LGBTQ+ Inclusive Cancer Care: Understanding Cancer Care Providers’ Competencies

Background: LGBTQ+ populations have higher rates of cancer risk behaviours (e.g., smoking) and specific cancers (e.g., colorectal cancer; Boehmer et al., 2012; Matthews et al., 2018). In healthcare settings, including cancer care LGBTQ+ people face discrimination (Arthur et al, 2021; Haviland et al., 2020). The lack of LGBTQ+ cultural competencies among staff is a barrier to inclusive cancer care (Squires et al., 2022; Ussher et al., 2022). Policy directives promote inclusive cancer care, yet little is known about staff’s LGBTQ+ views, practices, and knowledge.

We examine cancer care staff’s LGBTQ+ competencies and explore the role of past LGBTQ+ training/education and LGBTQ+ social contacts. Research suggests these variables may be influential (Jaffee et al., 2016).

Methods: The study was implemented in partnership with a cancer clinic in Ontario, Canada as part a LGBTQ+ inclusion project. We conducted a consensus with clinic employees inviting them to complete an anonymous survey. Recruitment included emails, e-posters, flyers, and presentations; participants could enter a draw (RR=61.6%; n=180, 91.6% women, 8.3% POC, 6.1% LGBTQ+, M=39yrs old, M=8.71yrs in cancer care, 71.7% clinicians).

We created LGBTQ+ competency measures based on existing scales (e.g., Kattari et al., 2018) and researcher-created items. Competency measures comprised 5 scales: LGBTQ+ attitudes (9-items, α=.91), personal comfort (4-items, α=.66), inclusive service provision knowledge (3-items, α=.78), inclusive service provision practice (3-items, α=.68), and inclusive pronoun practice (3-items, α=. .69); and the LGBTQ+ knowledge index (20-items, e.g., difference between sex and gender, α=NA). Scales used Likert-scale-type responses (theoretical range 1—6); index options were true, false, and don’t know options, with responses coded as correct/incorrect (theoretical range 0—20). Higher scores indicate greater competencies. Past LGBTQ+ training/education was binary (no/yes). LGBTQ social contacts included friends and acquaintances (none—7+).

Results: Mean scores were higher for views-related competencies (attitudes M=4.96 [SD=0.88], comfort M=4.89 [SD=0.94)] than inclusive service provision knowledge, M=3.85 (SD=1.19), inclusive service provision practice, M=3.70 (SD=1.15), and inclusive pronoun practices, M=1.84 (SD=0.82). The mean score for general LGBTQ+ knowledge was 11.66 (SD=4.54).

Bivariate analysis indicated all competency scores were significantly higher among participants who reported past LGBTQ+ training/education and those who had more LGBTQ+ friends and acquaintances (r=.20—.55, p=.003—<.001)

To further understand the nature of participants’ competencies, we conducted linear multivariable regressions inclusive of the three predictors (control: clinician/support staff). Past training/education positively predicted inclusive service provision practice, pronoun practice, and general knowledge scores (β=.14—.28, p=.002—.04). LGBTQ+ friends positively predicted all outcomes (β=.18—.38, p=.002—<.001) except inclusive service provision knowledge and inclusive service provision practice. Acquaintances positively predicted views-related competencies, inclusive service provision practice, and general knowledge (β=.22—.35, p=.006—<.001).

Conclusion: The findings illuminate the LGBTQ+ competency levels of cancer care staff and the differing role of past LGBTQ+ education/training and LGBTQ+ contacts on outcomes. Descriptive findings highlight the need to address general LGBTQ+ knowledge, and competences related to inclusion knowledge and practices, including pronouns. We will outline implications for future research, including regarding measures, and staff training, and suggest pedagogical strategies that could be implemented with this population.