Patients who identify as lesbian, gay, bisexual, or transgender (LGBT) experience health disparities, including poorer overall health and less satisfaction with cancer care compared with individuals who identify as heterosexual or cisgender. Julia Seay, PhD, Research Assistant Professor at Sylvester Comprehensive Cancer Center at the University of Miami Health System-who researches health disparities in cancer care-suspects one of the factors contributing to these disparities is a lack of understanding on the part of health care providers about the unique health care needs of LGBT patients.
"Many LGBT cancer survivors encounter clinic environments that are not inclusive or welcoming, and [they] may be more likely to have negative experiences with the health care system during cancer care. These experiences can contribute to poorer patient-provider communication, as well as poorer health outcomes among LGBT cancer survivors," Seay told Oncology Times.
Seay and her colleagues have developed an LGBT cultural competency training program, the Curriculum for Oncologists on LGBT populations to Optimize Relevance and Skills (COLORS), to try to increase that understanding in cancer care providers.
And a new study published online ahead of print in the journal Cancer that evaluated the feasibility of using such a program was promising (2019; doi.org/10.1002/cncr.32491). Thirty three of the 44 oncologists who participated in the study completed the program. Those who completed the program showed gains in LGBT-related knowledge, attitudes, and clinical practice after completing the program. And 82 percent of the physicians rated the training as high-quality and 97 percent reported they would recommend the training to a colleague.
Here's what else Seay told Oncology Times about the program and LGBT cultural competency training for oncologists and cancer care providers.
1 Can you explain what the key findings were from this study about the COLORS program?
"We have conducted a pilot study of the COLORS training among oncologists, and we do not yet know whether providing this training will lead to substantial improvement in LGBT patient outcomes. The pilot results are promising, however, and we are in the process of planning larger trials to examine whether this training will effectively address LGBT cancer disparities.
"The COLORS training is an interactive, web-based LGBT cultural competency training designed specifically for oncologists. It is comprised of four, 30-minute modules: 1) LGBT Basics; 2) Inclusive Environments; 3) Initiating Oncology Care with LGBT Patients; and 4) Issues in Cancer Survivorship among LGBT Patients.
"Each of these modules focuses on the development of effective communication strategies, which ideally may improve the patient-provider relationship, and ultimately clinical outcomes."
2 What are some of the barriers to implementing training programs like this one for practicing oncologists, as well as new medical students?
"A key barrier is that many medical schools do not yet have institutional support and policies regarding the provision of training in the unique care needs of LGBT patients. Thus, the onus is often on the individual physician and/or student to engage in LGBT cultural competency training. Additionally, oncologists and medical students often have extremely busy schedules, which can impede their ability to complete these types of trainings.
"We designed COLORS specifically with this barrier in mind, such that trainees can complete the training on their own time and at their own pace (all of the modules do not have to be completed at once)."
3 What is the takeaway message about your work and LGBT cultural competency training?
"Currently, many health care systems do not include sexual orientation and gender identity questions as part of the standard intake, and thus the disclosure of patient sexual orientation and gender identity within cancer care is limited. However, this information is important to understand, as LGBT cancer survivors face not only the stress of living with cancer, but often also the limitation of not being able to fully share who they are or details about their lives with their health care providers due to the fear of stigmatization.
"LGBT cancer survivors experience a myriad of health disparities, including poorer mental health and lower satisfaction with their cancer care than their cisgender and heterosexual counterparts. Lack of LGBT cultural competency among oncology care providers can lead to poor communication with LGBT patients and weaken the patient-provider relationship, contributing to the development of these disparities. Thus, LGBT cultural competency trainings may improve LGBT-related knowledge, attitudes, and clinical practices among providers, which ultimately may lead to improvements in care provision and patient outcomes.
"LGBT cultural competency training, such as the COLORS training, sheds light on these issues and encourages the development of effective communication skills among health care providers, ultimately aiming to address health disparities among LGBT cancer survivors. The COLORS training is a promising new intervention aimed at improving LGBT cultural competency among oncologists, and its effectiveness in improving patient outcomes will be examined in the future."