clinician-documented diagnosis of dementia, of which two reported a higher prevalence specifically among transgender versus cisgender individuals. Among the other four studies examining objective measures, two reported poorer cognitive performance or memory, one reported better performance, and another reported no difference. Comparisons across studies were challenging due to inconsistencies in how SOGI and cognitive impairment were operationalized, and the factors used for statistical adjustment; some studies adjusted for putative intermediary factors that potentially explain differences in cognitive impairment. Conclusions: Whereas most published studies identified a positive relationship between SOGI status and self-reported cognitive impairment, evidence is mixed with regard to objective cognitive performance. Well-designed longitudinal, observational studies are needed, using objective measures of cognitive function, with careful consideration of confounding versus intermediary risk factors.

S835 Description of Clinical Presentations of Inflammatory Bowel Disease (IBD) in Individuals Who Identify as LGBTQIA+

Introduction: While the demographics and clinical manifestations of Inflammatory Bowel Disease (IBD) have been widely described in the general population, little is known about the clinical presentation of patients belonging to the lesbian, gay, bisexual, transgender, queer, intersex, and asexual (LGBTQIA+) community. The aim of this study was to describe the clinical presentation of IBD in individuals who identify as LGBTQIA+ at their first presentation to an IBD clinic at a tertiary referral center. Methods: This is a retrospective chart review study where patients that identify as LGBTQIA+ and that have IBD were identified using an electronic data retrieval system at a tertiary referral center. We collected information regarding their sexual orientation, gender identity (SOGI), gastrointestinal (GI) symptoms, location of disease, extent of GI tract involvement and their IBD medications at the time of their first visit to the IBD clinic. We used descriptive statistics to analyze the data. Results: The demographics, SOGI, IBD diagnosis and medications of the 93 patients included in our study are described in Table. The median time (interquartile range) from symptom onset to diagnosis and to presentation to IBD clinic were 1.4 (0; 12.7) and 72.1 (10.3; 160.5) months respectively. The extent and location of bowel involvement at the initial visit are displayed in Figure. On presentation, 46% of patients reported abdominal pain, 45% diarrhea, 25% hematochezia, 16% weight loss and 15% fatigue. Ten percent of patients had a history of clostridium difficile colitis. There were 24 patients that had more than one IBD-related emergency department visit and 17 patients that had more than one hospitalization at a tertiary referral center within one year of presentation to IBD clinic. A history of mood or anxiety disorders was assessed in 41 patients (44%), 16 of which had a history of anxiety and 19 of depression. Indications of suicidality were only assessed in 10 patients (11%). Conclusion: While this study is the first to help clarify the GI manifestations and disease characteristics of IBD in patients who identify as LGBTQIA+, further studies are needed to deepen our understanding of the epidemiology and clinical presentations of IBD in this population in comparison to a non-LGBTQIA+ cohort. This will facilitate the identification of potential healthcare disparities and barriers to timely access of patients who identify as LGBTQIA+ with IBD to clinical care.Figure 1.: Gastrointestinal involvement in patients who identify as LGBTQIA+ and who have ulcerative colitis (A, n=25) and Crohn’s disease (B, n=45; C, n=32). Table 1. - Demographics, sexual orientation, gender identity, IBD diagnosis and IBD medications of 93 individuals who identify as LGBTQIA+ All patients (n=93) Age, in years, mean (SD) 30 (15) Sex assigned at birth, Female, N(%) 59 (63) Sexual orientation, N(%) Bisexual 48 (52) Gay/lesbian/homosexual 39 (42) Other 5 (5) Prefer not to disclose 1(1) Gender Identity, N(%) Female 52 (56) Male 30 (32) Genderqueer 2 (2) Transgender female 2 (2) Other 7 (8) Race, N(%) White 85 (92) Black 3 (3) American indian/Alaska native 1 (1) Asian 1 (1) Native Hawaiian/Pacific Native Islander 1 (1) Other 2 (2) IBD diagnosis, N(%) Ulcerative colitis 48 (52) Crohn's Disease 45 (48) IBD medications at initial visit, (n=37) Mesalamine 20 (54) Corticosteroids 15 (41) Thiopurines 10 (27) Infliximab 8 (21) Adalimumab 7 (19) Vedolizumab 2 (5) Ustekinumab 2 (5) Certolizomab 2 (5) Methotrexate 1 (3) IBD: Inflammatory Bowel Disease; Data shown: Number (percentage), unless stated otherwise.

Gender Diverse Youth: Opportunities to Identify and Address Systemic Inequities.

* Abbreviations: GD — : gender diverse SOGI — : sexual orientation–gender identity A significant number of youth are the victims of systemic and interpersonal discrimination as a result of claiming identities that are minoritized in the United States. Researchers in prevalence studies estimate that in the United States, 14% of high school youth identify as Black, 25% as Hispanic, and 1.8% as transgender.1,2 Black and Hispanic children are more likely to live in poverty and to be uninsured compared with their white peers.2–4 Transgender individuals face significantly higher risk of poverty, homelessness, and victimization compared with their cisgender peers; race and ethnicity only compound these outcomes.5 Current literature likely underestimates the prevalence and racial diversity of gender diverse (GD) individuals in the United States. Data from the Williams Institute at UCLA School of Law, a leading research center on sexual orientation, gender identity law, and public policy, reveal that there is overrepresentation of white respondents in some of the largest transgender surveys to date.5–8 Previous experience with rejection, victimization, and transmisogyny may cause GD persons not to self-identify. Limited sexual orientation–gender identity (SOGI) data options further exclude GD individuals who do not identify as cisgender or transgender or whose gender identity falls outside a binary (female or male) model of gender. In this issue of Pediatrics , the study “Prevalence of Gender Diverse Youth in an Urban School District” by Kidd et al9 contributes a unique and more accurate reflection of the distribution of GD youth and also reflects the growing appreciation of the complexity of adolescent identity formation: a major developmental task that paves the way to a healthy adulthood. Authors of this study also offer more nuanced opportunities to consider the intersection of race and gender in adolescent identity formation. They found that 9.2% of those in the urban … Address correspondence to Michelle Forcier, MD, MPH, Director Gender, Sex and Reproductive Justice Programming at Open Door Health, 7 Central Street, Providence, RI 02907. E-mail: mforcier1205{at}gmail.com

Breaking down barriers: A strategic initiative to collect sexual orientation and gender identity information in the oncology patient population.

128 Background: The LGBT community is a diverse population that crosses race, ethnicity, socioeconomic status, age, and other factors. It is estimated that 8.8 million Americans are part of the community and the number is likely higher due to under reporting. The population is at increased risk for certain cancers, sexually transmitted infections, and is more likely to use alcohol, tobacco, drugs, and suffer from obesity, and behavioral health issues. LGBT patients face barriers to accessing care due to being under-insured, fear of discrimination and lack of access to culturally competent health care providers. Our cancer center embraced the need to collect sexual orientation/gender identity (SOGI) data as a means to identify and address the comprehensive needs of our patients and set a goal to provide an inclusive, patient-centered environment through education of our teams to build a trusted patient-provider relationship. Methods: We implemented a history section in the EHR to assist with data collection including, preferred name, sexual orientation, gender identity, legal sex, and sex assigned at birth. A project team was developed in 2019 to improve utilization of the existing tool and provide education to increase the comfort level of our caregivers. Our target groups consist of advance practice providers, RN care coordinators, social workers and physicians. Educational sessions occurred through multiple modes and “champions” were identified within target groups to keep the momentum going. Results: There was initial hesitation in utilization due to lack of understanding of the impact on patient care and lack of confidence in communication. Training was modified to include communication techniques and the why collection of SOGI data is important. Conclusions: A monthly report was developed to determine utilization of the SOGI fields and as of May 2020 have increased from 1.5% utilization to 17.5% utilization. A survey has been deployed to education attendees to determine pre and post education comfort levels in addressing the SOGI needs of patients and early data is showing a marked improvement in the comfort level of caregivers.

Systematic Collection of Sexual Orientation and Gender Identity in a Public Health System: The San Francisco Health Network SO/GI Systems-Change Initiative

Lesbian, gay, bisexual, transgender, and queer (LGBTQ+) individuals experience disparate outcomes within health care that are often unacknowledged by health systems due to lack of systematic collection of sexual orientation/gender identity (SO/GI) data. This article describes a San Francisco Department of Public Health (SFDPH) initiative to standardize SO/GI data collection for every patient/client utilizing SFDPH services, as well as the training development and implementation around this initiative. This initiative incorporated community engagement throughout and had an aim of meeting new regulatory requirements, improving patient experience and, ultimately, equipping staff with the needed data to uncover and reduce health disparities. Upon completion of the first wave of training (May 2019), a total of 5618 (69.1%) staff completed the online training and 2189 (26.7%) staff completed the optional in-person training. As of June 2020, SO/GI was collected in 35.0 percent of empanelled primary care patients and in 26.8 percent of the unique patient encounters overall throughout the health network. This initiative demonstrated the feasibility of implementing SO/GI data collection as an inclusive and community-driven culture change initiative, fully integrated with the complexities of operational change in a diverse public health network. Next steps include providing ongoing training and support for clinicians, staff, and patients, implementing SO/GI data collection for pediatric patients/clients, and identifying health disparities within the network to create targeted interventions and improve the care experience for our LGBTQ+ patients/clients.

Queering Canadian Social Work Accreditation standards and procedures: a content analysis

ABSTRACTThis paper reviews and critically analyzes the Canadian Association for Social Work Education—Association Canadienne Pour La Formation En Travail Social’s (CASWE-ACFTS’) Accreditation Standards and Procedures from a Sexual Orientation Gender Identity and Expression (SOGIESC) lens to examine how such are addressed in relevant documents. The CASWE-ACFTS Queer Caucus undertook a lead role in examining ‘diversity’ in the documents as it serves as an umbrella term for SOGIESC and other intersecting positionalities. This paper iterates an initial response in the CASWE-ACFTS Queer Caucus’ ongoing consultation with the CASWE-ACFTS’s Education Policy Committee’s work on Education Policy and Accreditation Standards 2019 (EPAS2019). The content analysis of the documents reveals that SOGIESC issues are not adequately addressed and this has implications for undergraduate and graduate social work curricula in Canada. The authors provide recommendations that address the integration of SOGIESC in CASWE-ACFTS’s Accreditation Standards and Procedures documents.