Intersectionality and Shared Decision Making in LGBTQ Health

Ng, Henry

doi:10.1089/lgbt.2016.0115

Cited by 24 publications

(16 citation statements)

References 20 publications

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“…There may also be sociocultural factors at play in this and our study lacked the geographic data to look at differences between oncologists treating patients in rural versus urban settings, or with populations of differing socioeconomic status. We also acknowledge the greater levels of healthcare inequality and discrimination that may be faced by a trans person of colour or who has a disability, and that we have not examined knowledge of the importance of intersectionality healthcare 40 in this study. Further studies on this topic are warranted, but are beyond the scope of this work.…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2020

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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.

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Section: Discussionmentioning

confidence: 99%

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

et al. 2020

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“…TGD people who belong to racial and ethnic minority groups face even more challenges [31]. Intersectionality acknowledges that identity is multidimensional and is impacted on by historical, structural, and cultural factors [32,33]. Ng [33] eloquently explains that "Practicing medicine through the lens of intersectionality proactively considers patients' diverse identities and how the sociocultural factors associated with membership in multiple minority groups can affect their health risks and health care experiences, and ultimately health decision making and health outcomes" [33].…”

Section: Brief History Of Pathologisation Diagnostic and Statisticalmentioning

confidence: 99%

“…Intersectionality acknowledges that identity is multidimensional and is impacted on by historical, structural, and cultural factors [32,33]. Ng [33] eloquently explains that "Practicing medicine through the lens of intersectionality proactively considers patients' diverse identities and how the sociocultural factors associated with membership in multiple minority groups can affect their health risks and health care experiences, and ultimately health decision making and health outcomes" [33]. It is thus important to keep in mind that despite a shared marginalised identity, TGD people are not a homogenous group, and that sub-groups and individuals may have different health care needs.…”

Section: Brief History Of Pathologisation Diagnostic and Statisticalmentioning

confidence: 99%

Debate: Why should gender-affirming health care be included in health science curricula?

2020

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Background: Every person who seeks health care should be affirmed, respected, understood, and not judged. However, trans and gender diverse people have experienced significant marginalization and discrimination in health care settings. Health professionals are generally not adequately prepared by current curricula to provide appropriate healthcare to trans and gender diverse people. This strongly implies that health care students would benefit from curricula which facilitate learning about gender-affirming health care. Main body: Trans and gender diverse people have been pathologized by the medical profession, through classifications of mental illness in the Diagnostic and Statistical Manual of Mental Disorders (DSM) and International Classification of Disease (ICD). Although this is changing in the new ICD-11, tension remains between depathologization discourses and access to gender-affirming health care. Trans and gender diverse people experience significant health disparities and an increased burden of disease, specifically in the areas of mental health, Human Immunodeficiency Virus, violence and victimisation. Many of these health disparities originate from discrimination and systemic biases that decrease access to care, as well as from health professional ignorance. This paper will outline gaps in health science curricula that have been described in different contexts, and specific educational interventions that have attempted to improve awareness, knowledge and skills related to genderaffirming health care. The education of primary care providers is critical, as in much of the world, specialist services for gender-affirming health care are not widely available. The ethics of the gatekeeping model, where service providers decide who can access care, will be discussed and contrasted with the informed-consent model that upholds autonomy by empowering patients to make their own health care decisions. Conclusion: There is an ethical imperative for health professionals to reduce health care disparities of trans and gender diverse people and practice within the health care values of social justice and cultural humility. As health science educators, we have an ethical duty to include gender-affirming health in health science curricula in order to prevent harm to the trans and gender diverse patients that our students will provide care for in the future.

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“…While SDM has been studied in a variety of populations and conditions, it may be particularly appropriate to use in discussion about PrEP with Black transgender women given the aforementioned disparities. Yet, little is known about SDM for PrEP with patients who identify with multiple socially vulnerable groups (Peek et al 2016;Ng 2016). In this study, we aimed to explore perspectives of Black transgender women on SDM about PrEP with their providers, identifying individual, interpersonal, community, and healthcare factors that impact the SDM process, taking into account the intersectional experiences of Black transgender women.…”

Section: Introductionmentioning

confidence: 99%

Shared decision making for HIV pre-exposure prophylaxis (PrEP) with black transgender women

McNulty

Acree

Kerman

et al. 2021

Culture, Health & Sexuality

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Shared decision making is a collaborative process intended to develop a treatment plan that considers both the patient's preferences and the health provider's medical recommendations. It is one approach to reducing healthcare disparities by improving patientprovider communication and subsequent health outcomes. This study examines shared decision making about HIV pre-exposure prophylaxis (PrEP) with Black transgender women in Chicago, Illinois, USA, given high prevalence of HIV and disparities in PrEP use. Black transgender women were recruited online and in-person to participate in semi-structured interviews (n ¼ 24) and focus groups (2; n ¼ 14 total), conducted between 2016 and 2017. Iterative thematic content analysis took place. Analysis revealed that internalised transphobia and racism, combined with stigma from service providers, prevented disclosure of gender and sexual identity to providers. Stigma about PrEP as it relates to Black transgender women results in stereotype threat, which undermines patient-provider trust and deters shared decision making for PrEP. Shared decision making promotes cultural competence and humility and builds trust within the patient-provider relationship, leading to better communication and less stigma. The involvement of peers may be one way to mitigate stigma for Black transgender women around PrEP, promote cultural competence within organisations, and empower engagement in shared decision making for HIV prevention.

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Intersectionality and Shared Decision Making in LGBTQ Health

Cited by 24 publications

References 20 publications

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

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

Debate: Why should gender-affirming health care be included in health science curricula?

Shared decision making for HIV pre-exposure prophylaxis (PrEP) with black transgender women

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