Physician Perceptions on Cancer Screening for LGBTQ+ Patients
Abstract
:Simple Summary
Abstract
1. Introduction
2. Materials and Methods
- Prior medical experience and education specific to the LGBTQ+ community;
- Confidence in knowledge of patient concerns with screening using mammograms, Pap smears, and other HPV screening;
- Provider demographics including their medical specialty and geographic location.
3. Results
3.1. Provider Demographics, Medical Specialty, and Geographic Location
3.2. Prior Experience and Education with the LGBTQ+ Community
3.3. Knowledge of Patient Concerns and Cancer Screening Using Mammograms, Pap Smears, and Other HPV Screening
3.4. Logistic Regression of Characteristics on Provider Consensus
3.5. LGBTQ+ Education and Provider Perspectives
- Perceived importance of their patients’ sexual orientation (p < 0.001);
- Confidence in understanding LGBTQ+ health concerns (p < 0.001);
- Willingness to be listed as an “LGBTQ+-friendly” practice (p = 0.005);
- Perceptions of lesbian patients’ concerns with mammography (p = 0.036);
- Perceptions of transgender FTM patients’ concerns with Pap smear (p = 0.037).
4. Discussion
5. Conclusions
- National efforts toward a consensus on systematic SOGI collection and clear cancer screening standards for LGBTQ+ subpopulations;
- Improved educational programs for medical providers in primary care, oncology, and beyond, with the goals of improving healthcare delivery for the LGBTQ+ community and reducing disparities.
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
Appendix A
Questions on a 5-Point Likert Scale |
---|
1. I am confident I understand various health concerns unique to the LGBTQ+ community. |
2. I have had formal training on culturally-competent interactions with LGBTQ+ patients. |
3. It is important to know the sexual orientation of my patients to provide the best care. |
4. My clinic’s _________ are comfortable interacting and providing care for LGBTQ+ patients - Front Desk Staff - Medical Assistants - Nurses and NPs - Technologists |
5. The color, signage, and decor of my clinic’s waiting room are designed to make both female and male patients and their family comfortable waiting there. |
6. I feel that the patient robes/gowns offered at my clinic are gender neutral. |
7. My clinic has standardized forms that are appropriate for LGBTQ+ patients. |
8. My clinic would benefit from having staff training/in-service about LGBTQ+ health issues. |
9. Given the option, I would want to be included in a list of “LGBTQ+-friendly” practices that would be accessible online and/or in an LGBTQ+ publication. |
10. Within the LGBTQ+ community, subpopulations have very different health issues. |
11. Lesbian patients have concerns with: - Mammogram screening - Pap smear screening - Other HPV screening (oral health) |
12. Female-to-male transgender patients have concerns with: - Mammogram screening - Pap smear screening - Other HPV screening (oral health) |
13. Male-to-female transgender patients have concerns with: - Mammogram screening - Pap smear screening - Other HPV screening (oral health) |
Open-ended Questions |
14. How can clinics improve potential misgendering and discomfort of patients in the LGBTQ+ community to increase cancer screening? |
15. How can clinics improve the comfort and privacy of LGBTQ+ patients who come in for mammogram screening? |
Question | Response | All (n = 320) | Northeast or West (n = 164) | South or Midwest (n = 156) | p-Value |
---|---|---|---|---|---|
On average, how many LGBTQ+ patients do you see in a month? n (%) 1 | <1 1–5 6–10 10–20 >20 | 36 (11.3%) 173 (54.1%) 46 (14.4%) 23 (7.2%) 20 (6.3%) | 19 (11.6%) 83 (50.6%) 30 (18.3%) 9 (5.5%) 12 (7.3%) | 17 (10.9%) 90 (57.7%) 16 (10.3%) 14 (9.0%) 8 (5.1%) | 0.176 |
I am confident I understand various health concerns unique to the LGBTQ+ community, n (%) 2 | Strongly Agree Agree Neutral Disagree Strongly Disagree | 28 (8.8%) 124 (38.8%) 113 (35.3%) 44 (13.8%) 7 (2.2%) | 13 (7.9%) 67 (40.9%) 58 (35.4%) 20 (12.2%) 3 (1.8%) | 15 (9.6%) 57 (36.5%) 55 (35.3%) 24 (15.4%) 24 (15.4%) | 0.846 |
Given the option, I would want to be included in a list of “LGBTQ+-friendly” practices that would be accessible online and/or in an LGBTQ+ publication, n (%) 3 | Strongly Agree Agree Neutral Disagree Strongly Disagree | 96 (30.0%) 148 (46.3%) 60 (18.8%) 8 (2.5%) 5 (1.6%) | 53 (32.3%) 75 (45.7%) 31 (18.9%) 1 (0.6%) 1 (0.6%) | 43 (27.6%) 73 (46.8%) 29 (18.6%) 7 (4.5%) 4 (2.6%) | 0.122 |
Question | Response | All (n = 353) | 0–5 Years (n = 68) | 6–10 Years (n = 77) | >10 Years (n = 208) | p-Value |
---|---|---|---|---|---|---|
I have had formal training on culturally-competent interactions with LGBTQ+ patients, n (%) 1 | Strongly Agree/ Agree | 99 (28.0%) | 19 (27.9%) | 22 (28.6%) | 58 (27.9%) | 0.014 |
Neutral | 80 (22.7%) | 22 (32.4%) | 24 (31.2%) | 34 (16.6%) | ||
Disagree/ Strongly Disagree | 171 (48.9%) | 27 (39.7%) | 31 (40.3%) | 113 (55.1%) | ||
Within the LGBTQ+ community, subpopulations have very different health issues, n (%) 2 | Strongly Agree/ Agree | 301 (85.5%) | 61 (89.7%) | 68 (88.3%) | 172 (83.1%) | 0.703 |
Neutral | 42 (11.9%) | 6 (8.8%) | 7 (9.1%) | 29 (14.0%) | ||
Disagree/ Strongly Disagree | 9 (2.6%) | 1 (1.5%) | 2 (2.6%) | 6 (2.9%) | ||
It is important to know the sexual orientation of my patients to provide the best care, n (%) 2 | Strongly Agree/ Agree | 192 (54.6%) | 43 (63.2%) | 48 (62.3%) | 101 (48.8%) | 0.053 |
Neutral | 77 (21.9%) | 14 (20.6%) | 17 (22.1%) | 46 (22.2%) | ||
Disagree/ Strongly Disagree | 83 (23.6%) | 11 (16.2%) | 12 (15.6%) | 60 (29.0%) | ||
I am confident I understand various health concerns unique to the LGBTQ+ community, n (%) 3 | Strongly Agree/ Agree | 165 (47.3%) | 31 (45.6%) | 39 (50.6%) | 95 (46.6%) | 0.974 |
Neutral | 124 (35.5%) | 25 (36.8%) | 26 (33.8%) | 73 (35.8%) | ||
Disagree/ Strongly Disagree | 60 (17.2%) | 12 (17.6%) | 12 (15.6%) | 36 (17.7%) | ||
Given the option, I would want to be included in a list of “LGBTQ+-friendly” practices that would be accessible online and/or in an LGBTQ+ publication, n (%) 1 | Strongly Agree/ Agree | 267 (76.3%) | 53 (77.9%) | 53 (68.8%) | 161 (78.5%) | 0.300 |
Neutral | 68 (19.4%) | 14 (20.6%) | 20 (26.0%) | 34 (16.6%) | ||
Disagree/ Strongly Disagree | 15 (4.3%) | 1 (1.5%) | 4 (5.2%) | 10 (4.9%) |
Question | Response | 0–5 Years (n = 68) | 6–10 Years (n = 77) | >10 Years (n = 208) | p-Value |
---|---|---|---|---|---|
Lesbian patients have concerns with: | |||||
Mammogram screening, n (%) 1 | Strongly Agree/ Agree | 60 (88.2%) | 59 (78.7%) | 135 (69.2%) | 0.006 |
Disagree/ Strongly Disagree | 8 (11.8%) | 16 (21.3%) | 60 (30.8%) | ||
Pap smear screening, n (%) 2 | Strongly Agree/ Agree | 60 (88.2%) | 66 (88.0%) | 138 (73.0%) | 0.003 |
Disagree/ Strongly Disagree | 8 (11.8%) | 9 (12.0%) | 51 (27.0%) | ||
Other HPV screening (oral health), n (%) 3 | Strongly Agree/ Agree | 61 (89.7%) | 64 (85.3%) | 139 (73.9%) | 0.008 |
Disagree/ Strongly Disagree | 7 (10.3%) | 11 (14.7%) | 49 (26.1%) | ||
Female-to-male transgender patients have concerns with: | |||||
Mammogram screening, n (%) 4 | Strongly Agree/ Agree | 65 (97.0%) | 67 (93.1%) | 166 (86.9%) | 0.037 |
Disagree/ Strongly Disagree | 2 (3.0%) | 5 (6.9%) | 25 (13.1%) | ||
Pap smear screening, n (%) 5 | Strongly Agree/ Agree | 62 (92.5%) | 64 (88.9%) | 156 (86.2%) | 0.380 |
Disagree/ Strongly Disagree | 5 (7.5%) | 8 (11.1%) | 25 (13.8%) | ||
Other HPV screening (oral health), n (%) 6 | Strongly Agree/ Agree | 62 (92.5%) | 65 (90.3%) | 155 (86.1%) | 0.319 |
Disagree/ Strongly Disagree | 5 (7.5%) | 7 (9.7%) | 25 (13.9%) | ||
Male-to-female transgender patients have concerns with: | |||||
Mammogram screening, n (%) 7 | Strongly Agree/ Agree | 58 (86.6%) | 58 (78.4%) | 149 (76.8%) | 0.234 |
Disagree/ Strongly Disagree | 9 (13.4%) | 16 (21.6%) | 45 (23.2%) | ||
Pap smear screening, n (%) 8 | Strongly Agree/ Agree | 27 (40.9%) | 27 (36.5%) | 74 (40.9%) | 0.794 |
Disagree/ Strongly Disagree | 39 (59.1%) | 47 (63.5%) | 107 (59.1%) | ||
Other HPV screening (oral health), n (%) 8 | Strongly Agree/ Agree | 61 (91.0%) | 65 (87.8%) | 153 (85.0%) | 0.440 |
Disagree/ Strongly Disagree | 6 (9.0%) | 9 (12.2%) | 27 (15.0%) |
Perspectives on Concerns of Lesbian Patients | |||||||||
---|---|---|---|---|---|---|---|---|---|
Mammogram (n = 329) | Pap Smear (n = 323) | Other HPV (n = 322) | |||||||
OR | 95% CI | p-Value | OR | 95% CI | p-Value | OR | 95% CI | p-Value | |
Years in Practice | 0.040 | 0.067 | 0.102 | ||||||
>10 | 1.00 | Ref | 1.00 | Ref | 1.00 | Ref | |||
0–5 | 2.90 | (1.28, 6.59) | 0.011 | 2.25 | (0.99, 5.15) | 0.054 | 2.50 | (1.05, 5.96) | 0.039 |
6–10 | 1.18 | (0.61, 2.32) | 0.622 | 1.95 | (0.88, 4.33) | 0.101 | 1.43 | (0.67, 3.04) | 0.352 |
LGBTQ+ Training | 0.213 | 0.666 | 0.209 | ||||||
(Strongly) Disagree | 1.00 | Ref | 1.00 | Ref | 1.00 | Ref | |||
(Strongly) Agree | 1.62 | (0.86, 3.06) | 0.138 | 1.35 | (0.68, 2.71) | 0.392 | 1.13 | (0.58, 2.20) | 0.714 |
Neutral | 1.67 | (0.79, 3.51) | 0.181 | 1.23 | (0.56, 2.70) | 0.600 | 2.24 | (0.92, 5.47) | 0.077 |
Specialty | 0.207 | 0.099 | 0.243 | ||||||
Radiology | 1.00 | Ref | 1.00 | Ref | 1.00 | Ref | |||
Family/Internal Medicine | 2.02 | (0.98, 4.20) | 0.058 | 2.81 | (1.22, 6.49) | 0.015 | 2.28 | (1.01, 5.15) | 0.047 |
Medical/Radiation Oncology | 1.11 | (0.57, 2.14) | 0.761 | 1.39 | (0.69, 2.82) | 0.355 | 1.20 | (0.59, 2.44) | 0.618 |
Other | 2.04 | (0.65, 6.45) | 0.224 | 1.84 | (0.58, 5.85) | 0.301 | 1.63 | (0.51, 5.20) | 0.412 |
Gender | |||||||||
Female | 1.00 | Ref | 1.00 | Ref | 1.00 | Ref | |||
Male | 1.48 | (0.86, 2.54) | 0.156 | 1.02 | (0.57, 1.81) | 0.950 | 1.23 | (0.69, 2.20) | 0.491 |
Perspectives on Concerns of FTM Patients | |||||||||
Mammogram (n = 323) | Pap Smear (n = 313) | Other HPV (n = 312) | |||||||
OR | 95% CI | p-Value | OR | 95% CI | p-Value | OR | 95% CI | p-Value | |
Years in Practice | 0.223 | 0.456 | 0.633 | ||||||
>10 | 1.00 | Ref | 1.00 | Ref | 1.00 | Ref | |||
0–5 | 3.67 | (0.83, 16.26) | 0.087 | 1.94 | (0.69, 5.49) | 0.212 | 1.65 | (0.59, 4.63) | 0.343 |
6–10 | 1.30 | (0.45, 3.70) | 0.628 | 1.10 | (0.45, 2.71) | 0.838 | 1.18 | (0.46, 3.00) | 0.732 |
LGBTQ+ Training | 0.897 | 0.177 | 0.368 | ||||||
(Strongly) Disagree | 1.00 | Ref | 1.00 | Ref | 1.00 | Ref | |||
(Strongly) Agree | 1.25 | (0.49, 3.20) | 0.642 | 2.16 | (0.82, 5.67) | 0.120 | 1.89 | (0.75, 4.73) | 0.175 |
Neutral | 1.04 | (0.35, 3.11) | 0.945 | 0.78 | (0.31, 1.95) | 0.593 | 1.48 | (0.53, 4.09) | 0.455 |
Specialty | 0.137 | 0.291 | 0.730 | ||||||
Radiology | 1.00 | Ref | 1.00 | Ref | 1.00 | Ref | |||
Family/Internal Medicine | 6.24 | (1.33, 29.27) | 0.020 | 2.38 | (0.88, 6.42) | 0.088 | 1.67 | (0.62, 4.52) | 0.314 |
Medical/Radiation Oncology | 1.45 | (0.56, 3.75) | 0.444 | 1.74 | (0.68, 4.45) | 0.245 | 1.26 | (0.51, 3.14) | 0.615 |
Other | 1.15 | (0.31, 4.37) | 0.833 | 2.12 | (0.45, 9.94) | 0.342 | 1.74 | (0.37, 8.18) | 0.484 |
Gender | |||||||||
Female | 1.00 | Ref | 1.00 | Ref | 1.00 | Ref | |||
Male | 0.75 | (0.35, 1.65) | 0.478 | 1.23 | (0.60, 2.53) | 0.566 | 0.80 | (0.39, 1.66) | 0.552 |
Perspectives on Concerns of MTF Patients | |||||||||
Mammogram (n = 328) | Pap Smear (n = 314) | Other HPV (n = 314) | |||||||
OR | 95% CI | p-Value | OR | 95% CI | p-Value | OR | 95% CI | p-Value | |
Years in Practice | 0.310 | 0.706 | 0.656 | ||||||
>10 | 1.00 | Ref | 1.00 | Ref | 1.00 | Ref | |||
0–5 | 1.77 | (0.79, 3.94) | 0.164 | 1.03 | (0.57, 1.87) | 0.928 | 1.56 | (0.60, 4.04) | 0.363 |
6–10 | 0.91 | (0.46, 1.81) | 0.780 | 0.79 | (0.44, 1.44) | 0.445 | 1.05 | (0.45, 2.44) | 0.915 |
LGBTQ+ Training | 0.413 | 0.803 | 0.415 | ||||||
(Strongly) Disagree | 1.00 | Ref | 1.00 | Ref | 1.00 | Ref | |||
(Strongly) Agree | 1.48 | (0.76, 2.88) | 0.249 | 0.84 | (0.48, 1.47) | 0.550 | 1.37 | (0.62, 3.04) | 0.442 |
Neutral | 1.47 | (0.69, 3.10) | 0.319 | 0.86 | (0.46, 1.60) | 0.623 | 1.90 | (0.70, 5.16) | 0.207 |
Specialty | 0.044 | 0.794 | 0.886 | ||||||
Radiology | 1.00 | Ref | 1.00 | Ref | 1.00 | Ref | |||
Family/Internal Medicine | 1.28 | (0.58, 2.80) | 0.544 | 0.85 | (0.47, 1.56) | 0.604 | 1.16 | (0.47, 2.83) | 0.745 |
Medical/Radiation Oncology | 0.50 | (0.25, 0.98) | 0.043 | 0.93 | (0.50, 1.70) | 0.803 | 0.92 | (0.39, 2.16) | 0.853 |
Other | 0.47 | (0.18, 1.22) | 0.120 | 0.62 | (0.24, 1.63) | 0.332 | 1.68 | (0.36, 7.86) | 0.511 |
Gender | 0.891 | 0.976 | |||||||
Female | 1.00 | Ref | 1.00 | Ref | 1.00 | Ref | |||
Male | 0.84 | (0.48, 1.47) | 0.552 | 1.03 | (0.65, 1.65) | 0.891 | 1.01 | (0.51, 2.00) | 0.976 |
References
- Hollenbach, A.; Eckstrand, K.; Dreger, A. Implementing Curricular and Institutional Climate Changes to Improve Health Care for Individuals Who Are LGBT, Gender Nonconforming, or Born with DSD: A Resource for Medical Educators; Association of American Medical Colleges: Washington, DC, USA, 2014. [Google Scholar]
- Fredriksen-Goldsen, K.I.; Kim, H.J.; Barkan, S.E.; Muraco, A.; Hoy-Ellis, C.P. Health disparities among lesbian, gay, and bisexual older adults: Results from a population-based study. Am. J. Public Health 2013, 103, 1802–1809. [Google Scholar] [CrossRef]
- Charkhchi, P.; Schabath, M.B.; Carlos, R.C. Modifiers of Cancer Screening Prevention Among Sexual and Gender Minorities in the Behavioral Risk Factor Surveillance System. J. Am. Coll. Radiol. 2019, 16, 607–620. [Google Scholar] [CrossRef] [PubMed]
- Matthews, A.K.; Breen, E.; Kittiteerasack, P. Social Determinants of LGBT Cancer Health Inequities. Semin. Oncol. Nurs. 2018, 34, 12–20. [Google Scholar] [CrossRef]
- Arnold, E.; Dhingra, N. Health Care Inequities of Sexual and Gender Minority Patients. Dermatol. Clin. 2020, 38, 185–190. [Google Scholar] [CrossRef]
- Quinn, G.P.; Sanchez, J.A.; Sutton, S.K.; Vadaparampil, S.T.; Nguyen, G.T.; Green, B.L.; Kanetsky, P.A.; Schabath, M.B. Cancer and lesbian, gay, bisexual, transgender/transsexual, and queer/questioning (LGBTQ) populations. CA Cancer J. Clin. 2015, 65, 384–400. [Google Scholar] [CrossRef] [PubMed]
- Agénor, M.; Krieger, N.; Austin, S.B.; Haneuse, S.; Gottlieb, B.R. Sexual orientation disparities in Papanicolaou test use among US women: The role of sexual and reproductive health services. Am. J. Public Health 2014, 104, e68–e73. [Google Scholar] [CrossRef]
- Ceres, M.; Quinn, G.P.; Loscalzo, M.; Rice, D. Cancer Screening Considerations and Cancer Screening Uptake for Lesbian, Gay, Bisexual, and Transgender Persons. Semin. Oncol. Nurs. 2018, 34, 37–51. [Google Scholar] [CrossRef]
- Qureshi, R.; Zha, P.; Kim, S.; Hindin, P.; Naqvi, Z.; Holly, C.; Dubbs, W.; Ritch, W. Health Care Needs and Care Utilization Among Lesbian, Gay, Bisexual, and Transgender Populations in New Jersey. J. Homosex. 2018, 65, 167–180. [Google Scholar] [CrossRef]
- Lombardo, J.; Ko, K.; Shimada, A.; Nelson, N.; Wright, C.; Chen, J.; Maity, A.; Ruggiero, M.L.; Richard, S.; Papanagnou, D.; et al. Perceptions of and barriers to cancer screening by the sexual and gender minority community: A glimpse into the health care disparity. Cancer Causes Control 2022, 33, 559–582. [Google Scholar] [CrossRef]
- May, F.; Almario, C.V.; Ponce, N.; Spiegel, B.M.R. Racial minorities are more likely than whites to report lack of provider recommendation for colon cancer screening. Am. J. Gastroenterol. 2015, 110, 1388–1394. [Google Scholar] [CrossRef] [PubMed]
- Casey, L.S.; Reisner, S.L.; Findling, M.G.; Blendon, R.J.; Benson, J.M.; Sayde, J.M.; Miller, C. Discrimination in the United States: Experiences of lesbian, gay, bisexual, transgender, and queer Americans. Health Serv. Res. 2019, 54 (Suppl. S2), 1454–1466. [Google Scholar] [CrossRef] [PubMed]
- Lisy, K.; Peters, M.D.; Schofield, P.; Jefford, M. Experiences and unmet needs of lesbian, gay, and bisexual people with cancer care: A systematic review and meta-synthesis. Psycho-Oncology 2018, 27, 1480–1489. [Google Scholar] [CrossRef] [PubMed]
- Cathcart-Rake, E.J.; Breitkopf, C.R.; Kaur, J.; O’connor, J.; Ridgeway, J.L.; Jatoi, A. Teaching Health-Care Providers to Query Patients With Cancer About Sexual and Gender Minority (SGM) Status and Sexual Health. Am. J. Hosp. Palliat. Med. 2019, 36, 533–537. [Google Scholar] [CrossRef]
- Safdar, N.M. An Introduction to Health Disparities for the Practicing Radiologist. J. Am. Coll. Radiol. 2019, 16, 542–546. [Google Scholar] [CrossRef] [PubMed]
- Darwich, L.; Videla, S.; Cañadas, M.-P.; Piñol, M.; García-Cuyàs, F.; Vela, S.; Molina-López, R.A.; Coll, J.; Sirera, G.; Clotet, B. Distribution of human papillomavirus genotypes in anal cytological and histological specimens from HIV-infected men who have sex with men and men who have sex with women. Dis. Colon Rectum 2013, 56, 1043–1052. [Google Scholar] [CrossRef]
- Kathrins, M.; Kolon, T.F. Malignancy in disorders of sex development. Transl. Androl. Urol. 2016, 5, 794–798. [Google Scholar] [CrossRef]
- Pratt-Chapman, M.L.; Potter, J. Cancer Care Considerations for Sexual and Gender Minority Patients. Oncol. Issues 2019, 34, 26–36. [Google Scholar] [CrossRef]
- Goldenberg, T.; Reisner, S.L.; Harper, G.W.; Gamarel, K.E.; Stephenson, R. State-Level Transgender-Specific Policies, Race/Ethnicity, and Use of Medical Gender Affirmation Services among Transgender and Other Gender-Diverse People in the United States. Milbank Q. 2020, 98, 802–846. [Google Scholar] [CrossRef]
- Radix, A.; Maingi, S. LGBT Cultural Competence and Interventions to Help Oncology Nurses and Other Health Care Providers. Semin. Oncol. Nurs. 2018, 34, 80–89. [Google Scholar] [CrossRef]
- Felsenstein, D.R. Enhancing Lesbian, Gay, Bisexual, and Transgender Cultural Competence in a Midwestern Primary Care Clinic Setting. J. Nurses Prof. Dev. 2018, 34, 142–150. [Google Scholar] [CrossRef]
- Morris, M.; Cooper, R.L.; Ramesh, A.; Tabatabai, M.; Arcury, T.A.; Shinn, M.; Im, W.; Juarez, P.; Matthews-Juarez, P. Training to reduce LGBTQ-related bias among medical, nursing, and dental students and providers: A systematic review. BMC Med. Educ. 2019, 19, 325. [Google Scholar] [CrossRef] [PubMed]
- Donisi, V.; Amaddeo, F.; Zakrzewska, K.; Farinella, F.; Davis, R.; Gios, L.; Sherriff, N.; Zeeman, L.; Mcglynn, N.; Browne, K.; et al. Training healthcare professionals in LGBTI cultural competencies: Exploratory findings from the Health4LGBTI pilot project. Patient Educ. Couns. 2020, 103, 978–987. [Google Scholar] [CrossRef] [PubMed]
- Lee, M.; Tasa-Vinyals, E.; Gahagan, J. Improving the LGBTQ2S+ cultural competency of healthcare trainees: Advancing health professional education. Can. Med. Educ. J. 2021, 12, e7–e20. [Google Scholar] [CrossRef] [PubMed]
- Case, P.; Bryn Austin, S.; Hunter, D.J.; Manson, J.E.; Malspeis, S.; Willett, W.C.; Spiegelman, D. Sexual orientation, health risk factors, and physical functioning in the Nurses’ Health Study II. J. Women’s Health 2004, 13, 1033–1047. [Google Scholar] [CrossRef]
- Clavelle, K.; King, D.; Bazzi, A.R.; Fein-Zachary, V.; Potter, J. Breast Cancer Risk in Sexual Minority Women during Routine Screening at an Urban LGBT Health Center. Women’s Health Issues 2015, 25, 341–348. [Google Scholar] [CrossRef]
- Deutsch, M.B. Guidelines for the Primary Care of Transgender and Gender Nonbinary People; UCSF Transgender Care, Department of Family and Community Medicine, University of California San Francisco: San Francisco, CA, USA, 2016. [Google Scholar]
- Institute of Medicine (US) Committee on Lesbian, Gay, Bisexual, and Transgender Health Issues and Research Gaps and Opportunities. The Health of Lesbian, Gay, Bisexual, and Transgender People: Building a Foundation for Better Understanding; The National Academies Press: Washington, DC, USA, 2011. [Google Scholar]
- Eberman, L.E.; Winkelmann, Z.K.; Nye, E.A.; Walen, D.R.; Granger, K.C.; Walker, S.E. Providing Transgender Patient Care: Athletic Trainers’ Compassion and Lack of Preparedness. J. Athl. Train. 2021, 56, 252–262. [Google Scholar] [CrossRef]
- Joseph, A.; Cliffe, C.; Hillyard, M.; Majeed, A. Gender identity and the management of the transgender patient: A guide for non-specialists. J. R. Soc. Med. 2017, 110, 144–152. [Google Scholar] [CrossRef]
- Massie, J.P.; Streed, C.G., Jr.; Neira, P.M.; Morrison, S.D. Terminology in Transgender Patient Care. Plast. Reconstr. Surg. 2018, 141, 317e–318e. [Google Scholar] [CrossRef]
- Weyers, S.; Villeirs, G.; Vanherreweghe, E.; Verstraelen, H.; Monstrey, S.; Broecke, R.V.D.; Gerris, J. Mammography and breast sonography in transsexual women. Eur. J. Radiol. 2010, 74, 508–513. [Google Scholar] [CrossRef]
- Meads, C.; Moore, D. Breast cancer in lesbians and bisexual women: Systematic review of incidence, prevalence and risk studies. BMC Public Health 2013, 13, 1127. [Google Scholar] [CrossRef]
- Sterling, J.; Garcia, M.M. Cancer screening in the transgender population: A review of current guidelines, best practices, and a proposed care model. Transl. Androl. Urol. 2020, 9, 2771–2785. [Google Scholar] [CrossRef] [PubMed]
- Christensen, J.A.; Hunt, T.; Elsesser, S.A.; Jerpbak, C. Medical Student Perspectives on LGBTQ Health. PRiMER 2019, 3, 27. [Google Scholar] [CrossRef] [PubMed]
- Grasso, C.; Goldhammer, H.; Brown, R.J.; Furness, B.W. Using sexual orientation and gender identity data in electronic health records to assess for disparities in preventive health screening services. Int. J. Med. Inform. 2020, 142, 104245. [Google Scholar] [CrossRef] [PubMed]
- Nelson, N. Thomas Jefferson University LGBTQ Provider Survey—Dr. Nicole Simone.xlsx [Dataset]; FigShare: London, UK, 2023. [Google Scholar] [CrossRef]
Question | Response | All (n = 355) |
---|---|---|
Gender, n (%) 1 | Female Male Other | 192 (54.1%) 160 (45.1%) 1 (0.3%) |
How many years have you been in practice? n (%) | 0–5 6–10 >10 | 68 (19.2%) 77 (21.7%) 208 (58.6%) |
Which of the following best describes your practice, n (%) 2 | Family Medicine Gynecology Internal Medicine Medical Oncology Radiation Oncology Radiology Surgery Urology Other 3 | 43 (12.1%) 4 (1.1%) 53 (14.9%) 51 (14.4%) 30 (8.5%) 154 (43.4%) 7 (2.0%) 8 (2.3%) 5 (1.4%) |
Which of the following best describes the area you practice in? n (%) 2 | Rural Suburban Urban | 34 (9.6%) 117 (33.0%) 200 (56.3%) |
What region do you practice in? n (%) 2 | Mid-Atlantic Midwest Northeast South West Other 4 | 26 (7.3%) 84 (23.7%) 87 (24.5%) 72 (20.3%) 77 (21.7%) 5 (1.4%) |
Responded to “I Have Had Formal Training on Culturally-Competent Interactions with LGBTQ+ Patients”: | ||||
---|---|---|---|---|
Question | Response | Yes (Strongly Agree/ Agree, n = 100) | No (Disagree/ Strongly Disagree, n = 172) | p-Value |
Within the LGBTQ+ community, subpopulations have very different health issues, n (%) | Strongly Agree/ Agree | 92 (92.0%) | 147 (85.5%) | 0.171 |
Neutral | 5 (5.0%) | 20 (11.6%) | ||
Disagree/ Strongly Disagree | 3 (3.0%) | 5 (2.9%) | ||
It is important to know the sexual orientation of my patients to provide the best care, n (%) | Strongly Agree/ Agree | 67 (67.0%) | 74 (43.3%) | <0.001 |
Neutral | 21 (21.0%) | 42 (24.6%) | ||
Disagree/ Strongly Disagree | 12 (12.0%) | 55 (32.2%) | ||
I am confident I understand various health concerns unique to the LGBTQ+ community, n (%) | Strongly Agree/ Agree | 74 (74.8%) | 42 (24.6%) | <0.001 |
Neutral | 19 (19.2%) | 75 (43.9%) | ||
Disagree/ Strongly Disagree | 6 (6.0%) | 54 (31.6%) | ||
Given the option, I would want to be included in a list of “LGBTQ+-friendly” practices that would be accessible online and/or in an LGBTQ+ publication, n (%) | Strongly Agree/ Agree | 88 (88.9%) | 125 (73.1%) | 0.005 |
Neutral | 7 (7.1%) | 36 (21.1%) | ||
Disagree/ Strongly Disagree | 4 (4.0%) | 10 (5.9%) |
Question | Response | All (n = 355) | Family or Internal Medicine (n = 96) | Medical or Radiation Oncology (n = 82) | Radiology (n = 154) | Other (n = 23) | p-Value |
---|---|---|---|---|---|---|---|
Within the LGBTQ+ community, subpopulations have very different health issues, n (%) | Strongly Agree/Agree | 303 (85.4%) | 93 (96.9%) | 73 (89.0%) | 118 (76.6%) | 19 (82.6%) | <0.001 |
Neutral | 42 (11.8%) | 3 (3.1%) | 7 (8.5%) | 29 (18.8%) | 3 (13.0%) | ||
Disagree/Strongly Disagree | 9 (2.5%) | 0 (0.0%) | 1 (1.2%) | 7 (4.5%) | 1 (4.3%) | ||
Lesbian patients have concerns with: | |||||||
Mammogram screening, n (%) 1 | Strongly Agree/Agree | 255 (71.8%) | 82 (85.4%) | 59 (72.0%) | 95 (61.7%) | 19 (82.6%) | 0.010 |
Disagree/Strongly Disagree | 84 (23.7%) | 14 (14.6%) | 19 (23.2%) | 47 (30.5%) | 4 (17.4%) | ||
Pap smear screening, n (%) 2 | Strongly Agree/Agree | 265 (74.6%) | 87 (90.6%) | 63 (76.8%) | 96 (62.3%) | 19 (82.6%) | 0.002 |
Disagree/Strongly Disagree | 68 (19.2%) | 9 (9.4%) | 15 (18.3%) | 40 (26.0%) | 4 (17.4%) | ||
Other HPV screening (oral health), n (%) 3 | Strongly Agree/Agree | 265 (74.6%) | 86 (89.6%) | 62 (75.6%) | 98 (63.6%) | 19 (82.6%) | 0.010 |
Disagree/Strongly Disagree | 67 (18.9%) | 10 (10.4%) | 15 (18.3%) | 38 (24.7%) | 4 (17.4%) | ||
Female-to-male transgender patients [trans men] 9 have concerns with: | |||||||
Mammogram screening, n (%) 4 | Strongly Agree/Agree | 300 (84.5%) | 93 (96.9%) | 67 (81.7%) | 120 (77.9%) | 20 (87.0%) | 0.009 |
Disagree/Strongly Disagree | 32 (9.0%) | 2 (2.1%) | 8 (9.8%) | 19 (12.3%) | 3 (13.0%) | ||
Pap smear screening, n (%) 5 | Strongly Agree/Agree | 283 (79.7%) | 88 (91.7%) | 68 (82.9%) | 107 (69.5%) | 20 (87.0%) | 0.140 |
Disagree/Strongly Disagree | 38 (10.7%) | 7 (7.3%) | 7 (8.5%) | 22 (14.3%) | 2 (8.7%) | ||
Other HPV screening (oral health), n (%) 6 | Strongly Agree/Agree | 283 (79.7%) | 88 (91.7%) | 66 (80.5%) | 109 (70.8%) | 20 (87.0%) | 0.315 |
Disagree/Strongly Disagree | 37 (10.4%) | 7 (7.3%) | 8 (9.8%) | 20 (13.0%) | 2 (8.7%) | ||
Male-to-female transgender patients [trans women] 9 have concerns with: | |||||||
Mammogram screening, n (%) 7 | Strongly Agree/Agree | 267 (75.2%) | 83 (86.5%) | 54 (65.9%) | 115 (74.7%) | 15 (65.2%) | 0.027 |
Disagree/Strongly Disagree | 70 (19.7%) | 13 (13.5%) | 22 (26.8%) | 27 (17.5%) | 8 (34.8%) | ||
Pap smear screening, n (%) 8 | Strongly Agree/Agree | 128 (36.1%) | 34 (35.4%) | 32 (39.0%) | 56 (36.4%) | 6 (26.1%) | 0.368 |
Disagree/Strongly Disagree | 194 (54.6%) | 62 (64.6%) | 42 (51.2%) | 74 (48.1%) | 16 (69.6%) | ||
Other HPV screening (oral health), n (%) 8 | Strongly Agree/Agree | 280 (78.9%) | 86 (89.6%) | 64 (78.0%) | 110 (71.4%) | 20 (87.0%) | 0.729 |
Disagree/Strongly Disagree | 42 (11.8%) | 10 (10.4%) | 10 (12.2%) | 20 (13.0%) | 2 (8.7%) |
Responded to “I Have Had Formal Training on Culturally-Competent Interactions with LGBTQ+ Patients”: | ||||
---|---|---|---|---|
Question | Response | Yes (Strongly Agree/ Agree, n = 100) | No (Disagree/ Strongly Disagree, n = 172) | p-Value |
Lesbian patients have concerns with: | ||||
Mammogram screening, n (%) 1 | Strongly Agree/ Agree | 79 (80.6%) | 112 (68.7%) | 0.036 |
Disagree/ Strongly Disagree | 19 (19.4%) | 51 (31.3%) | ||
Pap smear screening, n (%) 2 | Strongly Agree/ Agree | 81 (84.4%) | 119 (74.8%) | 0.073 |
Disagree/ Strongly Disagree | 15 (15.6%) | 40 (25.2%) | ||
Other HPV screening (oral health), n (%) 3 | Strongly Agree/ Agree | 77 (81.1%) | 119 (74.8%) | 0.254 |
Disagree/ Strongly Disagree | 18 (19.0%) | 40 (25.2%) | ||
Female-to-male transgender patients have concerns with: | ||||
Mammogram screening, n (%) 4 | Strongly Agree/ Agree | 92 (92.9%) | 142 (88.2%) | 0.217 |
Disagree/ Strongly Disagree | 7 (7.1%) | 19 (11.8%) | ||
Pap smear screening, n (%) 5 | Strongly Agree/ Agree | 90 (93.8%) | 131 (85.1%) | 0.037 |
Disagree/ Strongly Disagree | 6 (6.3%) | 23 (14.9%) | ||
Other HPV screening (oral health), n (%) 5 | Strongly Agree/ Agree | 89 (92.7%) | 130 (84.4%) | 0.053 |
Disagree/ Strongly Disagree | 7 (7.3%) | 24 (15.6%) | ||
Male-to-female transgender patients have concerns with: | ||||
Mammogram screening, n (%) 1 | Strongly Agree/ Agree | 82 (82.8%) | 122 (75.3%) | 0.154 |
Disagree/ Strongly Disagree | 17 (17.2%) | 40 (24.7%) | ||
Pap smear screening, n (%) 6 | Strongly Agree/ Agree | 36 (37.5%) | 65 (42.8%) | 0.411 |
Disagree/ Strongly Disagree | 60 (62.5%) | 87 (57.2%) | ||
Other HPV screening (oral health), n (%) 6 | Strongly Agree/ Agree | 85 (88.5%) | 127 (83.6%) | 0.277 |
Disagree/ Strongly Disagree | 11 (11.5%) | 25 (16.5%) |
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Share and Cite
Nelson, N.G.; Lombardo, J.F.; Shimada, A.; Ruggiero, M.L.; Smith, A.P.; Ko, K.; Leader, A.E.; Mitchell, E.P.; Simone, N.L. Physician Perceptions on Cancer Screening for LGBTQ+ Patients. Cancers 2023, 15, 3017. https://doi.org/10.3390/cancers15113017
Nelson NG, Lombardo JF, Shimada A, Ruggiero ML, Smith AP, Ko K, Leader AE, Mitchell EP, Simone NL. Physician Perceptions on Cancer Screening for LGBTQ+ Patients. Cancers. 2023; 15(11):3017. https://doi.org/10.3390/cancers15113017
Chicago/Turabian StyleNelson, Nicolas G., Joseph F. Lombardo, Ayako Shimada, Marissa L. Ruggiero, Alexandria P. Smith, Kevin Ko, Amy E. Leader, Edith P. Mitchell, and Nicole L. Simone. 2023. "Physician Perceptions on Cancer Screening for LGBTQ+ Patients" Cancers 15, no. 11: 3017. https://doi.org/10.3390/cancers15113017
APA StyleNelson, N. G., Lombardo, J. F., Shimada, A., Ruggiero, M. L., Smith, A. P., Ko, K., Leader, A. E., Mitchell, E. P., & Simone, N. L. (2023). Physician Perceptions on Cancer Screening for LGBTQ+ Patients. Cancers, 15(11), 3017. https://doi.org/10.3390/cancers15113017