Disparities in Cancer Care: Gay Men and Lesbians

Background and Purpose: Medical and public health literature suggest that gay and lesbian individuals have increased risk factors that lead to major illnesses. These risks include: (a) increased tobacco usage, (b) increased alcohol consumption, (c) decreased adherence and screening, (d) increased nulliparity rates, (e) decreased birth control usage for females, and (f) increased body mass (i.e., overweight or obesity) for females (Boehmer, Bowen, & Bauer, 2007; Cochran et al., 2001; Diamant & Wold, 2003; Gruskin & Gordon, 2006). Yet, many gay men and lesbians face individual and institutionally based barriers in accessing the health care system and maximizing health care services (Diamant, Wold, Spritzer, & Gelberg, 2000; Kerker, 2006). The purpose of this study was to explore oncology social workers experiences of patients diagnosed with lung cancer. Among the findings were important indicators regarding their practice with patients who are gay or lesbian. This paper explores those findings. Methods: This qualitative study used a phenomenological approach to explore oncology social workers experiences of patients diagnosed with lung cancer. A purposive sample of eighteen oncology social workers were recruited between June 2007 and August 2007 from the top fifty U.S. cancer hospitals as defined by U.S. News & World Report (2007). Inclusion criteria consisted of social workers who a) were currently employed as oncology social workers in a medical facility, b) had a Master in Social Work degree, c) were licensed by the state in which they were employed, and d) had at least three months full-time experience providing direct care to people diagnosed with lung cancer. Oncology social workers who did not meet all of the inclusion criteria and/or functioned in a supervisory role were excluded from the study. Each oncology social worker participated in one audiotaped telephone interview lasting approximately 40 minutes. The interview was semi-structured using open-ended questions. Participants were asked to describe their work environment, describe any observed differences between people diagnosed with lung cancer and those diagnosed with other cancers, talk about a memorable case, and describe differences based on age, sex, sexual orientation, and ethnicity/race. Transcripts of these interviews were analyzed using a psychological phenomenological approach (Moustakas, 1994; Polkinghorne, 1994) to find themes and concepts that developed into meaning. Resulting themes and concepts were emailed back to the participants for member verification. Results: Several themes and sub-themes emerged under the topic of sexual orientation. Results suggest that oncology social workers either take a pro-active approach or a no-difference approach when it comes to the sexual orientation of their patients. Sub-themes of the pro-active approach include legalities, role of partner, and role of family, while sub-themes of the no-difference approach include privacy, irrelevancy, and difficulty in determining if a patient is gay. Conclusions and Implications: The findings from this study suggest continued disparity in healthcare for lesbians and gay men. It highlights the need for education that would promote culturally competent practice based on an understanding of the distinct needs and specific issues of the gay and lesbian population.