U Research Targets LGBTQ Health Disparities in Cancer Care

Your first impression of a new doctor’s office may come from the type of seating available in the waiting room or the style of pen handed to you to fill out your first-time patient form. But for people in the LGBTQ community, good first impressions go beyond the clinic’s ambiance to what’s asked on the patient form.

“Are these forms making assumptions on paperwork about relationship structures or family structures? Did the clinic staff ask their preferred name and pronouns?” asked Nic Rider, PhD, an assistant professor in the Program in Human Sexuality at the University of Minnesota Medical School. “Those are all clues on whether or not people feel it is a safe place.”

If they don’t feel safe, they won’t seek care, causing detrimental health disparities among those who identify as LGBTQ. This population is at a higher risk for cancer and mental health illnesses—to name a few—all because of factors related to the social determinants of health and lack of appropriate sensitivity and medical training for providers.

Dr. Rider, along with Stephanie Terezakis, MD, a professor in the Department of Radiation Oncology, recently received a grant from the Radiation Oncology Institute to evaluate these disparities, specifically in cancer care. Dr. Terezakis says this research will be one of few in current medical literature on the topic.

“We started searching in the literature for what’s been written or done in this domain in oncology and basically found a massive deficit, especially with regard to radiation oncology,” Dr. Terezakis said. “There have been some attempts at looking at what are the deficits and competencies for general oncology care, but really nothing for radiation oncology. It just sparked a concern that nothing was being done to evaluate how we could do better and how we can address these disparities.”

Sensitivities and Medical Competencies

According to Dr. Terezakis, a common, but avoidable, mishap occurs when providers make assumptions about the patient’s gender, sexual orientation and family structure.

“A doctor walks into the patient room to see a same-sex couple but may assume and say, ‘Is this your sister?’ Then, the patient has this automatic discomfort having to say no,” she said. “Those kinds of competencies and sensitivities are important, and I did not have the benefit of learning in my medical training to walk into a room and ask, ‘Can you introduce me to those you’ve brought to the appointment today?’”

That situation is an example of one of the sensitivities this research hopes to address, but Dr. Rider explains LGBTQ health disparities also exist due to lack of culturally competent knowledge and information among physicians. Some LGBTQ patients have shared that doctors have discounted their need for proper screenings, such as for HPV.

“Given that HPV can cause various types of cancer, this is creating a disparity where they are not getting the screenings they need,” Dr. Rider said. “We need to get accurate, culturally-responsive information to providers as well as to the people accessing health services.”

A Qualitative Study

To do that, Drs. Rider and Terezakis will lead a team at the U and at the Dana-Farber Cancer Institute in Boston to conduct a qualitative study focused on the viewpoints of residents, fellows, physicians, nurses and clinic staff. For the next two years, they will use semi-structured interviews to learn from each group about the training they may have already received and what else they will need to better serve the LGBTQ community. Dr. Terezakis says the data will inform a training webinar delivered nationally through the American Society for Radiation Oncology.

“This particular project will focus on competencies in delivering care, not necessarily the specifics of medical knowledge—but, medical knowledge could definitely be grown from here,” Dr. Terezakis said. “Eventually, we’re hoping to translate what’s missing and what people do not understand to inform a curriculum for clinic competency that can hopefully plug those holes across departments nationally.”