“Are you sure?”: Relations between sexual identity, certainty, disclosure, and psychological well-being

"I don't just say, Hi! I'm gay": Sexual Orientation Disclosures in Oncology Clinic Settings Among Sexual Minority Women Treated for Breast Cancer in the U.S. South

OBJECTIVES

Few studies examine sexual orientation disclosures (SODs) among women with breast cancer; fewer examine the impact of culture and geography on disclosure processes. This study explores how sexual minority women (SMW) in the Southern United States engage in SODs with oncology clinicians.

DATA SOURCES

We conducted in-depth interviews with SMW (eg, lesbian, bisexual) treated for early-stage (stages I-III), hormone receptor-positive breast cancer (N = 12), using a semistructured interview guide. Participants completed an online survey prior to the 60-minute interview. Data was analyzed using an adapted pile sorting approach and thematic analysis conventions.

CONCLUSION

Average age of participants was 49.5 years (range: 30-69), all self-identified as cisgender; 83.3% as lesbian, 58.3% were married, 91.7% had completed a 4-year college degree or higher, 66.7% identified as non-Hispanic White, 16.7% as Black, and 16.7% as Hispanic/Latina. Half of the sample had not engaged in SODs with an oncology clinician. Key themes were: (1) religious and political conservatism in the South create SOD barriers; (2) oncologist-specific barriers to SODs; (3) "straight passing" as a discrimination mitigation strategy; and (4) SOD facilitators in oncology settings (ie, strategic disclosures, medical privilege, and lesbian, gay, bisexual, and transgender-friendly branding of oncology centers).

IMPLICATIONS FOR NURSING PRACTICE

SMW with breast cancer living in the U.S. South navigate unique interpersonal barriers to SODs in oncology settings. Clinicians could encourage SODs by fostering inclusive environments via nonheteronormative language, inclusive intake forms, and respect for SMW's SOD navigation processes. Oncology clinicians require culturally relevant, geographic-specific communication training to facilitate SODs among SMW.

Anxiety, Attachment Styles and Life Satisfaction in the Polish LGBTQ+ Community

Poland is one of the most discriminatory places in Europe. The political situation, legal policies, and society's attitude towards people from the LGBTQ+ community in Poland clearly indicate the need to study the mental health and well-being of this group of individuals. Based on Meyer's minority stress theory, Bowlby's attachment theory, the Ainsworth attachment framework, Diener's subjective well-being model, and provided empirical evidence, this study examined the significance of attachment styles and anxiety as predictors of life satisfaction among the Polish LGBTQ+ community. It also explored the differences between LGBTQ+ and heterosexual individuals in the levels of tested variables. A total of 414 participants took part in this study, of whom most study participants were young adults (M = 24.50; SD = 6.94). Of those, 130 participants identified themselves as heterosexual, while 284 declared themselves members of the LGBTQ+ community. The Satisfaction with Life Scale, Plopa's Attachment Styles Questionnaire, and the State-Trait Anxiety Inventory were used. Data demonstrate that anxiety and attachment styles were significant predictors of life satisfaction in the LGBTQ+ community. Moreover, LGBTQ+ individuals had higher non-secure attachment styles and anxiety scores, and lower life satisfaction scores in comparison to heterosexual individuals. The presented study is the first Polish study to test such relationships in the Polish LGBTQ+ community. It draws attention to lower life satisfaction among study participants representing the LGBTQ+ community in comparison to cisgender heterosexual individuals. This indicates that researchers, clinical specialists and practitioners should try to improve the levels of subjective well-being in Polish LGBTQ+ individuals, for example, through psychoeducational and supportive programs. In addition, the presented results highlight the possible important role of attachment styles in the functioning of the presented group.

Knowing to Ask and Feeling Safe to Tell - Understanding the Influences of HCP-Patient Interactions in Cancer Care for LGBTQ+ Children and Young People

Background

Lesbian, gay, bisexual, transgender, queer or questioning (LGBTQ+) people experience healthcare inequalities in cancer care. Previous studies have focused on knowledge, attitudes and behaviours of healthcare professionals (HCPs) treating adults with cancer and how these contribute to inequalities. To date, no research has focused on HCPs treating LGBTQ+ children and adolescents with cancer in the UK. This is important given that this group may be at a critical time for exploring their gender identity and sexual orientation, whilst also facing a cancer diagnosis. We aimed to explore the knowledge, attitudes and behaviours of paediatric, teenage and young adult oncology HCPs treating LGBTQ+ patients in the UK.

Methods

We carried out semi-structured interviews with 8 HCPs in paediatric, teenage and young adult (TYA) oncology from the Royal Marsden NHS Foundation Trust. Eight questions were asked, which centred around participants' knowledge, attitudes and behaviours regarding management of LGBTQ+ patients in oncology. Interview transcripts were analysed by inductive thematic analysis.

Results

We identified 10 themes, including novel themes (how HCPs acquire knowledge and expectations of a 'third party' to be the expert) which may underlie previously observed trends in knowledge, attitudes and behaviours of HCPs. We highlight other themes and HCP concerns specific to care of LGBTQ+ patients in paediatrics (influence of the parental-carer dynamic, concerns around patient age and development as a barrier to disclosure) which require further research. We found evidence of the interrelatedness of HCP knowledge, attitudes and behaviours and the ability of these elements to positively influence each other. We mapped our themes across these elements to form a new suggested framework for improving HCP-patient interactions in LGBTQ+ Cancer Care. We found a need both for individual HCP education and organisational change, with creation of a culture of psychological safety to improve patient care.

Conclusion

Knowledge, attitudes and behaviours of HCPs are closely interdependent when providing care to young LGBTQ+ patients with cancer. The authors suggest that future efforts to improve care of these patients address this complexity by spanning the domains of our suggested framework. Whilst HCP education is essential, change must also occur at an organisational level.

The roles of mental illness disclosure and disclosure strategies on well-being among college students

ObjectivesTo examine how the degree of mental illness disclosure and disclosure strategies are associated with psychological and physical well-being among college students. Participants: Participants were 181 undergraduate students from two American universities who self-identified as having been diagnosed with mental illness. Method: Participants completed an online survey, which included measures of mental illness disclosure and a range of outcome measures (e.g., life satisfaction, self-report somatic complaints). Results: The degree of mental illness disclosure was positively related to well-being outcomes. After controlling for the effect of the degree of self-disclosure, a direct disclosure strategy was positively associated with well-being outcomes, whereas disclosure strategies involving entrapment, humor, and indirect medium were related to poorer well-being outcomes. Conclusions: Results suggest that the degree of mental illness disclosure and the manner in which individuals disclose their mental illness to others may have implications to the well-being of individuals living with mental illness.

Disclosure in lesbian, gay and bisexual cancer care: towards a salutogenic healthcare environment

Background

The literature on sexual orientation disclosure is arguably one of the most developed in the field of lesbian, gay and bisexual (LGB) people in healthcare in English speaking countries however, relatively little research has been conducted into disclosure in cancer care. Studies have been mainly undertaken in primary care where distinct circumstances pertain and where the benefits of disclosure include obtaining appropriate health information, treatment advice and avoiding misdiagnosis.

Methods

We conducted an in-depth qualitative study primarily recruiting patients through oncology care in hospital settings and through LGB community cancer support groups. Data were gathered through semi-structured interviews with 30 LGB patients with different cancer types.

Results

Data were analysed using thematic analysis and interpreted and interrogated through salutogenesis theory which offers a useful lens through which to consider the health promoting effects of sexual orientation disclosure in cancer care. We present three themes as part of the analysis: Authenticity as a driver for disclosure in cancer care, Partners as a (potential) salutogenic resource and Creating safe, healing environments conducive to disclosure. The findings are reported and discussed in relation to three inter-related concepts from current salutogenesis theorising including a sense of coherence, generalised resistance resources and healing environments which can facilitate sexual orientation disclosure.

Conclusion

Our findings enable a more nuanced approach to understanding disclosure in this context. This study contributes to the literature through its articulation of the salutogenic potential of disclosure (if responded to appropriately) for LGB patients as individuals, in relationship to their partners or carers and the role of creating a visible healing-oriented optimal environment to promote quality of life and recovery.

Electronic supplementary material

The online version of this article (10.1186/s12885-019-5895-7) contains supplementary material, which is available to authorized users.