Become a Welcoming Space: Small Steps Make A Great Impact

Today in the United States, 7% of adults self-identify as lesbian, gay, bisexual, transgender, queer, or other than heterosexual (LGBTQ+). Compared to previous generations, more US adults who fall into the millennial and Generation Z cohorts show a higher prevalence of LGBTQ+ identification. Approximately, 21% of Americans in the Gen Z generation identify as LGBTQ+, double that of millennials.

All people deserve the right to medical care without the concern of being mistreated, judged, or outright denied service. For many minority groups, including the LGBTQ+ community, they often delay health care because of past experiences of neglect or poor treatment. In fact, a survey conducted by the Center for American Progress found that LGBTQ+ people experience discrimination in health care settings which in turn discourages them from seeking future care. Discrimination, perceived or real, can endanger people’s lives through delays or denials of medically necessary care.

Understanding this, the Association of Community Cancer Centers (ACCC) has developed an initiative titled: Multidisciplinary Approaches to Addressing the Needs of Patients with Gynecologic Cancers. The aims of the initiative include:

• Identifying challenges, and practical solutions, in the implementation of best practices for cross-team care coordination and facilitate improved gynecologic oncology patient financial navigation.
• Identifying and assessing necessary components for the provision of high-quality multidisciplinary care delivery for ALL patients with gynecologic cancers.
  

As a part of this initiative, ACCCBuzz had an opportunity to speak with Scout, PhD, MA, executive director of the National LGBT Cancer Network in Providence, Rhode Island, and Al Asante PA-C, MBA, ACP supervisor, Gynecologic Oncology at Lenox Hill Hospital in New York, New York about their work on the Welcoming Spaces educational series, developed by a partnership of the Society of Gynecologic Oncology and the National LGBTQ Cancer Network, for anyone who works in health care and specifically for providers and administrative staff who provide gynecologic cancer care to transgender and gender non-conforming patients.

ACCCBuzz: Tell us the cause or need for the Welcoming Spaces training.

Scout: We were aware of some trainings that have been made on the subject, but they were not free or easily accessible. Sixty percent of oncologists have noted they do not know enough to treat gender minority patients. Seeing a need, we worked with industry funders and The Society for Gynecologic Oncology to try to get training out there for LGBTQIA cultural humility. We wanted to make a resource available to close the knowledge gap that could be completed at your own pace, own speed, and receive continuing education credits for it.

Al: Overall, there is a need for cultural competence in all of health care, but certainly in gynecologic oncology generally. Our aim is to get gyn care providers motivated to get involved in this work.

ACCCBuzz: How have you informed the provider community that this training is available?

Scout: We have been promoting the training through a road show of sorts – promoting available resources at conferences, such as ASCO, National Comprehensive Cancer Network, etc., and at over 50 other trainings and webinars last year alone. We are examining ways to offer the training as a standard resource at certain provider nexus points.

Al: We have been promoting it through the Society of Gynecologic Oncology, LGBTQ cancer network, and conferences. I have personally promoted it in New York City as a continuing medical education opportunity.

ACCCBuzz: How is it most appropriate for providers to identify how the patient defines themselves?

Scout: Providers need to show they are a safe space to share information before patients will feel comfortable being open and trusting them. Give us a sign, such as a LGBTQ welcoming message on the website, non-discrimination statements hung around the office, or pronouns on your lanyard. 

Al: Learn how to ask. The first thing providers can do is collect the information on their intake paperwork, such as assigned sex at birth, sexual orientation, etc. Second, include it as part of the discussion when meeting the patient. Such as, I use the following pronouns, what about you? And ask if they have a preferred name.

ACCCBuzz: What resources should providers have available in their offices to show it is a welcoming space?

Scout: There are things both outward and inward facing that can be done. A website with a visible welcome message, training intake staff to ask questions on preferred name and pronouns, reinforce the physical environment with a nondiscrimination statement posted or a sign saying all are welcome physically posted. Visible pronoun pins with logo of org on it. Pronoun choice with business logo.

“We aren’t expecting perfection, so don’t aim for it. Just give us a clue that you are meeting us where we are.”

Al: Physical environment is an easy way to note that your organization is welcoming such as some sort of diversity signage (all are welcome here), rainbow signs, pins, provider pronouns on website and welcome letter. Gender neutral bathrooms (noted as such). Collect data using the sexual orientation and gender identity (SOGI) data form. If you don’t explicitly collect this information, it is lost.

ACCCBuzz: Why is it important for gynecological providers specifically to be a welcoming space?

Scout: Two major points- know that stereotypes end up missing people. For transgender people specifically, you are asking us to screen body parts that we don’t think we have. We need providers to help us get over hesitancy, and more provider assistance to get routine medical care. Second, cancer screening programs are often gendered, such as “women’s health.” This marketing strategy is missing part of the patient population that needs the screening. Also, providers need to better engage with this high-risk population. Assumptions can start the relationship off on the wrong foot and prevent future visits.

Al: For transgender people specifically, screenings such as a pap test or mammogram remind you of your femaleness that you don’t identify with. This can make even the most welcoming provider uncomfortable for the patient. Providers need to work with this population to get over the emotional hurdles of necessary health screenings.

ACCCBuzz: Is there anything else you would like to add?

Scout: The National LGBT Cancer Network has free resources available that can be tailored (including co-branded) to any member organizations.

Al: We aren’t looking to change clinical management yet. We are working to train providers to better engage with their patients - get to know them as people to take care of them as people.

The Welcoming Spaces educational series has been generously supported by independent education grants from AstraZeneca, BMS GSK, Merck, and Seagen.

The Multidisciplinary Approaches to Addressing the Needs of Patients with Gynecologic Cancers initiative is supported by AstraZeneca and GlaxoSmithKline.