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Gorman JR, Corey SL, Ginavan I, Garcia J. "Just for pregnant women, not for you": a qualitative evaluation of the sexual and reproductive healthcare experiences of transgender and gender diverse cancer survivors. J Cancer Surviv 2024:10.1007/s11764-024-01633-z. [PMID: 38980652 DOI: 10.1007/s11764-024-01633-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2024] [Accepted: 06/17/2024] [Indexed: 07/10/2024]
Abstract
PURPOSE To identify opportunities to improve sexual and reproductive health (SRH) care for transgender and gender diverse (TGD) cancer survivors by describing (1) challenges experienced when navigating SRH care and (2) strategies to help overcome these challenges. METHODS We enrolled a purposive sample of 17 adult TGD cancer survivors and 5 co-survivors. We aimed for a diverse sample across cancer experience, age, racial/ethnic background, sexual orientation, and gender identity. We conducted 90-min individual interviews via videoconference and used reflexive thematic analysis, guided by a focus on three social determinants of health. RESULTS Themes describing challenges were as follows: (1) Cancer treatment's impact on sexual health was insufficiently addressed by cancer care providers; (2) fertility-related information and conversations were complicated by gendered expectations and ultimately did not meet survivors' needs; (3) feeling excluded and uncared-for in healthcare settings due to gendered language and lack of supportive services that met their needs; and (4) TGD survivors commonly reported high financial burden, negatively impacting their access to care. Strategies to overcome these challenges were (1) a solid social support network that can be integrated into the care team to meet the unique SRH needs of TGD survivors and (2) gender-affirming healthcare providers and environments to address SRH care needs and concerns. CONCLUSIONS TGD survivors and co-survivors desire improved access to gender-affirming SRH care in cancer survivorship. IMPLICATIONS FOR CANCER SURVIVORS Key opportunities to improve gender-affirming SRH care in cancer survivorship include fostering and engaging TGD survivors' support networks and implementing system-level changes in cancer care settings.
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Affiliation(s)
- Jessica R Gorman
- Health Promotion and Health Behavior Program, College of Health, Oregon State University, 2250 SW Jefferson Way, 160 SW 26thStreet, Corvallis, OR, 97331, USA.
| | - Stephanie L Corey
- Health Promotion and Health Behavior Program, College of Health, Oregon State University, 2250 SW Jefferson Way, 160 SW 26thStreet, Corvallis, OR, 97331, USA
| | - Isabelle Ginavan
- Health Promotion and Health Behavior Program, College of Health, Oregon State University, 2250 SW Jefferson Way, 160 SW 26thStreet, Corvallis, OR, 97331, USA
| | - Jonathan Garcia
- Health Promotion and Health Behavior Program, College of Health, Oregon State University, 2250 SW Jefferson Way, 160 SW 26thStreet, Corvallis, OR, 97331, USA
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Ziegler E, Slotnes-O'Brien T, Peters MDJ. Cancer Screening and Prevention in the Transgender and Gender Diverse Population: Considerations and Strategies for Advanced Practice Nurses. Semin Oncol Nurs 2024; 40:151630. [PMID: 38622043 DOI: 10.1016/j.soncn.2024.151630] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2023] [Revised: 03/09/2024] [Accepted: 03/15/2024] [Indexed: 04/17/2024]
Abstract
OBJECTIVES This discussion paper presents recent evidence regarding cancer screening and prevention among the transgender and gender diverse (TGD) community and highlights where and how advanced practice nurses (APNs), particularly those in primary care, can better contribute to closing the gap between healthcare disparities between TGD and cisgendered populations. METHODS Relevant publications on the topic and professional guidelines and evidence have formed the basis for this discussion paper. RESULTS TGD individuals are a vulnerable population with unique needs. They remain at risk of cancer and might be at greater risk of developing some cancers compared to cisgendered people but are underscreened. Barriers to gender-affirming care need to be addressed to improve access to prevention and screening services and improve the cancer care experiences and outcomes of TGD people. CONCLUSION APNs can work in collaboration with TGD individuals and the healthcare system to improve access to culturally safe cancer screening and more effective prevention of cancer and poor cancer outcomes. IMPLICATIONS FOR NURSING PRACTICE APNs have the potential to improve access to cancer screening for TGD people by increasing their understanding of the needs of the population, providing culturally safe care, and advocating for more preventative care and cancer screening. With greater knowledge and understanding of the needs and preferences of TGD people both broadly and in relation to cancer screening and prevention, targeted interventions and care approaches can be implemented. APNs should also aim to conduct evaluations and research into cancer prevention and screening to build the currently limited evidence base and nursing knowledge in this important field.
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Affiliation(s)
- Erin Ziegler
- Associate Professor, Daphen Cockwell School of Nursing, Toronto Metropolitan University, Toronto, Ontario, Canada.
| | - Toni Slotnes-O'Brien
- Senior Lecture, UniSA Clinical & Health Science, University of South Australia, Adelaide, Australia
| | - Micah D J Peters
- Associate Professor, UniSA Clinical & Health Science, University of South Australia, Adelaide, Australia
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Spencer JC, Charlton BM, Pretsch PK, Schnarrs PW, Spees LP, Hudgens MG, Barclay L, Wheeler SB, Brewer NT, Smith JS. Barriers to Cervical Cancer Screening by Sexual Orientation Among Low-Income Women in North Carolina. ARCHIVES OF SEXUAL BEHAVIOR 2024; 53:1645-1652. [PMID: 38627295 PMCID: PMC11106100 DOI: 10.1007/s10508-024-02844-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Revised: 02/21/2024] [Accepted: 02/22/2024] [Indexed: 05/21/2024]
Abstract
We sought to examine cervical cancer screening barriers by sexual orientation among low-income women in North Carolina. The MyBodyMyTest-3 Trial recruited low-income women (< 250% of federal poverty level) aged 25-64 years who were 1+ year overdue for cervical cancer screening. We compared perceptions of cervical cancer screening among those who self-identified as lesbian, gay, bisexual, or queer (LGBQ; n = 70) to straight/heterosexual women (n = 683). For both LGBQ and straight respondents, the greatest barriers to screening were lack of health insurance (63% and 66%) and cost (49% and 50%). LGBQ respondents were more likely than straight respondents to report forgetting to screen (16% vs. 8%, p = .05), transportation barriers (10% vs. 2%, p = .001), and competing mental or physical health problems (39% vs. 27%, p = .10). Addressing access remains important for improving cervical cancer screening among those under-screened. For LGBQ women, additional attention may be needed for reminders, co-occurring health needs, and transportation barriers.
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Affiliation(s)
- Jennifer C Spencer
- Department of Population Health, Dell Medical School, University of Texas at Austin, 1601 Trinity St., Bldg. A, Austin, TX, 78712, USA.
| | - Brittany M Charlton
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA, USA
| | - Peyton K Pretsch
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Phillip W Schnarrs
- Department of Population Health, Dell Medical School, University of Texas at Austin, 1601 Trinity St., Bldg. A, Austin, TX, 78712, USA
| | - Lisa P Spees
- Division of Pharmaceutical Outcomes and Policy, Eshelman School of Pharmacy, University of North Carolina, Chapel Hill, NC, USA
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Michael G Hudgens
- Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA
| | - Lynn Barclay
- American Sexual Health Association, Research Triangle Park, Durham, NC, USA
| | - Stephanie B Wheeler
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA
| | - Noel T Brewer
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA
| | - Jennifer S Smith
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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Zhang TR, Castle E, Dubach-Reinhold C, Blasdel G, Kloer C, Alford A, Bluebond-Langner R, Zhao LC. Pilot Test of A Gender-conscious Sexual Health Intake Questionnaire: Increasing Inclusivity and Mitigating Bias in Sexual History Taking. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2024; 12:e5614. [PMID: 38596592 PMCID: PMC11000753 DOI: 10.1097/gox.0000000000005614] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2023] [Accepted: 12/28/2023] [Indexed: 04/11/2024]
Abstract
Background Sexual health is critical to overall health, yet sexual history taking is challenging. LGBTQ+ patients face additional barriers due to cis/heteronormativity from the medical system. We aimed to develop and pilot test a novel sexual history questionnaire called the Sexual Health Intake (SHI) form for patients of diverse genders and sexualities. Methods The SHI comprises four pictogram-based questions about sexual contact at the mouth, anus, vaginal canal, and penis. We enrolled 100 sexually active, English-speaking adults from a gender-affirming surgery clinic and urology clinic from November 2022 to April 2023. All surveys were completed in the office. Patients also answered five feedback questions and 15 questions from the Patient-Reported Outcomes Measurement Information System Sexual Function and Satisfaction (PROMIS-SexFS) survey as a validated comparator. Results One hundred patients aged 19-86 years representing an array of racial/ethnic groups, gender identities, and sexuality completed the study. Forms of sexual contact varied widely and included all possible combinations asked by the SHI. Feedback questions were answered favorably in domains of clinical utility, inclusiveness of identity and anatomy, and comprehensiveness of forms of sexual behavior. The SHI captured more positive responses than PROMIS-SexFS in corresponding questions about specific types of sexual activity. The SHI also asks about forms of sexual contact that are not addressed by PROMIS-SexFS, such as penis-to-clitoris. Conclusions SHI is an inclusive, patient-directed tool to aid sexual history taking without cisnormative or heteronormative biases. The form was well received by a diverse group of participants and can be considered for use in the clinical setting.
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Affiliation(s)
- Tenny R. Zhang
- From the Department of Urology, NYU Langone Medical Center, New York, N.Y
- Department of Urology, NewYork-Presbyterian Hospital/Weill Cornell Medical Center, New York, N.Y
| | - Elijah Castle
- From the Department of Urology, NYU Langone Medical Center, New York, N.Y
- Hunter Alliance for Research and Translation, Hunter College of the City University of New York, New York, N.Y
| | - Charlie Dubach-Reinhold
- From the Department of Urology, NYU Langone Medical Center, New York, N.Y
- University of California San Francisco Medical School, San Francisco, Calif
| | | | - Carmen Kloer
- Hansjörg Wyss Department of Plastic Surgery, NYU Langone Medical Center, New York, N.Y
| | - Ashley Alford
- From the Department of Urology, NYU Langone Medical Center, New York, N.Y
| | | | - Lee C. Zhao
- From the Department of Urology, NYU Langone Medical Center, New York, N.Y
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Skuban-Eiseler T, Orzechowski M, Steger F. Why do transgender individuals experience discrimination in healthcare and thereby limited access to healthcare? An interview study exploring the perspective of German transgender individuals. Int J Equity Health 2023; 22:211. [PMID: 37817187 PMCID: PMC10566060 DOI: 10.1186/s12939-023-02023-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2023] [Accepted: 09/25/2023] [Indexed: 10/12/2023] Open
Abstract
BACKGROUND Transgender individuals experience limited access to healthcare. This results not least from experiences of discrimination to which they are exposed in the health system. These contribute to transgender individuals having poorer health than cis individuals, i.e. individuals whose sex assigned at birth is in line with their gender identity. It is an ethical duty to take effective measures to minimize inequalities in medical care. At best, such measures should also be assessed as appropriate from the perspective of those affected in order to be accepted and thus effective. It is therefore important to know whether measures touch on the subjectively assumed reasons for experiences of discrimination. Hence, to be able to take appropriate measures, it is important to identify the reasons that transgender individuals see as causal for their experiences of discrimination in healthcare. METHODS We conducted semi-structured interviews with 14 German transgender individuals and asked them about their own experiences of discrimination in healthcare and their assumptions on the reasons for discrimination. We analyzed the responses using the method of structured qualitative content analysis. RESULTS 13 transgender individuals reported experiences of discrimination in healthcare. These emanated from different professional groups and took place in trans-specific as well as general medical settings. We were able to identify a total of 12 reasons that transgender individuals see as causal for their experiences of discrimination: (1) internalized trans-hostility and "protection" of cis individuals, (2) lack of knowledge/uncertainties regarding transition, (3) "protection" of a binary worldview, (4) binary worldview in medicine, (5) structural deficits, (6) asymmetric interactions with specialists, (7) current political debate, (8) view of transgender individuals as a "burden for society", (9) objectification, (10) homophobia, (11) misogyny/androcentrism and (12) discrimination as reaction to discrimination. CONCLUSIONS German transgender individuals have a very differentiated picture regarding their subjective reasons for experiencing discrimination in healthcare. Overall, disrespect regarding gender identity and a confrontation with foreignness seems to be seen as the decisive factor. Thus, it is not enough to focus only on measures that aim to remedy the information deficit on the part of medical providers. Measures must be taken that can create a granting and respectful attitude towards transgender individuals.
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Affiliation(s)
- Tobias Skuban-Eiseler
- Institute of the History, Philosophy and Ethics of Medicine, Faculty of Medicine, Ulm University, Ulm, Germany.
- kbo-Isar-Amper-Klinikum Region München, München-Haar, Germany.
| | - Marcin Orzechowski
- Institute of the History, Philosophy and Ethics of Medicine, Faculty of Medicine, Ulm University, Ulm, Germany
| | - Florian Steger
- Institute of the History, Philosophy and Ethics of Medicine, Faculty of Medicine, Ulm University, Ulm, Germany
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Chadi A, Thirion DJG, David PM. Vaccine promotion strategies in community pharmacy addressing vulnerable populations: a scoping review. BMC Public Health 2023; 23:1855. [PMID: 37741997 PMCID: PMC10518112 DOI: 10.1186/s12889-023-16601-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Accepted: 08/23/2023] [Indexed: 09/25/2023] Open
Abstract
CONTEXT Social determinants of health are drivers of vaccine inequity and lead to higher risks of complications from infectious diseases in under vaccinated communities. In many countries, pharmacists have gained the rights to prescribe and administer vaccines, which contributes to improving vaccination rates. However, little is known on how they define and target vulnerable communities. OBJECTIVE The purpose of this study is to describe how vulnerable communities are targeted in community pharmacies. METHODS We performed a systematic search of the Embase and MEDLINE database in August 2021 inspired by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses protocols (PRISMA ScR). Articles in English, French or Spanish addressing any vaccine in a community pharmacy context and that target a population defined as vulnerable were screened for inclusion. RESULTS A total of 1039 articles were identified through the initial search, and 63 articles met the inclusion criteria. Most of the literature originated from North America (n = 54, 86%) and addressed influenza (n = 29, 46%), pneumococcal (n = 14, 22%), herpes zoster (n = 14, 22%) or human papilloma virus vaccination (n = 14, 22%). Lifecycle vulnerabilities (n = 48, 76%) such as age and pregnancy were most often used to target vulnerable patients followed by clinical factors (n = 18, 29%), socio-economical determinants (n = 16, 25%) and geographical vulnerabilities (n = 7, 11%). The most frequently listed strategy was providing a strong recommendation for vaccination, promotional posters in pharmacy, distributing leaflet/bag stuffers and providing staff training. A total of 24 barriers and 25 facilitators were identified. The main barriers associated to each vulnerable category were associated to effective promotional strategies to overcome them. CONCLUSION Pharmacists prioritize lifecycle and clinical vulnerability at the expense of narrowing down the definition of vulnerability. Some vulnerable groups are also under targeted in pharmacies. A wide variety of promotional strategies are available to pharmacies to overcome the specific barriers experienced by various groups.
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Affiliation(s)
- Alexandre Chadi
- Faculty of Pharmacy, Université de Montréal, Montreal, QC, Canada.
| | - Daniel J G Thirion
- Faculty of Pharmacy, Université de Montréal, Montreal, QC, Canada
- McGill University Health Centre, Montreal, QC, Canada
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Shihabuddin CD, Lee G, Casler K. Evidence-based sexual healthcare for the LGBTQIA2+ patient across the lifespan. Nurse Pract 2023; 48:22-30. [PMID: 37643142 DOI: 10.1097/01.npr.0000000000000089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/31/2023]
Abstract
ABSTRACT People who identify as lesbian, gay, bisexual, transgender, queer/questioning, intersex, asexual, two-spirit, or other minority sexual and gender identities (LGBTQIA2+) often avoid seeking healthcare due to social discrimination and stigma. Clinical education in LGBTQIA2+-affirming care is essential but often lacking across disciplines. Provider acceptance, awareness of personal biases, and understanding of microaggressions affecting LGBTQIA2+ people can improve access, outcomes, and survival for this population. Expertise in caring for LGBTQIA2+ people in rural and suburban communities, for people who are transgender, and for people who have undergone or are in the process of undergoing gender-affirming surgeries is essential to offer best-practice healthcare.
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Muacevic A, Adler JR, Yacoub J, Kashmer D. Medical Students' Preparedness to Discuss Lesbian, Gay, Bisexual, Transgender, Queer, and Other (LGBTQ+) Patient-Related Topics: A Survey Study. Cureus 2023; 15:e34237. [PMID: 36843749 PMCID: PMC9957532 DOI: 10.7759/cureus.34237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2022] [Accepted: 01/23/2023] [Indexed: 01/27/2023] Open
Abstract
How well do doctors know their patients? Is the future generation of doctors prepared for real-world patient encounters? Lesbian, gay, bisexual, transgender, queer, and other (LGBTQ+) patients are disproportionately affected by a wide range of health issues, and many of these patients face barriers and stigma when accessing healthcare. Our research aimed to explore the awareness current medical students hold toward some of the health disparities faced by LGBTQ+ patients. Second-year medical students at our institution filled out a survey following their standardized patient exams to examine how prepared they felt to diagnose and treat a patient self-identifying as a member of the LGBTQ+ community.
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Affiliation(s)
| | - John R Adler
- Simulation, Edward Via College of Osteopathic Medicine, Auburn, USA
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Ropero-Padilla C, Rodríguez-Valbuena C, Rodriguez-Arrastia M, Ruiz-Fernández MD, Roman P, Sanchez-Labraca N. Exploring the microaggression experiences of LGBTQ+ community for a culturally safe care: A descriptive qualitative study. NURSE EDUCATION TODAY 2022; 115:105423. [PMID: 35661578 DOI: 10.1016/j.nedt.2022.105423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Revised: 05/03/2022] [Accepted: 05/25/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Microaggressions, stigma and minority stress still occur among sexual and gender minorities on an individual, interpersonal, and structural level. Cultural immersion may therefore be an effective strategy in order to find potential healthcare approaches and foster more comprehensive, critical, intersectional, and inclusive care practices. OBJECTIVE The aim of this study was to develop insight into the experiences of LGBTQ+ community members to obtain in-depth perceptions of microaggressions and an understanding of their healthcare needs to provide a culturally safe and sensitive care. DESIGN A qualitative descriptive study was conducted between September to November 2021. SETTINGS This study was conducted at the University of Almeria with LGBTQ+ community members. PARTICIPANTS Twenty-one LGBTQ+ individual participated in this study, aged between 18 and 56 years old. METHODS Participants were recruited using a purposive sampling. Responses from semi-structured interviews were studied using a thematic analysis. Methods and findings are reported in line with Standards for Reporting Qualitative Research recommendations. RESULTS Three themes emerged from the qualitative analysis: (i) experiences to understand the impact of a heteronormative society, (ii) perceptions of engaging with health education and promotion, and (iii) healthcare access, use and experiences within the LGTBQ+ community. CONCLUSIONS This study yields findings about the difficulties that LGBTQ+ community members face in the healthcare system in order to ensure equal care for vulnerable communities and integrate a culturally safe care approach into nursing practice. Certain microaffirmation strategies against social determinants of health such as school-based nursing strategies can help to raise awareness and knowledge among heterosexual peers and reduce cultural invisibility, microaggressions, stigma and minority stress. In order to provide culturally safe care, educators might also explore the inclusion of gender and sexual minority care content in both in-faculty education and ongoing continuing education for nurse practitioners.
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Affiliation(s)
- Carmen Ropero-Padilla
- Faculty of Health Sciences, Pre-Department of Nursing, Jaume I University, Castello de la Plana, Spain.
| | - Cristian Rodríguez-Valbuena
- Faculty of Health Sciences, Department of Nursing Science, Physiotherapy and Medicine, University of Almeria, Almeria, Spain.
| | - Miguel Rodriguez-Arrastia
- Faculty of Health Sciences, Pre-Department of Nursing, Jaume I University, Castello de la Plana, Spain.
| | - María Dolores Ruiz-Fernández
- Faculty of Health Sciences, Department of Nursing Science, Physiotherapy and Medicine, University of Almeria, Almeria, Spain; Health Research Centre, University of Almeria, Almeria, Spain; Research Group CTS-451 Health Sciences, University of Almeria, Almeria, Spain.
| | - Pablo Roman
- Faculty of Health Sciences, Department of Nursing Science, Physiotherapy and Medicine, University of Almeria, Almeria, Spain; Health Research Centre, University of Almeria, Almeria, Spain; Research Group CTS-451 Health Sciences, University of Almeria, Almeria, Spain.
| | - Nuria Sanchez-Labraca
- Faculty of Health Sciences, Department of Nursing Science, Physiotherapy and Medicine, University of Almeria, Almeria, Spain; Health Research Centre, University of Almeria, Almeria, Spain.
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Hsiang E, Ritchie AM, Lall MD, Driver L, Moll J, Sonn B, Totten VY, Williams DB, McGregor AJ, Egan DJ. Emergency care of LGBTQIA+ patients requires more than understanding the acronym. AEM EDUCATION AND TRAINING 2022; 6:S52-S56. [PMID: 35783082 PMCID: PMC9222885 DOI: 10.1002/aet2.10750] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Revised: 11/06/2021] [Accepted: 11/21/2021] [Indexed: 06/15/2023]
Abstract
Emergency physicians (EPs) frequently deliver care to members of the LGBTQIA+ community in the emergency department. This community suffers from many health disparities important to understand as part of comprehensive care, and these disparities are infrequently discussed in emergency medicine education. Previous data also suggest a need for broader education to increase the comfort of EPs caring for LGBTQIA+ patients. A group of content experts identified key disparities, opportunities for expanded education, and strategies for more inclusive care of LGBTQIA+ patients.
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Affiliation(s)
- Elaine Hsiang
- Department of Emergency MedicineUniversity of CaliforniaSan FranciscoCaliforniaUSA
| | - Amanda M. Ritchie
- Departments of Emergency Medicine and Internal MedicineLouisiana State UniversityNew OrleansLouisianaUSA
| | - Michelle D. Lall
- Department of Emergency MedicineEmory University School of MedicineAtlantaGeorgiaUSA
| | - Lachlan Driver
- Department of Emergency MedicineHarvard Affiliated Emergency Medicine ResidencyMass General BrighamBostonMassachusettsUSA
| | - Joel Moll
- Department of Emergency MedicineVCU School of MedicineVCU HealthRichmondVirginiaUSA
| | | | | | - Dustin B. Williams
- Department of Emergency MedicineUT‐Southwestern Medical CenterDallasTexasUSA
| | - Alyson J. McGregor
- Department of Emergency MedicineDivision of Sex and Gender in Emergency MedicineWarren Alpert Medical School of Brown UniversityProvidenceRhode IslandUSA
| | - Daniel J. Egan
- Department of Emergency MedicineHarvard Affiliated Emergency Medicine ResidencyMass General BrighamBostonMassachusettsUSA
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Driver L, Egan DJ, Hsiang E, Lall MD, Moll J, Ritchie AM, Sonn BJ, Totten VY, Williams DB, McGregor AJ. Block by block: Building on our knowledge to better care for LGBTQIA+ patients. AEM EDUCATION AND TRAINING 2022; 6:S57-S63. [PMID: 35783077 PMCID: PMC9222888 DOI: 10.1002/aet2.10755] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Revised: 02/04/2022] [Accepted: 02/15/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Emergency physicians need to recognize the diversity of identities held by sexual and gender minorities, as well as the health implications and inequities experienced by these communities. Identities such as lesbian, gay, bisexual, transgender, queer, questioning, intersex, asexual, aromantic, and many others fall under the LGBTQIA+ acronym. This wide spectrum is seldom discussed in emergency medicine but nonetheless impacts both patient care and patient experience in acute and critical care settings. AIMS This commentary aims to provide a brief but nonexhaustive review of LGBTQIA+ identities and supply a critical framework for applying this understanding to patient encounters in the emergency department, as well as describe the challenges and educational aims at the level of medical school, residency, and postresidency. MATERIALS AND METHODS The commonly used and widely accepted definitions of LGBTQIA+ terms are described, as well as implications for patient care and emergency physician education. The authors of this writing group represent the Society for Academic Emergency Medicine, LGBTQ Task Force of the Academy of Diversity Inclusion in Medicine. RESULTS LGB terms are addressed, with LGBTQIA+ adding "intersex," "asexual," and "+," to include other gender identities and sexual orientations which are not already included. This paper also addresses the terms "transition," "nonbinary," "polyamorous." "two-spirit," "queer," and others. These acronyms and terms continually expand and evolve in the pursuit of inclusivity. Additionally, with some health issues potentially related to medications, hormones, surgery, or to internal or external genitalia, important EM physician tools include gathering an "organ inventory," asking about sexual history, and conducting a physical exam. DISCUSSION Most persons have congruent biological sex, gender identity, and attraction to the "opposite" gender. However, humans can have every imaginable variation and configuration of chromosomes, genitalia, gender identities, sexual attractions, and sexual behaviors. Terms and definitions are constantly changing and adapting; they may also vary by local culture. Obtaining relevant medical history, conducting an "organ inventory," asking about sexual history in a nonjudgmental way, and conducting a physical exam when warranted can all be important in delivering best possible medical care. Although there has been increased focus on education at the medical school, residency, and faculty level on LGBTQIA+ patient care in the ED, much work remains to be done. CONCLUSION Emergency physicians should feel confident in providing a model of care that affirms the sexual and gender identities of all the patient populations we serve. Optimal patient-centric care requires a deeper understanding of the patient's biology, gender identity, and sexual behavior encapsulated into the ever-growing acronym LGBTQIA+.
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Affiliation(s)
- Lachlan Driver
- Department of Emergency MedicineHarvard Affiliated Emergency Medicine ResidencyMass General BrighamBostonMassachusettsUSA
| | - Daniel J. Egan
- Department of Emergency MedicineHarvard Affiliated Emergency Medicine ResidencyMass General BrighamBostonMassachusettsUSA
| | - Elaine Hsiang
- Department of Emergency MedicineUniversity of CaliforniaSan FranciscoCaliforniaUSA
| | - Michelle D. Lall
- Department of Emergency MedicineEmory University School of MedicineAtlantaGeorgiaUSA
| | - Joel Moll
- Department of Emergency MedicineVCU School of MedicineVCU HealthRichmondVirginiaUSA
| | - Amanda M. Ritchie
- Departments of Emergency Medicine and Internal MedicineLouisiana State UniversityNew OrleansLouisianaUSA
| | - Brandon J. Sonn
- Department of Emergency MedicineUniversity of Colorado Anschutz Medical CampusAuroraColoradoUSA
| | - Vicken Y. Totten
- Emergency MedicineKaweah Delta Health SystemsVisaliaCaliforniaUSA
| | - Dustin B. Williams
- Department of Emergency MedicineUT‐Southwestern Medical CenterDallasTexasUSA
| | - Alyson J. McGregor
- Department of Emergency MedicineDivision of Sex and Gender in Emergency MedicineWarren Alpert Medical School of Brown UniversityProvidenceRhode IslandUSA
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Martinez IV, Waryold JM. Implementing PrEP to Decrease HIV Transmission Rates Among Females. J Nurse Pract 2022. [DOI: 10.1016/j.nurpra.2021.11.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Blanchette JE, Aaron SP, Allen NA, Litchman ML. Equity in the Provision of Diabetes Self-Management Education and Support. Diabetes Spectr 2022; 35:284-294. [PMID: 36082013 PMCID: PMC9396716 DOI: 10.2337/dsi22-0005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Diabetes self-management education and support (DSMES) interventions must be accessible to all people with diabetes. To address equity in the delivery of DSMES, interventions should consider the unique needs of various populations. This article outlines the needs of a wide range of populations, including people with diabetes who are racially or ethnically diverse; have limited English proficiency or literacy; are deaf or hard of hearing; are blind or have low vision; are neurodiverse; live with learning disabilities or intellectual or developmental disabilities; have dementia or cognitive impairment; or are of sexual and/or gender minority. The authors discuss how best to tailor DSMES to meet the needs of these diverse groups.
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Affiliation(s)
- Julia E. Blanchette
- Center for Diabetes and Obesity, University Hospitals Cleveland Medical Center, Cleveland, OH
- School of Medicine, Case Western Reserve University, Cleveland, OH
- Corresponding author: Julia E. Blanchette,
| | | | - Nancy A. Allen
- University of Utah College of Nursing, Salt Lake City, UT
| | - Michelle L. Litchman
- University of Utah College of Nursing, Salt Lake City, UT
- Utah Diabetes and Endocrinology Center, Salt Lake City, UT
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