Oncologists Seek Education on Health Needs of LGBTQ Patients

February 6, 2019

A recent study showed oncologists lack knowledge, but are interested in receiving additional training to learn about the healthcare needs of LGBTQ patients.

Oncologists’ knowledge about lesbian, gay, bisexual, transgender, and queer/questioning (LGBTQ) health is limited, according to the results of a nationwide study; however, the majority of respondents expressed an interest in increasing this knowledge through education.

The survey was sent to a random sample of 450 oncologists from 45 National Cancer Institute (NCI)-Designated Comprehensive Cancer Centers and measured attitudes and knowledge about LGBTQ health and institutional practices.

According to study researcher Matthew B. Schabath, PhD, of H. Lee Moffitt Cancer Center and Research Institute, and colleagues, data from studies like this “provide crucial evidence to develop both culturally sensitive and clinically knowledgeable curriculum and guidelines addressing cancer disparities in LGBTQ patients across the cancer care continuum.”

According to the study, there is some evidence that the LGBTQ population may be at increased risk and have worse outcomes for certain cancers, while also being less likely to engage in early detection and screening. In addition, LGBTQ patients report lower satisfaction with cancer care, are less likely to be insured, and have higher perceived rates of discrimination in health care settings.

The survey included 12 attitude items, six knowledge items, three items on institutional practices, 18 demographic items, and two post-survey confidence items about knowledge on LGB (lesbian, gay, and bisexual) health and transgender health.

About one-third of oncologists responded. Although almost all respondents (95.3%) said they were comfortable treating LGB patients, only about half (53.1%) reported they were confident in their knowledge of the health needs of these patients. Fewer oncologists (82.5%) said they were comfortable treating transgender patients and were comfortable in their knowledge of this groups’ health needs (36.9%).

There was a high rate of agreement (65.8%) about the importance of knowing gender identity of patients, compared with only 39.6% of respondents reporting it was important to know sexual orientation. Despite this, 63.1% of respondents reported that their institutional intake forms did not inquire about a patient’s sexual orientation, and more than half did not inquire about a patient’s sex at birth or their current gender identity.

About 70% of respondents reported interest in education regarding the unique health needs of LGBTQ patients, and more than 40% reported belief that there should be mandatory training in this area.

“Professional membership societies have published policy statements calling for provider education and training to address cancer disparities in the LGBTQ community,” the researchers wrote. “Providers with a general awareness and understanding of LGBTQ issues will provide improved quality of care for LGBTQ patients.”

There was a significant decrease in oncologist confidence in knowledge of health care needs for LGB patients from the survey assessment to the post-survey assessment (P < .001). Similarly, there was a decrease in confidence about knowledge of the needs of transgender patients from one assessment to the next (P < .001).

“This observed decrease suggests a developed awareness of lack of knowledge, and subsequent decreased confidence, perhaps attributed to exposure to survey items related to practice intake forms inquiring about SOGI [sexual orientation/gender identity] information or the high number of ‘do not know or prefer not to answer’ responses to knowledge items,” according to the researchers. “As such, the results from this study can be leveraged toward future research to develop LGBTQ-centric training and resources for the development of evidence-based competency curriculum to prepare and train the oncology workforce for cancer disparities in the LGBTQ community.”

The researchers noted that one limitation of the study is its generalizability to oncologists outside of NCI-designated centers.

“Future studies are needed to assess these metrics in community settings and academic centers not affiliated with NCI-Designated Comprehensive Cancer Centers,” they wrote.

Commenting on these results, Jennifer J. Griggs, MD, MPH, FACP, FASCO, professor, Department of Medicine, Hematology/Oncology and Health Management and Policy at the University of Michigan, told Cancer Network that this well-done survey identified “gaps in confidence regarding the needs of patients who belong to the LGBTQ community, gaps that increased with completion of the survey.”

“The survey instrument presumably acted as an intervention, a finding that itself is intriguing,” Griggs said. “Interest in receiving education about the needs of the LGBTQ+ patients with cancer was high among survey respondents. Such education is available and is one way to increase provider knowledge, confidence, and patient- and family-centered care.”

“Another important finding is that very few of the centers collect data on sexual orientation and gender identity on patient intake forms,” Griggs said. “Collecting such data is not objectionable to patients, regardless of their sexual orientation and gender identity, and should become standard practice regardless of the setting of care [oncology practice or otherwise].”