We know that a welcoming and affirming healthcare environment can make a difference to sexual and gender minority patients. There’s also a lot written about what kinds of things are helpful, like visual cues (such as safe space stickers, pride flags), staff education and better policies and processes. What’s less discussed is HOW these things happen. Some are mandated (for example, a change in national policy dealing with the collection of patient data about sexual orientation or gender identity). But some (maybe the best) changes come from inside the organisation, from a group of passionate healthcare professionals who see the need for better patient care. One example of such a group that we’d like to highlight is the Sexual and Gender Diversity in Cancer Care (SGDc) Program at Canada’s largest cancer centre, Princess Margaret Hospital in Toronto.
The program started about two years ago, when co-leads Dr. Christian Schulz-Quach (a psychiatrist working with cancer patients) and Margo Kennedy (an oncology social worker) identified a need for change to improve the local cancer care experience for sexual and gender diverse patients and (chosen) families. The program includes 2SLGBTQIA+ healthcare professions and people working with and for patients at Princess Margaret. They provide cancer information specific to queer, trans and non-binary patients, caregivers and chosen families and connect them with supports and services tailored to their needs. The program serves as an important point of contact for Princess Margaret’s healthcare professionals, providing education and consultation. The SGDc has also presented at a national and international level and is currently conducting research into the needs of their patient population. This year the program celebrated Pride with several local events and collaborations and ended off with the SGDc marching in its first ever Toronto Pride parade!
A unique feature of the program is the new part time role within the Department of Supportive Care. Margo Kennedy, program co-lead, began supporting queer, trans and non-binary patients, caregivers and chosen families who can self-refer or be referred to her from other departments. We asked Margo about her role, and if she felt her sexual orientation makes a difference to patients and their chosen families:
I think as a out, proud, lesbian social worker, it is a definite advantage, it makes it easy for me to cut through silence and explore issues or questions that might be on the patient’s mind, to ask questions in a compassionate but direct way – that may be harder for heterosexual HCP’s. My personal experience also gives more insight about issues to explore, that may not even come to mind for some of my colleagues.
Sometimes staff can be unsure about how to respond in an affirming way, when patients share their sexual orientation and/or gender identity. Staff may feel concerned that they will say the wrong thing or be unsure where to take a conversation after asking about pronouns. Pronouns are just the beginning of the conversation, and may not reveal any information about a patient’s gender identity or sexual orientation. It is so important to ask open ended, gender neutral questions, to not make assumptions and to listen carefully.
Many healthcare professionals are cautious about sharing their sexual orientation or gender identities at work. Healthcare can be very conservative, and additionally queer, trans and non-binary people may fear being discriminated against or being seen as “unprofessional”. However, Margo’s experience illustrates that, for some patients, out and proud healthcare professionals can make a difference:
I think when I am out, it is a definite relief for some patients, even when they don’t verbalize it, I can sometimes tell by their expression and body language. I always feel especially connected to this patient group … they don’t have to worry about feeling awkward or making me feel “uncomfortable”. They can have the freedom to relax, just be without judgment, just be cared about and taken care of. Isn’t this what every patient should expect? “They” becomes “we and us”, not “other”. Patient’s who come out at such a vulnerable time when so much is at stake, always inspire me. If they can be “out”, it reminds me that I can be out as well. That is a gift too hard to walk away from.
QC founder Dr. Amanda Bolderston is currently the SGDc inaugural post-doctoral fellow, working with the group to look at the experiences of sexual and gender diverse oncology staff. The SGDc hopes the post-doctoral role will continue to attract researchers who want to improve the care of sexual and gender diverse people affected by cancer. We hope the model that the SGDc has developed will be taken up by other cancer centres, and QC are excited to be working with them!
For more information, check out the SGDc’s website where they have information for patients and healthcare professionals including the downloadable Toronto-based “SGD and Cancer: A Guide to Resources in the Community” and the “Need A Break From Cancer?” resource to support self-care and coping for SGDc patients. You can also find them on social media at @PMChosenFamily.