...Because LGBTQ disparities are evident, it is crucial to
implement effective strategies to address and ultimately eliminate such
disparities. Interventions to assist LGBTQ patients with cancer health care
access and decision-making are needed. In the United States, certain basic
rights for this population are limited or nonexistent due to a complex
patchwork of legislation. Some legislation is vague regarding state and federal
rights for end-of-life decisions among LGBTQ patients and their loved ones, often
causing these patients to mistakenly believe their rights are covered when they
may not be.152 Health
insurance providers play a key role in improving access among LGBTQ patients.
First, health insurance needs to expand coverage for transgender patients in
order for them to obtain appropriate access to care. Second, insurers could
incorporate a link to the Gay and Lesbian Medical Association’s database of physicians
into their own provider directory so patients have the option to seek care from
a LGBTQ-friendly provider.153
Another avenue for patients to find LGBTQ-friendly services
is through The Healthcare Equality Index (HEI), which was created by the Human
Rights Campaign Foundation as a way for health care facilities to affirm that
they comply with the Joint Commission and Centers for Medicare and Medicaid
Services requirements for LGBTQ equity, are committed to LGBTQ patient-centered
care, and extend nondiscrimination protection to their LGBTQ employees.12 Medical
institutions, physicians, nurse educators, and practitioners play critical
roles in the accessibility and promotion of health care12 by
building trust and cultivating partnerships with the LGBTQ community.154 The
availability of a provider directory and facilities that promote LGBTQ health
care equity will be even more necessary for patients as awareness of LGBTQ
unique needs for health care increases. Although listings in the HEI or other
LGBTQ directories can provide some assurance regarding LGBTQ-related
institutional policies and staff training, the degree to which an institution’s
rating in the HEI translates into improved patient experiences is less clearly
defined.
Implementing local, state, federal, and institutional
policies that include LGBTQ populations is another strategy to reduce
disparities. For example, policies regarding marriage, housing, health
insurance coverage and other governmental agencies/programs affect the health
of LGBTQ individuals and need to be inclusive of their needs and concerns.155 The
American Medical Association acknowledges that a statewide ban on same-sex
marriage contributes to health disparities by causing a struggle for validation
and acceptance, leading to stress and possible destructive or risky behaviors,
and reduces the ability to access health care provided through marriage
benefits.155 Also,
workplace policies should expand to be inclusive of LGBTQ employees and their
partners and/or dependents.156,157 Health
care organizations should understand how governmental and institutional
policies impact LGBTQ patients and critically examine current shortcomings and
limitations within their policies and make appropriate modifications to be more
inclusive of LGBTQ populations.158,159
Healthy People 2020160 has
for the first time acknowledged health disparities in the LGBT population. One
goal of LGBT health improvement for Healthy People 2020 is to increase the
number of population-based data systems used to monitor Healthy People 2020
objectives that include in their core a standardized set of questions used to
identify LGBT populations. The inclusion of sexual orientation and gender
identity within electronic medical records is essential to provide a foundation
for understanding the LGBTQ population status and needs.5,6,161,162 There
are several essential ways to collect sexual orientation and gender identity
information, such as registration forms and patient-provider open dialogue.163 The
inclusion of sexual orientation and gender identity may cause privacy and
confidentiality concerns among LGBTQ patients. Thus, healthcare organizations
need to be prepared to communicate their infrastructure and procedures for
ensuring privacy.
Finally, improving the mechanism for LGBTQ-related research
is also an effective strategy for eliminating disparities in this population.
The inclusion of sexual orientation and gender identity questions on national
population surveys and registries, such as the SEER cancer registries, is
needed to identify the demography and disparities of the LGBTQ population.
Moreover, sexual orientation and gender identity questions should also be
included in health care provider intakes, clinical trials, and academic-centric
research Presently, because this demographic is not routinely collected, it is
difficult to identify whether LGBTQ knowledge, attitudes, beliefs, and
satisfaction are represented in cancer health studies.6 Furthermore,
it will help identify gaps in care and disparities and will support the need
for public health initiatives and interventions within this population.119,164 In
addition, LGBTQ-related research funding is lacking. One study found
approximately 0.1% of all National Iinstitutes of Health-funded research in
2012 focused on LGBTQ health-related research, excluding HIV/AIDS or other
sexual health matters.165 In
2012, for every $100 awarded by US foundations, only 24 cents went to LGBTQ
issues.166 Fortunately,
the National Institutes of Health has recently created a LGBTQI Health Research
Strategic Plan to begin efforts to increase grant funding for LGBTQI studies.167
Full article at:
By:
1Department of Health Outcomes and
Behavior, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL
2Department of Oncologic Sciences, Morsani
College of Medicine, University of South Florida
3Department of Gastrointestinal Oncology,
H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL
4Department of Biostatistics and
Bioinformatics, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL
5Department of Family Medicine and
Community Health, University of Pennsylvania, Philadelphia, PA
6Diversity and Communication Relations, H.
Lee Moffitt Cancer Center and Research Institute, Tampa, FL
7Department of Cancer Epidemiology; H. Lee
Moffitt Cancer Center and Research Institute, Tampa, FL
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