An evaluation of self-perceived knowledge, attitudes and behaviours of UK oncologists about LGBTQ+ patients with cancer

Abstract

IntroductionOver one million people in the UK identify as LGBTQ+ (lesbian, gay, bisexual, transgender, queer or questioning). Research has shown that this population experience differing cancer risk factors compared with non-LGBTQ+ patients and persistent inequalities in cancer care. Literature concerning the knowledge of oncologists of this group’s healthcare needs is limited; our study aimed to evaluate knowledge, attitudes and behaviours of UK oncologists about LGBTQ+ patients.MethodsA 53-question survey was delivered via a secure online platform. Questions covered respondent demographics, knowledge, attitudes and behaviours with the majority of responses on a Likert scale. Oncologists were recruited via email from professional bodies and social media promotion. Informed consent was sought and responses fully anonymised. Multifactorial ordinal logistic regression and Fisher’s exact test were used to assess for interactions between demographics and responses with Holm-Bonferroni multiple testing correction.Results258 fully completed responses were received. Respondents had a median age of 43 years (range 28–69); 65% consultants and 35% registrars; 42% medical, and 54% clinical, oncologists. 84% felt comfortable treating LGBTQ+ patients but only 8% agreed that they were confident in their knowledge of specific LGBTQ+ patient healthcare needs. There were low rates of routine enquiry about sexual orientation (5%), gender identity (3%) and preferred pronouns (2%). 68% of oncologists felt LGBTQ+ healthcare needs should be a mandatory component of postgraduate training.ConclusionsThis survey showed that UK oncologists feel comfortable treating LGBTQ+ patients but may fail to identify these patients in their clinic, making it more difficult to meet LGBTQ+ healthcare needs. There is self-awareness of deficits in knowledge of LGBTQ+ healthcare and a willingness to address this through postgraduate training. Educational resources collated and developed in accordance with this study would potentially improve the confidence of oncologists in treating LGBTQ+ patients and the cancer care these patients receive.

Developing UK Guidance on How Long Men Should Abstain from Receiving Anal Sex before, During and after Interventions for Prostate Cancer

“…Furthermore, only 13% said they ask about anal sex if they are aware their patient is gay or bisexual. Similarly, in a recent survey of UK oncologists, 5% said they ask about a patient's sexual orientation as part of their consultation and just 8% felt confident in their knowledge of the specific healthcare needs of LGBTQþ patients [10].…”

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“…These studies are limited by small sample sizes [42] and lack of focus on UK genetic counselling curricula [6]. However, these figures are alarming, especially the finding that only 8% of UK oncologists felt confident in their knowledge of the specific healthcare needs of LGBT + cancer patients (43). To equip future clinicians with the knowledge and skills to ensure equally high standards of care, it is imperative that their curricula adequately cover topics relevant to trans patients, including, but not limited to, cultural competencies.…”

Education to Improve Cancer Care for LGBTQ+ Patients in the UK

“…The differential impact of COVID-19 on Black and ethnic minority communities has highlighted this again, but other minority groups experience health inequalities and have unique healthcare needs. Members of the LGBTQþ (lesbian, gay, bisexual, queer or questioning) community are another such group and two recent articles have highlighted the importance of education for UK oncologists and other cancer care professionals in helping to achieve the best possible outcomes for these patients [1,2].…”

“…It is estimated that 3% of adults in the UK identify as lesbian, gay or bisexual (LGB), a sexual orientation other than heterosexual, and about 0.5% of adults identify as transgender, with up to 4.5% identifying as gender diverse [2]. Disclosure rates for LGBTQþ identities are increasing with successive generations and as cancer is mostly a disease of aging, increasing numbers of this population will be treated within oncology services.…”

“…In their systematic review, Webster and Drury-Smith [1] found 'improvement of healthcare professionals' knowledge and education' as one of its five key themes in improving the support of LGBTQþ patients in oncology. A UK-wide study highlighted the need and desire among UK oncologists for further education on this topic [2]. Over 10% of UK consultant and trainee oncologists (medical and clinical) participated.…”