In blog one of our Pride series, we’re talking about communication. This series was written to help healthcare providers improve the cancer care experience for LGBTQ2+ patients.
LGBTQ2+ individuals with cancer may have unique concerns and priorities compared to their heterosexual/cisgender counterparts. In order for healthcare providers to address these concerns, they need to be aware of their patients’ sexual orientation and gender identity. Therefore, when it comes to working with LGBTQ2+ individuals in healthcare settings, communication around sexual orientation and gender identity is key!
In a 2015 online study of 291 LGBT cancer survivors (Kamen et al., 2015), the majority of participants (230, or 79%) disclosed their LGBT identity to at least one healthcare provider. Of those 230 participants, 65% disclosed their identity in order to correct assumptions made by their healthcare provider that they were heterosexual. Only approximately 19% disclosed their sexual orientation/gender identity because a healthcare provider asked them about it. Across all identities, bisexual individuals were the least likely to disclose their sexual orientation to a healthcare provider; those with a same-gender partner were more likely to disclose their sexual orientation than single individuals.
Participants in a UK-based interview study of 15 lesbian, gay, and bisexual individuals with a previous cancer diagnosis described feeling like they had a lack of opportunity to disclose their sexual orientation to their healthcare provider (Fish & Williamson, 2016). Some participants described hoping that their healthcare providers would tune into clues about their sexual orientation and start a conversation; this often did not occur, and heterosexual assumptions were common. To quote one participant (“Quentin”, age 56, gay man with prostate cancer): “It’s a funny thing because it’s almost, there isn’t the opportunity in some ways. [My partner] has been with me to various appointments…and I have not found there is that opportunity, people don’t ask” (p. 5). Other participants described being open and up-front about their sexual orientation, such as “Craig” (age 59, gay man with prostate cancer): “Well there is no need to be apologetic and I think if you are out front with it, it doesn’t give people any cause for ambiguity” (p. 5). Despite many participants wanting either to disclose their sexual orientation, or for their healthcare providers to ask about it, still other participants felt that their sexual orientation was irrelevant to cancer treatment, or feared possible negative reactions from healthcare providers in response to their coming out.
What can we take away from these findings? For effective communication, it’s important not to make assumptions about individuals’ sexual orientations and gender identities. By asking about patients’ sexual orientation and gender identity, healthcare providers can avoid making harmful assumptions and can open the door for communication around topics that might be especially relevant to patients of diverse sexual orientations and/or gender identities. Some patients may not feel that their sexual orientation/gender identity is relevant to their cancer care, and healthcare providers should respect this perspective, as well. Most importantly, the healthcare setting in which this communication takes place needs to be safe, accepting, and welcoming, so that participants feel comfortable disclosing their identity to their providers.
Fish, J., & Williamson, I. (2016). Exploring lesbian, gay and bisexual patients’ accounts of their experiences of cancer care in the UK. European Journal of Cancer Care, 27(1) https://doi.org/10.1111/ecc.12501
Kamen, C., Smith-Stoner, M., Heckler, C., Flannery, M., & Margolies, L. (2015). Social support, self-rated health, and lesbian, gay, bisexual, and transgender identity disclosure to cancer care providers. Oncology Nursing Forum, 42(1), 44–51. https://doi.org/10.1188/15.ONF…
Photo credit: Zachary Drucker The Gender Spectrum Collection