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Winter N, Ugalde A, Coyne E, Dieperink KB, Jongebloed H, Livingston P. People affected by cancer and their carers from gender and sexually diverse communities: their experiences and the role of smartphone applications. BMC Public Health 2024; 24:1649. [PMID: 38902694 PMCID: PMC11191337 DOI: 10.1186/s12889-024-19144-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: 08/06/2023] [Accepted: 06/14/2024] [Indexed: 06/22/2024] Open
Abstract
BACKGROUND People living with cancer, or carers who are from lesbian, gay, bisexual, transgender, queer, intersex or asexual (LGBTQIA+) communities experience unique information and support needs. Accessible technology-based resources providing tailored support are required to promote wellbeing, however this is a growing area of research requiring further investigation. The purpose of this study was to explore the experiences of healthcare services among people living with cancer, and their carers, who belong to sexual or gender diverse communities (LGBTQIA+), and identify how smartphone applications (apps) could support people from LGBTQIA + communities. METHODS This was a qualitative descriptive study where people living with cancer or carers from LGBTQIA + communities participated in phone interviews. Participants were recruited across Australia via social media advertisements, LGBTQIA + medical practices, and cancer advocacy groups. Participants were asked questions about their experiences, and were provided with screenshots of an existing app and asked to provide feedback on content and inclusiveness. Transcripts were coded and codes grouped together to form similar and concepts. Inductive and deductive analyses were used to create themes. RESULTS 13 patients (mean age 56 (SD:13)), and three carers (mean age 64 (SD:19)) completed phone interviews. The majority of participants identified their gender as female (patients n = 9, carers 3), and their sexuality as gay or lesbian (patients n = 10, carers n = 3). Four themes were created: (1) navigating disclosure in healthcare, described emotional challenges surrounding disclosure; (2) the power of positive experiences with clinicians, described positive interactions and gaps in care from clinicians; (3) impact of gender and sexuality on informal support, outlined support received from informal network and gaps in support, and; (4) opportunities to increase inclusivity in smartphone apps, generated ideas on how apps can be tailored to meet needs identified. CONCLUSION Disclosure of gender or sexuality, and interactions with clinicians had the potential to impact participants' experience of cancer care. Gaps in informal networks pointed at how to better support LGBTQIA + communities, and identified opportunities for inclusion in an app that will be tailored and trialled for this community. Future work should focus on addressing systems-level processes in acknowledging and supporting priority groups affected by cancer.
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Affiliation(s)
- Natalie Winter
- School of Nursing and Midwifery, The Centre for Quality and Patient Safety in the Institute for Health Transformation, Deakin University, Geelong, 3220, Australia.
| | - Anna Ugalde
- School of Nursing and Midwifery, The Centre for Quality and Patient Safety in the Institute for Health Transformation, Deakin University, Geelong, 3220, Australia
| | - Elisabeth Coyne
- School of Nursing, Griffith University, Brisbane, Australia
- School of Nursing, University of Southern Denmark, Odense, Denmark
| | - Karin B Dieperink
- Family Focused Healthcare Research Center FaCe, University of Southern Denmark, Odense, Denmark
- Department of Oncology, Odense University Hospital, Odense, Denmark
| | - Hannah Jongebloed
- School of Nursing and Midwifery, The Centre for Quality and Patient Safety in the Institute for Health Transformation, Deakin University, Geelong, 3220, Australia
| | - Patricia Livingston
- School of Nursing and Midwifery, The Centre for Quality and Patient Safety in the Institute for Health Transformation, Deakin University, Geelong, 3220, Australia
- Faculty of Health, Deakin University, Geelong, 3220, Australia
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Reisner SL, Deutsch MB, Mayer KH, Pletta DR, Campbell J, Potter J, Keuroghlian AS, Hughto JMW, Asquith A, Pardee DJ, Harris A, Quint M, Grasso C, Gonzalez A, Radix A. Decreased Anogenital Gonorrhea and Chlamydia in Transgender and Gender Diverse Primary Care Patients Receiving Gender-Affirming Hormone Therapy. J Gen Intern Med 2024; 39:1164-1172. [PMID: 37989820 PMCID: PMC11116345 DOI: 10.1007/s11606-023-08531-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Accepted: 11/08/2023] [Indexed: 11/23/2023]
Abstract
BACKGROUND Transgender and gender diverse (TGD) adults in the U.S. experience health disparities, including in anogenital sexually transmitted infections (STI). Gender-affirming hormone therapy (GAHT) is known to be medically necessary and improve health. Few studies have assessed the effect of GAHT on STI diagnoses. OBJECTIVE To evaluate the effect of GAHT delivered in primary care as an intervention to improve STI outcomes for TGD adults. DESIGN LEGACY is a longitudinal, multisite cohort study of adult TGD primary care patients from two federally qualified community health centers in Boston, MA, and New York, NY. PARTICIPANTS Electronic health record data for eligible adult TGD patients contributed to the LEGACY research data warehouse (RDW). A total of 6330 LEGACY RDW patients were followed from 2016 to 2019, with 2555 patients providing STI testing data. MAIN MEASURES GAHT exposure was being prescribed hormones, and the clinical outcome was anogenital gonorrhea or chlamydia diagnoses. Log-Poisson generalized estimating equations assessed the effect of prescription GAHT on primary outcomes, adjusting for age, race, ethnicity, gender identity, poverty level, health insurance, clinical site, and cohort years. KEY RESULTS The median age was 28 years (IQR = 13); the racial breakdown was 20.4% Black, 8.1% Multiracial, 6.9% Asian/Pacific Islander, 1.8% Other; 62.8% White; 21.3% Hispanic/Latinx; 47.0% were assigned female at birth, and 16.0% identified as nonbinary. 86.3% were prescribed hormones. Among those tested, the percentage of patients with a positive anogenital STI diagnosis ranged annually from 10.0 to 12.5% between 2016 and 2019. GAHT prescription was associated with a significant reduction in the risk of anogenital STI diagnosis (aRR = 0.75; 95% CI = 0.59-0.96) over follow-up. CONCLUSIONS GAHT delivered in primary care was associated with less STI morbidity in this TGD cohort over follow-up. Patients may benefit from individualized and tailored clinical care alongside GAHT to optimize STI outcomes.
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Affiliation(s)
- Sari L Reisner
- Brigham and Women's Hospital, 221 Longwood Ave, Boston, MA, USA.
- Harvard Medical School, Boston, MA, USA.
- Harvard T.H. Chan School of Public Health, Boston, MA, USA.
- The Fenway Institute, Fenway Health, Boston, MA, USA.
| | | | - Kenneth H Mayer
- Harvard Medical School, Boston, MA, USA
- Harvard T.H. Chan School of Public Health, Boston, MA, USA
- The Fenway Institute, Fenway Health, Boston, MA, USA
- Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - David R Pletta
- Harvard T.H. Chan School of Public Health, Boston, MA, USA
- The Fenway Institute, Fenway Health, Boston, MA, USA
| | | | - Jennifer Potter
- Harvard Medical School, Boston, MA, USA
- The Fenway Institute, Fenway Health, Boston, MA, USA
- Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Alex S Keuroghlian
- Harvard Medical School, Boston, MA, USA
- The Fenway Institute, Fenway Health, Boston, MA, USA
- Massachusetts General Hospital, Boston, MA, USA
| | - Jaclyn M W Hughto
- The Fenway Institute, Fenway Health, Boston, MA, USA
- Brown University School of Public Health, Providence, RI, USA
- Center for Health Promotion and Health Equity, Brown University, Providence, RI, USA
| | | | - Dana J Pardee
- The Fenway Institute, Fenway Health, Boston, MA, USA
| | | | - Meg Quint
- Brigham and Women's Hospital, 221 Longwood Ave, Boston, MA, USA
| | - Chris Grasso
- The Fenway Institute, Fenway Health, Boston, MA, USA
| | - Alex Gonzalez
- Harvard Medical School, Boston, MA, USA
- The Fenway Institute, Fenway Health, Boston, MA, USA
- Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Asa Radix
- Callen-Lorde Community Health Center, New York, NY, USA
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3
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Starling CM, Smith M, Kazi S, Milicia A, Grisham R, Gruber E, Blumenthal J, Arem H. Understanding social needs screening and demographic data collection in primary care practices serving Maryland Medicare patients. BMC Health Serv Res 2024; 24:448. [PMID: 38600578 PMCID: PMC11005183 DOI: 10.1186/s12913-024-10948-7] [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: 01/22/2024] [Accepted: 04/03/2024] [Indexed: 04/12/2024] Open
Abstract
BACKGROUND Health outcomes are strongly impacted by social determinants of health, including social risk factors and patient demographics, due to structural inequities and discrimination. Primary care is viewed as a potential medical setting to assess and address individual health-related social needs and to collect detailed patient demographics to assess and advance health equity, but limited literature evaluates such processes. METHODS We conducted an analysis of cross-sectional survey data collected from n = 507 Maryland Primary Care Program (MDPCP) practices through Care Transformation Requirements (CTR) reporting in 2022. Descriptive statistics were used to summarize practice responses on social needs screening and demographic data collection. A stepwise regression analysis was conducted to determine factors predicting screening of all vs. a targeted subset of beneficiaries for unmet social needs. RESULTS Almost all practices (99%) reported conducting some form of social needs screening and demographic data collection. Practices reported variation in what screening tools or demographic questions were employed, frequency of screening, and how information was used. More than 75% of practices reported prioritizing transportation, food insecurity, housing instability, financial resource strain, and social isolation. CONCLUSIONS Within the MDPCP program there was widespread implementation of social needs screenings and demographic data collection. However, there was room for additional supports in addressing some challenging social needs and increasing detailed demographics. Further research is needed to understand any adjustments to clinical care in response to identified social needs or application of data for uses such as assessing progress towards health equity and the subsequent impact on clinical care and health outcomes.
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Affiliation(s)
- Claire M Starling
- Implementation Science, Healthcare Delivery Research Program, MedStar Health Research Institute, 6525 Belcrest Road, Suite 700, Hyattsville, MD, 20782, USA.
| | - Marjanna Smith
- Implementation Science, Healthcare Delivery Research Program, MedStar Health Research Institute, 6525 Belcrest Road, Suite 700, Hyattsville, MD, 20782, USA
| | - Sadaf Kazi
- Department of Emergency Medicine, Georgetown University School of Medicine, 3900 Reservoir Road, Washington, NWDC, 20007, USA
- National Center for Human Factors in Healthcare, MedStar Health Research Institute, 3007 Tilden St.Suite 6N, Washington, NWDC, 20008, USA
| | - Arianna Milicia
- National Center for Human Factors in Healthcare, MedStar Health Research Institute, 3007 Tilden St.Suite 6N, Washington, NWDC, 20008, USA
| | - Rachel Grisham
- Maryland Primary Care Program, Maryland Department of Health, 201 W. Preston Street, Baltimore, MD, 21201, USA
| | - Emily Gruber
- Maryland Primary Care Program, Maryland Department of Health, 201 W. Preston Street, Baltimore, MD, 21201, USA
| | - Joseph Blumenthal
- MedStar Center for Biostatistics, Informatics and Data Science, MedStar Health Research Institute, 3007 Tilden St.Suite 6N, Washington, NWDC, 20008, USA
| | - Hannah Arem
- Implementation Science, Healthcare Delivery Research Program, MedStar Health Research Institute, 6525 Belcrest Road, Suite 700, Hyattsville, MD, 20782, USA
- Department of Oncology, Georgetown University School of Medicine, 3900 Reservoir Road, Washington, NWDC, 20007, USA
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Seiger KW, McNamara B, Berrahou IK. Gynecologic Care for Sexual and Gender Minority Patients. Obstet Gynecol Clin North Am 2024; 51:17-41. [PMID: 38267126 DOI: 10.1016/j.ogc.2023.10.001] [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] [Indexed: 01/26/2024]
Abstract
Sexual and gender minority (SGM) people, including lesbian, gay, bisexual, transgender, and queer individuals, are a diverse population with a wide spectrum of gynecologic needs. Institutionalized cisheteronormativity, stigmatization, lack of provider training, and fear of discrimination contribute to health disparities in this patient population. In this article, we review key topics in the gynecologic care of SGM patients and provide strategies to enable gynecologists to provide SGM people with equitable and inclusive full spectrum reproductive health care.
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Affiliation(s)
- Kyra W Seiger
- Yale University School of Medicine, 367 Cedar Street, New Haven, CT 06510, USA
| | - Blair McNamara
- Department of Obstetrics, Gynecology & Reproductive Sciences, Yale University School of Medicine, 333 Cedar Street, New Haven, CT 06520, USA
| | - Iman K Berrahou
- Department of Obstetrics, Gynecology & Reproductive Sciences, Yale University School of Medicine, 333 Cedar Street, PO Box 208063, Suite 302 FMB, New Haven, CT 06520-806, USA.
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Keuroghlian AS. Cisgender Privilege in Public Health Research. Am J Public Health 2024; 114:142-143. [PMID: 38335497 PMCID: PMC10862193 DOI: 10.2105/ajph.2023.307542] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/12/2024]
Affiliation(s)
- Alex S Keuroghlian
- The author is with Harvard Medical School, Boston, MA; The Fenway Institute, Fenway Health, Boston; and the Department of Psychiatry, Massachusetts General Hospital, Boston
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Baker KE, Sarkodie E, Kwait J, Medina C, Radix A, Flynn R. Advancing Sexual and Gender Minority Population Health Using Electronic Health Record Data. Am J Public Health 2023; 113:1287-1289. [PMID: 37939335 PMCID: PMC10632836 DOI: 10.2105/ajph.2023.307467] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2023]
Affiliation(s)
- Kellan E Baker
- Kellan E. Baker, Eleanor Sarkodie, Jennafer Kwait, and Caroline Medina are with Whitman-Walker Institute, Washington, DC. Asa Radix is with Callen-Lorde Community Health Center, New York, NY. Risa Flynn is with the Los Angeles LGBT Center, Los Angeles, CA
| | - Eleanor Sarkodie
- Kellan E. Baker, Eleanor Sarkodie, Jennafer Kwait, and Caroline Medina are with Whitman-Walker Institute, Washington, DC. Asa Radix is with Callen-Lorde Community Health Center, New York, NY. Risa Flynn is with the Los Angeles LGBT Center, Los Angeles, CA
| | - Jennafer Kwait
- Kellan E. Baker, Eleanor Sarkodie, Jennafer Kwait, and Caroline Medina are with Whitman-Walker Institute, Washington, DC. Asa Radix is with Callen-Lorde Community Health Center, New York, NY. Risa Flynn is with the Los Angeles LGBT Center, Los Angeles, CA
| | - Caroline Medina
- Kellan E. Baker, Eleanor Sarkodie, Jennafer Kwait, and Caroline Medina are with Whitman-Walker Institute, Washington, DC. Asa Radix is with Callen-Lorde Community Health Center, New York, NY. Risa Flynn is with the Los Angeles LGBT Center, Los Angeles, CA
| | - Asa Radix
- Kellan E. Baker, Eleanor Sarkodie, Jennafer Kwait, and Caroline Medina are with Whitman-Walker Institute, Washington, DC. Asa Radix is with Callen-Lorde Community Health Center, New York, NY. Risa Flynn is with the Los Angeles LGBT Center, Los Angeles, CA
| | - Risa Flynn
- Kellan E. Baker, Eleanor Sarkodie, Jennafer Kwait, and Caroline Medina are with Whitman-Walker Institute, Washington, DC. Asa Radix is with Callen-Lorde Community Health Center, New York, NY. Risa Flynn is with the Los Angeles LGBT Center, Los Angeles, CA
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Purcell LK, Schnitker JW, Moore TM, Peña AM, Love MF, Ford AI, Vassar BM. Health inequities in dialysis care: A scoping review. Semin Dial 2023; 36:430-447. [PMID: 37734842 DOI: 10.1111/sdi.13176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Revised: 08/14/2023] [Accepted: 09/04/2023] [Indexed: 09/23/2023]
Abstract
MAIN PROBLEM We aim to look at potential gaps in current dialysis literature on inequities and explore future research that could contribute to more equitable care. METHODS Following guidelines from the Joanna Briggs Institute (JBI) and the Preferred Reporting Items for Systematic reviews and Meta Analyses extension for Scoping Reviews (PRISMA-ScR), we conducted a scoping review of health inequities in dialysis. PubMed and Ovid Embase were searched in July 2022 for articles published between 2016 and 2022 that examined at least one of the following NIH defined health inequities: race/ethnicity, sex/gender, LGBTQ+ identity, underserved rural populations, education level, income, and occupation status. Frequencies of each health inequity as well as trends over time of the four most examined inequities were analyzed. RESULTS In our sample of 69 included studies, gaps were identified in LGBTQ+ identity and patient education. Inequities pertaining to race/ethnicity, sex/gender, underserved rural populations, and income were sufficiently reported. No trends between inequities investigated over time were identified. CONCLUSIONS Our scoping review examined current literature on health inequities pertaining to dialysis and found gaps concerning LGBTQ+ and patients with lower levels of education. To help fill these gaps, and possibly alleviate additional burden to these patients, we recommend cultural competency training for providers and dialysis center staff as well as community-based educational programs to improve dialysis patients' health literacy.
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Affiliation(s)
- Lindsey Kay Purcell
- Office of Medical Student Research, Oklahoma State University Center for Health Sciences, Tulsa, Oklahoma, USA
| | - Joseph William Schnitker
- Office of Medical Student Research, Oklahoma State University Center for Health Sciences, Tulsa, Oklahoma, USA
| | - Ty Michael Moore
- Office of Medical Student Research, Oklahoma State University Center for Health Sciences, Tulsa, Oklahoma, USA
| | - Andriana Mercedes Peña
- Office of Medical Student Research, Oklahoma State University Center for Health Sciences, Tulsa, Oklahoma, USA
| | - Mitchell Faris Love
- Office of Medical Student Research, Oklahoma State University Center for Health Sciences, Tulsa, Oklahoma, USA
| | - Alicia Ito Ford
- Office of Medical Student Research, Oklahoma State University Center for Health Sciences, Tulsa, Oklahoma, USA
- Department of Psychiatry and Behavioral Sciences, Oklahoma State University Center for Health Sciences, Tulsa, Oklahoma, USA
| | - Benjamin Matt Vassar
- Office of Medical Student Research, Oklahoma State University Center for Health Sciences, Tulsa, Oklahoma, USA
- Department of Psychiatry and Behavioral Sciences, Oklahoma State University Center for Health Sciences, Tulsa, Oklahoma, USA
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Birnbaum A, Karamitopoulos M, Carter CW. Musculoskeletal health considerations for the transgender athlete. PHYSICIAN SPORTSMED 2023; 51:387-393. [PMID: 35373697 DOI: 10.1080/00913847.2022.2057787] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2021] [Accepted: 03/21/2022] [Indexed: 10/18/2022]
Abstract
BACKGROUND In addition to the familiar sports-related injuries and conditions experienced by cisgender athletes, transgender athletes may also face unique challenges to maintaining their musculoskeletal health. Encouraging sports medicine professionals to become familiar with accepted nomenclature and terminology related to transgender athletes will enable open communication on the field, in the athletic training facility, and office. OBJECTIVE Understanding contemporary medical and surgical gender-affirming treatments and the unique ways in which the musculoskeletal system might be affected by each - such as impairments in bone health, changes in ligamentous function and the potential increased risk for deep venous thromboembolism - is essential for provision of optimal musculoskeletal care to transgender athletes. Knowledge of the existing participation policies for transgender athletes is also key for enabling sports medicine professionals to effectively counsel athletes about the need for specialized protective equipment. Additionally, this knowledge is important for appropriately managing therapeutic use exemptions in the competitive sports setting. CONCLUSION This article provides an overview of the current accepted nomenclature, common gender-affirming medical and surgical treatments, unique musculoskeletal health considerations, and participation policies for transgender athletes.
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Affiliation(s)
- Amy Birnbaum
- Department of Orthopedic Surgery, NYU Langone Health, New York, NY, USA
| | | | - Cordelia W Carter
- Department of Orthopedic Surgery, NYU Langone Health, New York, NY, USA
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Alpert AB, Mehringer JE, Orta SJ, Hernandez T, Redwood EF, Rivers L, Manzano C, Ruddick R, Adams S, Sevelius J, Belanger E, Operario D, Griggs JJ. Transgender People's Experiences Sharing Information With Clinicians: A Focus Group-Based Qualitative Study. Ann Fam Med 2023; 21:408-415. [PMID: 37748898 PMCID: PMC10519763 DOI: 10.1370/afm.3010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Revised: 05/07/2023] [Accepted: 05/10/2023] [Indexed: 09/27/2023] Open
Abstract
PURPOSE Investigating transgender people's experiences sharing health information in clinical encounters may yield insights for family medicine clinicians. METHODS This was a qualitative study using a community-based participatory research approach and interpretive description methodology. Seven qualitative focus groups were conducted with 30 transgender adults living in North America. We used purposive sampling to ensure diversity. The focus groups were transcribed verbatim, and 2 investigators independently reviewed and coded each transcript, then they mutually reviewed the transcripts, reconciled their coding, and summarized the codes into themes. Themes were reviewed with community members, participants, and uninvolved clinically oriented investigators for member checking and peer debriefing. RESULTS Four themes were noted: (1) transgender people often perceive clinicians' questions as voyeuristic, stigmatizing, or self-protective; (2) patients describe being pathologized, denied or given substandard care, or harmed when clinicians learned they are transgender; (3) transgender people frequently choose between risking stigma when sharing information and risking ineffective clinical problem solving if clinicians do not have all the information about their medical histories; (4) improving the safety of transgender people is difficult in the context of contemporary medical systems. CONCLUSIONS Transgender people often must choose between stigma and potentially suboptimal care. Improvements in medical culture, policies, procedures, and data collection tools are necessary to improve the quality and safety of clinical care for transgender people. Institutional and systems changes may be required to safely and effectively implement sexual orientation and gender identity (SOGI) data collection in clinical settings.
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Affiliation(s)
- Ash B Alpert
- Yale Cancer Center, Yale School of Medicine, New Haven, Connecticut (A.B.A.);
- Center for Gerontology and Healthcare Research, Department of Health Services, Policy & Practice, Brown University School of Public Health, Providence, Rhode Island (A.B.A., E.B.)
- Department of Public Health Sciences, University of Rochester Medical Center, Rochester, New York (A.B.A.)
| | - Jamie E Mehringer
- Department of Pediatrics, University of Rochester Medical Center, Rochester, New York (J.E.M.)
| | - Sunshine J Orta
- University Health Services, University of Rochester, Rochester, New York (S.J.O.)
| | - Tresne Hernandez
- University of Rochester School of Medicine and Dentistry, Rochester, New York (T.H.)
| | - Emile F Redwood
- Department of Obstetrics and Gynecology, New York University Langone Health, New York, New York (L.R., E.R., C.M., R.R.)
| | - Lexis Rivers
- Department of Obstetrics and Gynecology, New York University Langone Health, New York, New York (L.R., E.R., C.M., R.R.)
| | - Charlie Manzano
- Department of Obstetrics and Gynecology, New York University Langone Health, New York, New York (L.R., E.R., C.M., R.R.)
| | - Roman Ruddick
- Department of Obstetrics and Gynecology, New York University Langone Health, New York, New York (L.R., E.R., C.M., R.R.)
| | - Spencer Adams
- Transgender Cancer Patient Project, Ashland, Oregon (S.A.)
| | - Jae Sevelius
- Western Michigan University, Kalamazoo, Michigan (J.S.)
| | - Emma Belanger
- Center for Gerontology and Healthcare Research, Department of Health Services, Policy & Practice, Brown University School of Public Health, Providence, Rhode Island (A.B.A., E.B.)
| | - Don Operario
- Department of Medicine, University of California San Francisco, San Francisco, California (D.O.)
- Department of Behavioral, Social, and Health Education Sciences, Rollins School of Public Health, Emory University, Atlanta, Georgia (D.O.)
| | - Jennifer J Griggs
- Division of Hematology and Oncology, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan (J.J.G.)
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, Michigan (J.J.G.)
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Doucette C, Milano MT, Kamen C. Patient Perceptions of Sexual Orientation and Gender Identity Data Collection in an Outpatient Radiation Oncology Setting. Int J Radiat Oncol Biol Phys 2023; 116:68-78. [PMID: 36549346 DOI: 10.1016/j.ijrobp.2022.12.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Revised: 11/14/2022] [Accepted: 12/11/2022] [Indexed: 12/23/2022]
Abstract
PURPOSE Sexual and gender minority patients with cancer experience significant health disparities requiring tailored care. Collecting sexual orientation and gender identity (SOGI) data in the electronic medical record (EMR) could allow care to be tailored and is in line with radiation oncology's mission to better serve diverse patients. This article describes a systematic method for collecting SOGI data for all patients starting radiation treatment in a department of radiation oncology (DRO). METHODS AND MATERIALS During a 3-month experimental period, DRO staff administered a demographic questionnaire and attitude survey to new adult patients. SOGI demographic data, entered into the EMR by nursing staff, were extracted and analyzed for all patients from the experimental period and from the 3 months prior (control period). Descriptive and categorical data completion rates were compared between the experimental and control periods using independent-samples t tests and Pearson χ2 tests. RESULTS A total of 788 patients were included in this analysis: 368 in the control period and 420 in the experimental period. Of the 420 patients enrolled in the experimental period, 267 (63.6%) were offered a survey, of whom 211 (79.0%) completed the survey. There were higher rates of sexual orientation responses entered into the EMR for the experimental group compared with the control group (56.9% vs 27.1%; P <.001), with the highest response rates for patients who completed a survey (82.9%). Ten patients (2.9%) identified as gay or lesbian and 100% identified as cisgender. The majority of patients were not upset by the form, with only 11 patients (5.2%) stating that any specific question caused them distress. CONCLUSIONS Collecting SOGI data via a demographic form is feasible in an outpatient DRO. This approach was well received by the majority of patients and could lead to provision of higher-quality, tailored care.
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Affiliation(s)
| | | | - Charles Kamen
- Surgery, University of Rochester Medical Center, Rochester, New York.
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Provider perspectives on clinical decision support to improve HIV prevention in pediatric primary care: a multiple methods study. Implement Sci Commun 2023; 4:18. [PMID: 36810099 PMCID: PMC9945664 DOI: 10.1186/s43058-023-00394-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Accepted: 01/25/2023] [Indexed: 02/24/2023] Open
Abstract
BACKGROUND Clinical decision support (CDS) is a promising intervention for improving uptake of HIV testing and pre-exposure prophylaxis (PrEP). However, little is known regarding provider perspectives on acceptability, appropriateness, and feasibility of CDS for HIV prevention in pediatric primary care, a key implementation setting. METHODS This was a cross-sectional multiple methods study utilizing surveys and in-depth interviews with pediatricians to assess acceptability, appropriateness, and feasibility of CDS for HIV prevention, as well as to identify contextual barriers and facilitators to CDS. Qualitative analysis utilized work domain analysis and a deductive coding approach grounded in the Consolidated Framework of Implementation Research. Quantitative and qualitative data were merged to develop an Implementation Research Logic Model to conceptualize implementation determinants, strategies, mechanisms, and outcomes of potential CDS use. RESULTS Participants (n = 26) were primarily white (92%), female (88%), and physicians (73%). Using CDS to improve HIV testing and PrEP delivery was perceived as highly acceptable (median score 5), IQR [4-5]), appropriate (5, IQR [4-5]), and feasible (4, IQR [3.75-4.75]) using a 5-point Likert scale. Providers identified confidentiality and time constraints as two key barriers to HIV prevention care spanning every workflow step. With respect to desired CDS features, providers sought interventions that were integrated into the primary care workflow, standardized to promote universal testing yet adaptable to the level of a patient's HIV risk, and addressed providers' knowledge gaps and bolstered self-efficacy in providing HIV prevention services. CONCLUSIONS This multiple methods study indicates that clinical decision support in the pediatric primary care setting may be an acceptable, feasible, and appropriate intervention for improving the reach and equitable delivery of HIV screening and PrEP services. Design considerations for CDS in this setting should include deploying CDS interventions early in the visit workflow and prioritizing standardized but flexible designs.
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Haviland K, Mueller M, Walters CB, Kelechi TJ. Disparities in Cancer Screening in Sexual and Gender Minority Populations: A Secondary Analysis of Behavioral Risk Factor Surveillance System Data. Oncol Nurs Forum 2023; 50:157-167. [PMID: 37677801 PMCID: PMC10903742 DOI: 10.1188/23.onf.157-167] [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] [Indexed: 09/09/2023]
Abstract
OBJECTIVES To describe cancer screening characteristics and better understand individual-, environmental-, and organizational-level barriers of sexual and gender minority (SGM) populations. . SAMPLE & SETTING This study was conducted using a combined sample from the Behavioral Risk Factor Surveillance System (BRFSS) national dataset from 2014 and 2016. METHODS & VARIABLES Chi-square tests for independence and logistic regression analysis tests were performed to determine whether relationships existed between SGM status and demographics. RESULTS Black respondents or those who reported their race as other, were female, had some college or technical school or more, and had healthcare coverage were less likely to present for cancer screening. SGM respondents who were in good or better health; were unmarried; were aged 18-44 years or 45-55 years; or were Asian, Native American, or Hawaiian, or reported their race as other, had higher odds of screening for cancer. IMPLICATIONS FOR NURSING Disparities in cancer screening among SGM populations are not well documented. These findings will inform structured education and preventative interventions to improve screening participation among SGM populations.
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Fisher Z, Hughes G, Staggs J, Moore T, Kinder N, Vassar M. Health Inequities in Coronary Artery Bypass Grafting Literature: A Scoping Review. Curr Probl Cardiol 2023; 48:101640. [PMID: 36792023 DOI: 10.1016/j.cpcardiol.2023.101640] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2023] [Accepted: 02/04/2023] [Indexed: 02/15/2023]
Abstract
Although life saving, health inequities exist regarding access and patient outcomes in Coronary artery bypass grafting (CABG), especially among marginalized groups. This scoping review's goal is to outline existing literature and highlight gaps for future research. Researchers followed guidance from the Joanna Briggs Institute and PRISMA extension for scoping reviews. We conducted a search to identify articles published between 2016 and 2022 regarding CABG and inequity groups, defined by the National Institutes of Health. Fifty-seven articles were included in our final sample. Race/Ethnicity was examined in 39 incidences, Sex or Gender 29 times, Income 17 instances, Geography 10 instances, and Education Level 3 instances. Occupation Status 2 instances, and LGBTQ+ 0 times. Important disparities exist regarding CABG access and outcomes, especially involving members of the LGBTQ+, Native American, and Black communities. Further research is needed to address health disparities and their root causes for focused action and improved health of minoritized groups.
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Affiliation(s)
- Zachariah Fisher
- Office of Medical Student Research, Oklahoma State University Center for Health Sciences, Tulsa, OK.
| | - Griffin Hughes
- Office of Medical Student Research, Oklahoma State University Center for Health Sciences, Tulsa, OK
| | - Jordan Staggs
- Office of Medical Student Research, Oklahoma State University Center for Health Sciences, Tulsa, OK
| | - Ty Moore
- Office of Medical Student Research, Oklahoma State University Center for Health Sciences, Tulsa, OK
| | | | - Matt Vassar
- Office of Medical Student Research, Oklahoma State University Center for Health Sciences, Tulsa, OK
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Examining participant representation by sex, race, ethnicity and age in United States blood donation and blood transfusion clinical trials. Transfus Apher Sci 2023:103653. [PMID: 36781328 DOI: 10.1016/j.transci.2023.103653] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Revised: 02/03/2023] [Accepted: 02/07/2023] [Indexed: 02/11/2023]
Abstract
Significant inequities based on sex, race, ethnicity, and age exist among participants in clinical trials dedicated to investigating medical disease states. While general demographic data regarding blood donors and blood transfusion recipients have been studied extensively, the demographics of participants involved in blood donation and blood transfusion clinical trials are unknown. We performed a cross-sectional analysis of United States (U.S.) -based interventional blood donation and blood transfusion clinical trials registered with Clinicaltrials.gov to ascertain the composition of participants' sex, race, ethnicity, and age, as well as diagnostic conditions and geographic trial locations.Eligible trials were undertaken between July 2003 and August 2020. Thirty-eight of the one hundred and fifty-two blood donation and blood transfusion clinical trials met inclusion criteria (seven blood donation and thirty-one blood transfusion trials). While the participant dataset from trial reports were incomplete, 100 % of blood donation trials reported sex and age, 71.4 % reported race, and 42.3 % reported ethnicity. 96.8 % of blood transfusion trials reported sex, 51.6 % reported race, 38.7 % reported ethnicity, and 100 % reported age. Among 2720 participants enrolled in the seven blood donation trials, females were underrepresented (28.5 %) compared to U.S. Census data. Conversely, female (50.8 %) and male participants (49.2 %) were equally represented in blood transfusion trials (9255 participants). White participants were overrepresented in blood donation trials (73.4 %), while Hispanic or Latinos were underrepresented in both blood donation (7.7 %) and blood transfusion (8.2 %) trials compared to 2019 U.S.Census data. Only 8.3 % of blood transfusion clinical trials open to adults reported including older adults (i.e., ≥ 65yo). Despite mandatory reporting requirements and an already established framework, researchers frequently failed to report complete demographics of blood donation and blood transfusion clinical trial participants. Furthermore, various demographic groups were underrepresented in blood donation and/or blood transfusion clinical trials, including females, Hispanic or Latino individuals, and older adults. These findings demonstrate the need for implementation of strategies to ensure equitable representation of individuals in blood donation and transfusion clinical trials.
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15
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Hayward JH. Updates in Transgender Breast Imaging. Semin Ultrasound CT MR 2023; 44:23-34. [PMID: 36792271 DOI: 10.1053/j.sult.2022.10.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Transgender patients are seen in breast imaging centers for routine screening mammography and diagnostic imaging of the symptomatic breast. This comprehensive review of transgender breast imaging aims to update the radiologist on appropriate terminology, breast cancer risk in different patient populations, screening guidelines, and diagnostic scenarios. The chapter concludes with practical tips on how to optimize the patient experience.
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Affiliation(s)
- Jessica H Hayward
- Department of Radiology and Biomedical Imaging, University of California, San Francisco.
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16
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Reducing Adult Transgender Barriers to Care in the Emergency Department: Strategies to Improve Policies and Practices. Adv Emerg Nurs J 2023; 45:3-10. [PMID: 36757740 DOI: 10.1097/tme.0000000000000446] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/10/2023]
Abstract
The Research to Practice column is intended to improve the research critique skills of the advanced practice registered nurse (APRN) and the emergency department (ED) registered nurse (RN) and to assist with translating research into practice. In this column, we review a recent qualitative research study by M. Allison, S. Marshall, G. Stewart, M. Joiner, C. Nash, and M. Stewart (2021) titled "Experiences of Transgender and Gender Nonbinary Patients in the Emergency Department and Recommendations for Health Care Policy, Education, and Practice" with discussion of how their findings can be applied to inform providers how to deliver appropriate care of transgender patients within the ED.
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Marshall SA, Stewart MK, Barham C, Ounpraseuth S, Curran G. Facilitators and barriers to providing affirming care for transgender patients in primary care practices in Arkansas. J Rural Health 2023; 39:251-261. [PMID: 35644535 PMCID: PMC9705606 DOI: 10.1111/jrh.12683] [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] [Indexed: 02/01/2023]
Abstract
PURPOSE This study assessed factors affecting the provision of affirming-care best practices (ACBPs) for transgender individuals by primary care providers (PCPs) in a rural, southern state METHODS: We conducted a sequential explanatory mixed-methods study in 2020, including a statewide survey (phase 1) and interviews (phase 2). Surveyed PCPs (phase 1) included Medical Doctors/Doctors of Osteopathy (MDs/DOs), nurse practitioners, and 1 physician assistant. Interview participants (phase 2) included providers and staff in 6 practices throughout the state. We used an exploratory approach to data collection and performed content analysis to classify interview data into categories representing overarching themes RESULTS: Among surveyed PCPs who reported they had provided care to transgender patients (n = 35), the most common reason for providing gender-affirming medical services was "because of my ethical obligation to treat patients equally" (n = 27, 77%). The most common reason for not providing such services was because the PCPs "have not been trained/don't feel competent to provide these services" (n = 12, 34%). Interviews revealed the following themes: (1) willingness to provide "culturally competent care"; (2) continuum of accepting to affirming attitudes toward transgender individuals; (3) basic understanding of stigma and an awareness of its impact; (4) changes needed to provide "culturally competent care"; and (5) preferred clinical support strategies. CONCLUSION Training and education to provide ACBPs are warranted and would meet the needs of patients and providers. Facilitating telemedicine visits for transgender patients with gender-affirming care experts was a favorable implementation strategy for clinical support and is recommended to address access to affirming care.
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Affiliation(s)
- Sarah Alexandra Marshall
- Department of Health Behavior and Health Education, Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Mary Kathryn Stewart
- Department of Health Policy and Management, Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Caroline Barham
- College of Medicine, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Songthip Ounpraseuth
- Department of Biostatistics, Fay W. Boozman College of Public Health/College of Medicine, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Geoffrey Curran
- College of Pharmacy/College of Medicine, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
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Keegan G, Crown A, Joseph KA. Diversity, Equity, and Inclusion in Clinical Trials. Surg Oncol Clin N Am 2023; 32:221-232. [PMID: 36410919 DOI: 10.1016/j.soc.2022.08.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Minority groups are vastly underrepresented in clinical trial participants and leadership. Because these studies provide innovative and revolutionary treatment options to patients with cancer and have the potential to extend survival, it is imperative that public and private stakeholders, as well as hospital and clinical trial leadership, prioritize equity and inclusion of diverse populations in clinical trial development and recruitment strategies. Achieving equity in clinical trials could be an important step in reducing the overall cancer burden and mortality disparities in vulnerable populations.
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Affiliation(s)
- Grace Keegan
- Keegan-University of Chicago, Pritzker School of Medicine, 924 E. 57th Street, Chicago, IL 60637, USA
| | - Angelena Crown
- Breast Surgery, True Family Women's Cancer Center, Swedish Cancer Institute, Seattle, WA, USA
| | - Kathie-Ann Joseph
- Department of Surgery, New York University Grossman School of Medicine, NYC Health and Hospitals/Bellevue, New York, NY, USA; NYU Langone Health's Institute for Excellence in Health Equity, 180 Madison Avenue, New York, NY, USA.
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19
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Chronic Obstructive Pulmonary Disease in the LGBTQI + Population. Ann Am Thorac Soc 2022; 19:2111-2112. [PMID: 36103717 PMCID: PMC9743471 DOI: 10.1513/annalsats.202207-653le] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
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20
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Kamen CS, Reichelt M, Dadgostar P, Alpert AB, Doucette C, Vaughan P, Keuroghlian AS, Yousefi-Nooraie R. Sexual and gender minority cultural humility training for oncology settings: An example of iterative adaptation and implementation. FRONTIERS IN HEALTH SERVICES 2022; 2:958274. [PMID: 36925900 PMCID: PMC10012625 DOI: 10.3389/frhs.2022.958274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Accepted: 10/19/2022] [Indexed: 11/11/2022]
Abstract
Background Multiple national organizations recommend that cancer care providers and oncology practices be responsive to the needs of sexual and gender minority (SGM) patients. Oncology practices have attempted to incorporate this recommendation through SGM-focused cultural humility training interventions. It is unclear how best to adapt and implement such training across practices. This manuscript outlines one process for adapting a widely-used SGM training from The Fenway Institute to the context of oncology settings using the Framework for Reporting Adaptations and Modifications-Enhanced (FRAME) model. Methods We conducted training sessions in two oncology care settings: a breast oncology center and a radiation oncology department. Subsequently, we conducted in-depth interviews with the three trainers involved in adapting The Fenway Institute's training to these two practices. Two independent investigators coded the interviews using components of the FRAME model as an analytic guide. Results Training team members described the mechanisms by which FRAME adaption occurred both proactively and reactively; the importance of involving SGM-identified trainers of diverse backgrounds as well as champions from within oncology practices in which trainings were conducted; the importance of adapting both the context and content of training to be relevant to oncology audiences; and the ways in which fidelity to the core principles of improving health care for SGM patients was maintained throughout the process. Discussion SGM cultural humility training for oncology providers and staff must undergo iterative adaptation to address the political and social context of specific practice environments and advocate for broader institutional culture change to achieve responsiveness to SGM health needs.
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Affiliation(s)
| | | | | | - Ash B. Alpert
- Brown University School of Public Health, Providence, RI, United States
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21
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Srinivasan S, Goldhammer H, Crall C, Kitts R, Keuroghlian AS. A Novel Medical Student Elective Course in Lesbian, Gay, Bisexual, Transgender, Queer, Intersex, Asexual, and Sexually and Gender Diverse Health: Training Tomorrow's Physician-Leaders. LGBT Health 2022; 10:252-257. [PMID: 36350692 DOI: 10.1089/lgbt.2022.0161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Purpose: Inadequate medical training in lesbian, gay, bisexual, transgender, queer, intersex, asexual, and sexually and gender diverse (LGBTQIA+) health care contributes to health disparities. This article reports on a novel 4-week elective course at Harvard Medical School that prepares students to become physician-leaders in LGBTQIA+ health care. Methods: The course engages students in multidisciplinary clinical placements, self-directed learning, and mentored scholarly projects, all specifically relevant to LGBTQIA+ health. The authors qualitatively reviewed student experiences, and quantitatively analyzed course evaluations. Results: Between 2016 and 2022, 30 students completed the course, and 12 scholarly projects resulted in a published peer-reviewed article authored by the student. Students who completed evaluations rated the course as excellent and reported increased interest and core knowledge in LGBTQIA+ health care. Conclusion: This novel program has demonstrated feasibility and may serve as a model for establishing other advanced medical student clinical and scholarly electives on LGBTQIA+ health care.
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Affiliation(s)
| | | | - Cary Crall
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA
- Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Robert Kitts
- University Counseling Services, Boston College, Chestnut Hill, Massachusetts, USA
| | - Alex S. Keuroghlian
- The Fenway Institute, Fenway Health, Boston, Massachusetts, USA
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA
- Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts, USA
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22
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Staggs S, Sewell R, Buchanan C, Claussen L, Franklin R, Levett L, Poppy DC, Porto A, Reirden DH, Simon A, Whiteside S, Nokoff NJ. Instituting Sexual Orientation and Gender Identity Training and Documentation to Increase Inclusivity at a Pediatric Health System. Transgend Health 2022; 7:461-467. [PMID: 36311186 PMCID: PMC9587792 DOI: 10.1089/trgh.2021.0016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
In this mixed-methods quality improvement project, we implemented and evaluated sexual orientation and gender identity (SOGI) form rollout in the electronic medical record. Families in our gender diversity program completed a baseline survey in 2017 (55/328 responded) and follow-up in 2020 (180/721 responded) to evaluate the frequency of affirmed name and pronoun use in the hospital. Survey feedback informed system-wide inclusivity efforts and training. SOGI was implemented in 2020 after 1,662 providers completed an online training and 11,090 team members completed gender and sexual orientation inclusivity training. We recommend similar trainings for health systems utilizing SOGI.
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Affiliation(s)
- Syd Staggs
- Department of Pediatrics, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
- Department of Pediatrics, Children's Hospital Colorado, Aurora, Colorado, USA
| | - Rachel Sewell
- Department of Pediatrics, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
- Department of Pediatrics, Children's Hospital Colorado, Aurora, Colorado, USA
| | - Cindy Buchanan
- Department of Pediatrics, Children's Hospital Colorado, Aurora, Colorado, USA
- Department of Psychiatry and Surgery, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Lori Claussen
- Department of Accreditation, Children's Hospital Colorado, Aurora, Colorado, USA
| | - Robert Franklin
- Diversity, Health Equity & Inclusion, Children's Hospital Colorado, Aurora, Colorado, USA
| | - Lev Levett
- Department of Pediatrics, Children's Hospital Colorado, Aurora, Colorado, USA
| | | | - Ariel Porto
- Department of Pediatrics, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
- Department of Pediatrics, Children's Hospital Colorado, Aurora, Colorado, USA
| | - Daniel H. Reirden
- Department of Pediatrics, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
- Department of Pediatrics, Children's Hospital Colorado, Aurora, Colorado, USA
| | - Abby Simon
- Department of Pediatrics, Children's Hospital Colorado, Aurora, Colorado, USA
| | - Stacey Whiteside
- Launch Program, Children's Hospital Colorado, Aurora, Colorado, USA
| | - Natalie J. Nokoff
- Department of Pediatrics, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
- Department of Pediatrics, Children's Hospital Colorado, Aurora, Colorado, USA
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Hermosillo D, Cygan HR, Lemke S, McIntosh E, Vail M. Achieving Health Equity for LGBTQ+ Adolescents. J Contin Educ Nurs 2022; 53:348-354. [PMID: 35914274 DOI: 10.3928/00220124-20220706-05] [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: 11/20/2022]
Abstract
The lesbian, gay, bisexual, transgender, and queer (LGBTQ+) adolescent population experiences health disparities due to barriers to care, including lack of access to culturally competent health care providers. The purpose of this quality improvement project was to increase access to culturally competent care through continuing education, a physical makeover of clinic space, and a social marketing campaign. The impact of the project on the number of LGBTQ+ adolescent patients at the clinic and the rate of documentation of sexual orientation and gender identity data was evaluated via a chart audit. Changes in nurses' and health care providers' knowledge as a result of the continuing education were evaluated with a pretest and a posttest. The number of LGBTQ+ patients and provider knowledge increased following the continuing education. Sexual orientation and gender identity data were documented during 87.5% of visits. The participants' knowledge increased by 4.7% following the continuing education. Further, five physical changes to the clinic were completed and a social marketing campaign was launched. This quality improvement project demonstrates that continuing education can be an effective way to increase cultural competence for the care of LGBTQ+ individuals. [J Contin Educ Nurs. 2022;53(8):348-354.].
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Berrahou IK, Leonard SA, Zhang A, Main EK, Obedin-Maliver J. Sexual and/or gender minority parental structures among California births from 2016 to 2020. Am J Obstet Gynecol MFM 2022; 4:100653. [PMID: 35462057 DOI: 10.1016/j.ajogmf.2022.100653] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Revised: 04/06/2022] [Accepted: 04/18/2022] [Indexed: 10/18/2022]
Abstract
BACKGROUND Sexual and/or gender minority people account for roughly 7.1% of the US population, and an estimated one-third are parents. Little is known about sexual and/or gender minority people who become pregnant, despite this population having documented healthcare disparities that may affect pregnancy. OBJECTIVE Our objective was to describe parental structures among birth parents and the prepregnancy characteristics of parents giving birth in likely sexual and/or gender minority parental structures from California birth certificates. STUDY DESIGN We conducted a population-based study using birth certificate data from all live births in California from 2016 through 2020 (n=2,257,974). The state amended its birth certificate in 2016 to enable the recording of more diverse parental roles. Now, parents on birth certificates are classified as "parent giving birth" and "parent not giving birth" and people in either role can identify as "mother," "father," or "parent." We examined all potential combinations of parenting roles, and grouped parental structures of "mother-mother" and those designating a "father" as the "parent giving birth" into likely sexual and/or gender minority groups. We assessed the distribution of prepregnancy characteristics across parental structure groups ("mother-father," "sexual and/or gender minority," "mother only," "unclassified," and "missing both parental roles"). RESULTS Sexual and/or gender minority parents accounted for 6802 (0.3%) of live births in California over the 5-year study period. The most common sexual and/or gender minority parental structures were "mother-mother" (n=4310; 63% of the group) and "father-father" (n=1486; 22% of the group). Compared with "parents giving birth" in the "mother-father" structure (n=2,055,038; 91%), a higher proportion of "parents giving birth" in the "sexual and/or gender minority" group were aged ≥35 years, White, college-educated, and had commercial health insurance. In addition, a higher proportion had a high prepregnancy body mass index. Although likely underreported overall, the proportion of those who used assisted reproductive technology was much higher in the "sexual and/or gender minority" group (1.4%) than in the "mother-father" group (0.05%). Cigarette smoking in the 3 months before pregnancy was similar in both groups. CONCLUSION Changes to the California birth certificate have revealed a multiplicity of parental structures. Our findings suggest that sexual and/or gender minority parents differ from other parental structures and from the general sexual and/or gender minority population and warrant further research.
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Affiliation(s)
- Iman K Berrahou
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, San Francisco, CA (Dr Berrahou).
| | - Stephanie A Leonard
- Department of Obstetrics and Gynecology, Stanford University, Stanford, CA (Drs Leonard, Main, and Obedin-Maliver)
| | - Adary Zhang
- Stanford University School of Medicine, Stanford, CA (Mx. Zhang)
| | - Elliott K Main
- California Maternal Quality Care Collaborative, Palo Alto, CA (Drs Leonard and Main)
| | - Juno Obedin-Maliver
- Department of Obstetrics and Gynecology, Stanford University, Stanford, CA (Drs Leonard, Main, and Obedin-Maliver); Department of Epidemiology and Population Health, Stanford University School of Medicine, Stanford, CA (Dr Obedin-Maliver)
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25
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Goldhammer H, Grasso C, Katz-Wise SL, Thomson K, Gordon AR, Keuroghlian AS. Pediatric sexual orientation and gender identity data collection in the electronic health record. J Am Med Inform Assoc 2022; 29:1303-1309. [PMID: 35396995 PMCID: PMC9196694 DOI: 10.1093/jamia/ocac048] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Revised: 03/18/2022] [Accepted: 03/24/2022] [Indexed: 11/14/2022] Open
Abstract
The systematic documentation of sexual orientation and gender identity data in electronic health records can improve patient-centered care and help to identify and address health disparities affecting sexual and gender minority populations. Although there are existing guidelines for sexual orientation and gender identity data among adult patients, there are not yet standard recommendations for pediatric patients. In this article, we discuss methods that pediatric primary care organizations can use to collect and document sexual orientation and gender identity information with children and adolescents in electronic health records. These recommendations take into consideration children's developmental stages, the role of caregivers, and the need to protect the privacy of this information. We also focus on the current limitations of electronic health records in capturing the nuances of sexual and gender minority identities and make suggestions for addressing these limitations.
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Affiliation(s)
| | - Chris Grasso
- The Fenway Institute, Fenway Health, Boston, Massachusetts, USA
| | - Sabra L Katz-Wise
- Division of Adolescent/Young Adult Medicine, Boston Children’s Hospital, Boston, Massachusetts, USA
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, USA
- Department of Social and Behavioral Sciences, Harvard T. H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Katharine Thomson
- Department of Psychiatry, Boston Children’s Hospital, Boston, Massachusetts, USA
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA
| | - Allegra R Gordon
- Division of Adolescent/Young Adult Medicine, Boston Children’s Hospital, Boston, Massachusetts, USA
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, USA
- Department of Community Health Sciences, Boston University School of Public Health, Boston, Massachusetts, USA
| | - Alex S Keuroghlian
- The Fenway Institute, Fenway Health, Boston, Massachusetts, USA
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA
- Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts, USA
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McDowell A, Myong C, Tevis D, Fung V. Sexual Orientation and Gender Identity Data Reporting Among U.S. Health Centers. Am J Prev Med 2022; 62:e325-e332. [PMID: 35232619 PMCID: PMC9843854 DOI: 10.1016/j.amepre.2021.12.017] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Revised: 11/22/2021] [Accepted: 12/09/2021] [Indexed: 01/19/2023]
Abstract
INTRODUCTION Sexual orientation and gender identity data collection is necessary to address health inequities. This study examines sexual orientation and gender identity data reporting among community health centers. METHODS Using the 2016-2019 Uniform Data System for 1,381 community health centers, trends in reporting of sexual orientation and gender identity data were examined. Multivariable logistic regression was used to assess associations between community health center characteristics and whether sexual orientation and gender identity data were available for ≥75% of a community health center's patients in 2019. Data were analyzed in 2021. RESULTS In 2016-2019, the percentage of community health centers with sexual orientation and gender identity data for ≥75% of patients increased from 14.9% to 53.0%. In 2019, community health centers were more likely to have this data for ≥75% of patients if they were in nonmetro counties (OR=1.48, 95% CI=1.04, 2.10 versus metro), were in the South (OR=2.27, 95% CI=1.57, 3.31) or West (OR=1.91, 95% CI=1.27, 2.88 versus the Northeast), and had more patients aged between 18 and 39 years (OR=1.04, 95% CI=1.02, 1.07), between 40 and 64 years (OR=1.04, 95% CI=1.02, 1.06 vs <18 years), or veterans (OR=1.10, 95% CI=1.01, 1.20). This was less likely among community health centers serving 10,000-20,000 patients (OR=0.70, 95% CI=0.52, 0.95) and >20,000 patients (OR=0.44, 95% CI=0.32, 0.61 vs <10,000) and community health centers with more patients of American Indian/Alaskan Native (OR=0.98, 95% CI=0.97, 0.99) or unknown race (OR=0.92, 95% CI=0.86, 0.97 versus White). CONCLUSIONS Collection of sexual orientation and gender identity data by community health centers has increased substantially since 2016, although gaps remain.
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Affiliation(s)
- Alex McDowell
- Mongan Institute Health Policy Research Center, Massachusetts General Hospital, Boston, Massachusetts; Department of Medicine, Harvard Medical School, Boston, Massachusetts.
| | - Catherine Myong
- Mongan Institute Health Policy Research Center, Massachusetts General Hospital, Boston, Massachusetts; Vagelos College of Physicians & Surgeons, Columbia University Irving Medical Center, New York, New York
| | - Delaney Tevis
- Mongan Institute Health Policy Research Center, Massachusetts General Hospital, Boston, Massachusetts; School of Medicine, University of California San Francisco, San Francisco, California
| | - Vicki Fung
- Mongan Institute Health Policy Research Center, Massachusetts General Hospital, Boston, Massachusetts; Department of Medicine, Harvard Medical School, Boston, Massachusetts
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Palanica A, Lopez L, Gomez A, Fossat Y. Effects of Including Gender Pronoun Questions in Surveys. Front Psychol 2022; 13:873442. [PMID: 35615163 PMCID: PMC9125176 DOI: 10.3389/fpsyg.2022.873442] [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: 02/10/2022] [Accepted: 04/21/2022] [Indexed: 11/25/2022] Open
Abstract
This research examines whether the mere presence of asking about gender pronouns (e.g., she/her, he/him, they/them, and ze/zir) in a survey enhances participants’ attitudes and satisfaction of answering the questions. A large sample (N = 1,511) of heterosexual, cisgender, and LGBTQIA+ participants across the United States (US) were surveyed an online “personality test” (as a deception), with the real purpose of examining whether asking a pronoun question enhanced their perceptions of the survey. Three demographic groups were included: (i) heterosexual–cisgender (n = 503), (ii) gay–cisgender (n = 509), and (iii) genderqueer (trans, non-conforming, other, n = 499). Half of each group were randomly given either a survey that included a gender pronoun question (test) or not (control), and then all rated their perceptions of the survey questions. For participants who identified as heterosexual or gay, no major differences were found between survey conditions. However, participants who identified as genderqueer experienced significant increases of satisfaction, comfort level, and perceived relevance of the questions when given a survey that asked their gender pronouns versus the survey that did not. These findings have implications for any surveys that ask about personal demographics, and suggest that any form of written communication should include clarity about gender pronouns.
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Affiliation(s)
- Adam Palanica
- Klick Applied Sciences, Klick Health, Toronto, ON, Canada
| | - Luke Lopez
- People Practices, Klick Health, Toronto, ON, Canada
| | - Amy Gomez
- Diversity Strategy, Klick Health, Toronto, ON, Canada
| | - Yan Fossat
- Klick Applied Sciences, Klick Health, Toronto, ON, Canada
- *Correspondence: Yan Fossat,
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Blosnich JR, Boyer TL. Concordance of Data About Sex From Electronic Health Records and the National Death Index: Implications for Transgender Populations. Epidemiology 2022; 33:383-385. [PMID: 35067566 PMCID: PMC8986558 DOI: 10.1097/ede.0000000000001460] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
BACKGROUND Transgender individuals have greater health risks than cisgender individuals, which may bode for greater mortality. However, research is limited by lack of gender identity information at the time of death. Novel opportunities to combine administrative data with National Death Index (NDI) data may facilitate mortality research about transgender populations, but binary measures of sex and gender may pose problems for analyses. This study explored differences in sex recorded in Veterans Health Administration (VHA) electronic health record (EHR) and NDI data between transgender and cisgender decedents. METHODS We used VHA EHR data from fiscal years 2000-2016 to identify deaths among a sample of transgender and cisgender patients. We cross-tabulated sex recorded in the NDI with EHR-based sex from VHA EHR data. We extracted data in 2018 and conducted analyses in 2020. RESULTS Death occurred for 1109 transgender patients and 7757 cisgender patients. For cisgender decedents, EHR-based sex and NDI-based sex were 100% concordant. For transgender decedents, 46 (4%) were discordant between data sources. Of transgender decedents with female EHR-based sex (n = 259), 17% were indicated as male in NDI data; of those with male EHR-based sex (n = 850), 0.2% were indicated as female in NDI data. CONCLUSIONS Data linkage between EHR and the NDI can facilitate transgender mortality research, but examining mortality specific to various transgender identities remains difficult. Improved documentation of sex and gender is needed within US mortality surveillance.
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Affiliation(s)
- John R. Blosnich
- =University of Southern California, Suzanne Dworak-Peck School of Social Work, 669 W 34 St., Los Angeles, CA 90089, USA
- =Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania 15240, USA
| | - Taylor L. Boyer
- =Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania 15240, USA
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Dubin S, Cook T, Liss A, Doty G, Moore K, Greene R, Radix A, Janssen A. Comparing Electronic Health Record Domains' Utility to Identify Transgender Patients. Transgend Health 2022; 7:78-84. [PMID: 36644028 PMCID: PMC9829151 DOI: 10.1089/trgh.2020.0069] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
Purpose Earlier literature has reported on the utility of diagnostic codes and demographic information for identifying transgender patients. We aim to assess which method identifies the most transgender patients utilizing readily available tools from within the electronic health record (EHR). Methods A de-identified patient database from a single EHR that allows for searching any discrete data point in the EHR was used to query International Statistical Classification of Diseases and Related Health Problems, 10th Revision (ICD-10) diagnostic codes and demographic data specific to transgender patients from January 2011 to April 2019. Results Demographic data and ICD-10 codes yielded 1494 individual EHRs with transgender-specific data domains. ICD-10 diagnostic codes alone identified 942 (63.05%) unique EHRs. Demographics alone identified 218 (14.59%) unique EHRs. A total of 334 (22.36%) unique EHRs had both ICD-10 and demographic identifiers. Of those identified by transgender-specific demographic data (552), 294 (53.26%) were trans masculine, 215 (38.95%) were trans feminine, and 43 (7.79%) were nonbinary. Of the 552 demographic-identified transgender patients, 141 (25.86%) were identified by a two-part gender identity demographic question. Conclusions ICD-10 diagnostic codes, not demographic data, identified the most transgender patient records, but neither diagnostic codes alone nor demographic data captured the full population. Only 26.36% of the charts identified as transgender patients had both ICD-10 codes and demographic data. We recommend that when identifying transgender populations through EHR domains, a combination of diagnostic codes and demographic data be used. Furthermore, research is needed to optimize disclosure and collection of demographic information for gender minority populations.
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Affiliation(s)
- Samuel Dubin
- NYU Langone Health, New York University Grossman School of Medicine, New York, New York, USA.,Address correspondence to: Samuel Dubin, MD, NYU Langone Health, NYU Grossman School of Medicine, 550 1st Avenue, New York, NY 10010, USA,
| | - Tiffany Cook
- NYU Langone Health, New York University Grossman School of Medicine, New York, New York, USA
| | - Alison Liss
- NYU Langone Health, New York University Grossman School of Medicine, New York, New York, USA
| | - Glenn Doty
- NYU Langone Health, New York University Grossman School of Medicine, New York, New York, USA
| | - Kevin Moore
- NYU Langone Health, New York University Grossman School of Medicine, New York, New York, USA
| | - Richard Greene
- NYU Langone Health, New York University Grossman School of Medicine, New York, New York, USA
| | - Asa Radix
- Callen Lorde Community Health Center, New York, New York, USA
| | - Aron Janssen
- Pritzker Department of Psychiatry and Behavioral Health, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, USA
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30
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Fernandez A, Stoller ML. Is “Benign” Urology Benign? Eur Urol 2022; 81:547-548. [DOI: 10.1016/j.eururo.2022.01.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Accepted: 01/18/2022] [Indexed: 11/04/2022]
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Reif S, Wilson E, Cooper H, Hunter G, McAllaster C. Identification and Reporting of Gender Identity in HIV Surveillance Data in the Deep South. SEXUALITY RESEARCH & SOCIAL POLICY : JOURNAL OF NSRC : SR & SP 2022; 19:1357-1364. [PMID: 35075373 PMCID: PMC8771604 DOI: 10.1007/s13178-021-00684-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 12/27/2021] [Indexed: 06/14/2023]
Abstract
Introduction Although studies have identified high prevalence of HIV among individuals who are transgender, HIV surveillance data regarding gender identity is incomplete, resulting in uncertainty regarding the gender identity, including transgender and other diverse gender identities, of individuals diagnosed with HIV. This information is critical to planning strategies for HIV prevention and care. Methods From August 2018 to March 2019, interviews were conducted with HIV surveillance leadership (including Surveillance Directors, Epidemiologists, and HIV/STI Prevention Staff) at offices of epidemiology from eight US Deep South states regarding their practices related to gender identity documentation in HIV surveillance data and the barriers encountered in these documentation processes as well as their recommendations for improving gender identity data collection. Results Interview findings indicated significant barriers to collection of accurate gender identity information in HIV surveillance data including lack of standardized data systems for collecting gender identity; difficulty obtaining gender identity information from HIV testing sites, laboratories, and medical databases; and need for enhanced cultural sensitivity and gender identity knowledge at all levels of the data collection process. Recommendations from the state HIV surveillance staff, leaders, and epidemiologists are included in the findings. Conclusions and Policy Implications Effective, well-coordinated strategies are needed to improve gender identity information in HIV surveillance reporting. Recommendations include standardizing and enhancing data collection strategies, providing cultural sensitivity training at all levels of HIV testing/reporting, and developing formal guidance and providing technical assistance that targets and educates laboratories and medical organizations to implement systems of data collection that routinely and safely capture gender identity data.
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Affiliation(s)
- Susan Reif
- Center for Health Policy and Inequalities Research, Duke University, Durham, USA
| | - Elena Wilson
- Center for Health Policy and Inequalities Research, Duke University, Durham, USA
| | - Haley Cooper
- Center for Health Policy and Inequalities Research, Duke University, Durham, USA
| | - Genevieve Hunter
- Center for Health Policy and Inequalities Research, Duke University, Durham, USA
| | - Carolyn McAllaster
- Colin W. Brown Clinical Professor Emerita of Law, Duke University, Durham, USA
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Affiliation(s)
- Alex S Keuroghlian
- The Fenway Institute, Fenway Health, Boston, Massachusetts, USA. .,Massachusetts General Hospital, Boston, Massachusetts, USA. .,Harvard Medical School, Boston, Massachusetts, USA.
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Marney HL, Vawdrey DK, Warsame L, Tavares S, Shapiro A, Breese A, Brayford A, Chittalia AZ. Overcoming technical and cultural challenges to delivering equitable care for LGBTQ+ individuals in a rural, underserved area. J Am Med Inform Assoc 2021; 29:372-378. [PMID: 34791308 DOI: 10.1093/jamia/ocab227] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Revised: 07/14/2021] [Accepted: 10/05/2021] [Indexed: 11/13/2022] Open
Abstract
The lesbian, gay, bisexual, transgender, queer, or questioning (LGBTQ+) community is vulnerable to health-care disparities. Many health-care organizations are working to collect sexual orientation and gender identity in their electronic health records (EHRs), with the goal of providing more inclusive care to their LGBTQ+ patients. There are significant human and technical barriers to making these efforts successful. Based on our 5-year experience at Geisinger (an integrated health system located in a rural, generally conservative area), this case report provides insights to overcome challenges in 4 critical areas: (1) enabling the EHR to collect and use information to support the health-care needs of LGBTQ+ patients, (2) building a culture of awareness and caring, empowering members of the health-care team to break down barriers of misunderstanding and mistrust, (3) developing services to support the needs of LGBTQ+ patients, and (4) partnering with local communities to become a trusted health-care provider.
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Affiliation(s)
- Heather L Marney
- Steele Institute of Innovation, Geisinger, Danville, Pennsylvania, USA
| | - David K Vawdrey
- Steele Institute of Innovation, Geisinger, Danville, Pennsylvania, USA.,Biomedical Informatics, Columbia University, New York, New York, USA
| | - Leyla Warsame
- Steele Institute of Innovation, Geisinger, Danville, Pennsylvania, USA
| | - Spencer Tavares
- Steele Institute of Innovation, Geisinger, Danville, Pennsylvania, USA
| | - Andrea Shapiro
- Steele Institute of Innovation, Geisinger, Danville, Pennsylvania, USA
| | - Arthur Breese
- Human Resources, Geisinger, Pittston, Pennsylvania, USA
| | - Amy Brayford
- Human Resources, Geisinger, Pittston, Pennsylvania, USA
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34
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Waters AR, Tennant K, Cloyes KG. Cultivating LGBTQ+ Competent Cancer Research: Recommendations from LGBTQ+ Cancer Survivors, Care Partners, and Community Advocates. Semin Oncol Nurs 2021; 37:151227. [PMID: 34753639 DOI: 10.1016/j.soncn.2021.151227] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Revised: 09/28/2021] [Accepted: 09/28/2021] [Indexed: 10/19/2022]
Abstract
OBJECTIVE Sexual and gender minority (SGM) or LGBTQ+ communities were designated as a National Institutes of Health (NIH) disparity population in 2016, yet research exploring SGM cancer disparities is still limited. Thus, we sought the insight of LGBTQ+ cancer survivors, care partners, and community advocates to learn their recommendations for cultivating competent and inclusive cancer research for LGBTQ+ individuals. DATA SOURCES We conducted a focus group with LGBTQ+ survivors and care partners of LGBTQ+ survivors who were 18 years or older (N = 8) and interviews with community advocates who are leaders in LGBTQ+ cancer (N = 8). The focus group and interviews were recorded, transcribed, and qualitatively analyzed using an inductive thematic analysis. CONCLUSION Qualitative analysis elicited an overarching theme of cultivating competent research for LGBTQ+ individuals, including three subthemes: (i) Cisheteronormativity: An inhospitable ecosystem for LGBTQ+ patients, survivors, and care partners, (ii) Study design: Shifting from invasive 'othering' to a sustainable community-driven climate, and (iii) Recruitment and data collection: Ways to cultivate ecosystem health. Cultivating inclusive, competent research with SGM populations is crucial for addressing health disparities and improving cancer survivors' and care partners' health. IMPLICATIONS FOR NURSING PRACTICE Recommendations from LGBTQ+ survivors, care partners, and community advocates ranged from small alterations to systemic changes, highlighting the multifaceted yet feasible process of cultivating LGBTQ+ competent cancer research. The process of cultivating competent research for LGBTQ+ populations will take substantial investment from researchers, providers, and health systems.
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Affiliation(s)
- Austin R Waters
- Cancer Control and Population Sciences Research Program, Huntsman Cancer Institute, Salt Lake City, Utah.
| | - Karrin Tennant
- College of Nursing, University of Utah, Salt Lake City, Utah
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35
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Wagner TL, Kitzie VL, Lookingbill V. Transgender and nonbinary individuals and ICT-driven information practices in response to transexclusionary healthcare systems: a qualitative study. J Am Med Inform Assoc 2021; 29:239-248. [PMID: 34725682 DOI: 10.1093/jamia/ocab234] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Revised: 09/28/2021] [Accepted: 10/13/2021] [Indexed: 01/18/2023] Open
Abstract
OBJECTIVE This qualitative research examines how transgender and gender nonbinary (T/GNB) persons from South Carolina navigate informational barriers within healthcare systems. This navigation can be described through the lens of information practices, or how T/GNB participants create, seek, use, and share information to achieve desired healthcare outcomes. Special focus is given to the roles of Information and Communication Technologies (ICTs) in shaping these practices. MATERIALS AND METHODS The research utilizes participant data from semistructured interviews and focus groups conducted with 26 T/GNB individuals focusing on their health information practices. Data analysis utilized emic/etic coding and the constant comparative method to identify themes describing transexclusionary information barriers and respondent ICT-led information practices. RESULTS Findings note healthcare systems producing cisnormativity by design resulting in T/GNB individuals viewing healthcare spaces as exclusionary. Exclusionary barriers included over reliance on medical, expert authority ignoring T/GNB embodiment, and a lack of contextual perspective to identities. In response, T/GNB seek, create, use, and share information via ICTs to challenge exclusionary practices. DISCUSSION T/GNB ICT use addresses systemic barriers within healthcare systems suggesting a need to reframe healthcare systems through the lens of design justice, one that values T/GNB agency in understanding and producing health knowledge. CONCLUSION While many healthcare providers are not intentionally being transexclusionary, the design of healthcare information systems rely on cisnormative values, thus excluding many T/GNB from accessing healthcare in comfortable and safe ways. Shifting toward the values and practices of T/GNB as informed by ICT use will afford healthcare providers ways to undo barriers to care.
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Affiliation(s)
- Travis L Wagner
- College of Information and Communication, School of Information Science, The University of South Carolina Davis College, South Carolina, USA
| | - Vanessa L Kitzie
- College of Information and Communication, School of Information Science, The University of South Carolina Davis College, South Carolina, USA
| | - Valerie Lookingbill
- College of Information and Communication, School of Information Science, The University of South Carolina Davis College, South Carolina, USA
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36
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Almazan AN, King D, Grasso C, Cahill S, Lattanner M, Hatzenbuehler ML, Keuroghlian AS. Sexual Orientation and Gender Identity Data Collection at US Health Centers: Impact of City-Level Structural Stigma in 2018. Am J Public Health 2021; 111:2059-2063. [PMID: 34499534 PMCID: PMC8630472 DOI: 10.2105/ajph.2021.306414] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/17/2021] [Indexed: 11/04/2022]
Abstract
Objectives. To examine the relationship between city-level structural stigma pertaining to sexual orientation and gender identity (SOGI) and completeness of patient SOGI data collection at US federally qualified health centers (FQHCs). Methods. We used the Human Rights Campaign's Municipal Equality Index to quantify city-level structural stigma against sexual and gender minority people in 506 US cities across 49 states. We ascertained the completeness of SOGI data collection at FQHCs from the 2018 Uniform Data System, which describes FQHC patient demographics and service utilization. We included FQHCs in cities captured by the structural stigma index in multinomial generalized linear mixed models to examine the relationship between city-level structural stigma and SOGI data completeness. Results. FQHCs in cities with more protective sexual orientation nondiscrimination policies reported more complete patient sexual orientation data (adjusted odds ratio [AOR] = 1.6; 95% confidence interval [CI] = 1.2, 2.1). This association was also found for gender identity nondiscrimination policies and gender identity data collection (AOR = 1.7; 95% CI = 1.3, 2.2). Conclusions. Municipal sexual and gender minority nondiscrimination laws are associated with social and municipal environments that facilitate patient SOGI data collection.(Am J Public Health. 2021;111(11):2059-2063. https://doi.org/10.2105/AJPH.2021.306414).
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Affiliation(s)
- Anthony N Almazan
- Anthony N. Almazan is with Harvard Medical School, Boston, MA. Dana King, Chris Grasso, Sean Cahill, and Alex S. Keuroghlian are with The Fenway Institute, Fenway Health, Boston. Micah Lattanner and Mark L. Hatzenbuehler are with the Department of Psychology, Harvard University, Boston
| | - Dana King
- Anthony N. Almazan is with Harvard Medical School, Boston, MA. Dana King, Chris Grasso, Sean Cahill, and Alex S. Keuroghlian are with The Fenway Institute, Fenway Health, Boston. Micah Lattanner and Mark L. Hatzenbuehler are with the Department of Psychology, Harvard University, Boston
| | - Chris Grasso
- Anthony N. Almazan is with Harvard Medical School, Boston, MA. Dana King, Chris Grasso, Sean Cahill, and Alex S. Keuroghlian are with The Fenway Institute, Fenway Health, Boston. Micah Lattanner and Mark L. Hatzenbuehler are with the Department of Psychology, Harvard University, Boston
| | - Sean Cahill
- Anthony N. Almazan is with Harvard Medical School, Boston, MA. Dana King, Chris Grasso, Sean Cahill, and Alex S. Keuroghlian are with The Fenway Institute, Fenway Health, Boston. Micah Lattanner and Mark L. Hatzenbuehler are with the Department of Psychology, Harvard University, Boston
| | - Micah Lattanner
- Anthony N. Almazan is with Harvard Medical School, Boston, MA. Dana King, Chris Grasso, Sean Cahill, and Alex S. Keuroghlian are with The Fenway Institute, Fenway Health, Boston. Micah Lattanner and Mark L. Hatzenbuehler are with the Department of Psychology, Harvard University, Boston
| | - Mark L Hatzenbuehler
- Anthony N. Almazan is with Harvard Medical School, Boston, MA. Dana King, Chris Grasso, Sean Cahill, and Alex S. Keuroghlian are with The Fenway Institute, Fenway Health, Boston. Micah Lattanner and Mark L. Hatzenbuehler are with the Department of Psychology, Harvard University, Boston
| | - Alex S Keuroghlian
- Anthony N. Almazan is with Harvard Medical School, Boston, MA. Dana King, Chris Grasso, Sean Cahill, and Alex S. Keuroghlian are with The Fenway Institute, Fenway Health, Boston. Micah Lattanner and Mark L. Hatzenbuehler are with the Department of Psychology, Harvard University, Boston
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Norori N, Hu Q, Aellen FM, Faraci FD, Tzovara A. Addressing bias in big data and AI for health care: A call for open science. PATTERNS (NEW YORK, N.Y.) 2021; 2:100347. [PMID: 34693373 PMCID: PMC8515002 DOI: 10.1016/j.patter.2021.100347] [Citation(s) in RCA: 87] [Impact Index Per Article: 29.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Artificial intelligence (AI) has an astonishing potential in assisting clinical decision making and revolutionizing the field of health care. A major open challenge that AI will need to address before its integration in the clinical routine is that of algorithmic bias. Most AI algorithms need big datasets to learn from, but several groups of the human population have a long history of being absent or misrepresented in existing biomedical datasets. If the training data is misrepresentative of the population variability, AI is prone to reinforcing bias, which can lead to fatal outcomes, misdiagnoses, and lack of generalization. Here, we describe the challenges in rendering AI algorithms fairer, and we propose concrete steps for addressing bias using tools from the field of open science.
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Affiliation(s)
- Natalia Norori
- Institute of Computer Science, University of Bern, Neubrückstrasse 10 3012 Bern, Switzerland
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol BS8 1UD, UK
| | - Qiyang Hu
- Institute of Computer Science, University of Bern, Neubrückstrasse 10 3012 Bern, Switzerland
| | | | - Francesca Dalia Faraci
- Institute of Digital Technologies for Personalized Healthcare (MeDiTech), Department of Innovative Technologies, University of Applied Sciences and Arts of Southern Switzerland, 6962 Lugano, Switzerland
| | - Athina Tzovara
- Institute of Computer Science, University of Bern, Neubrückstrasse 10 3012 Bern, Switzerland
- Sleep Wake Epilepsy Center | NeuroTec, Department of Neurology, Inselspital, Bern University Hospital, University of Bern, 3010 Bern, Switzerland
- Helen Wills Neuroscience Institute, University of California Berkeley, Berkeley, CA 94720, USA
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McClure RC, Macumber CL, Kronk C, Grasso C, Horn RJ, Queen R, Posnack S, Davison K. Gender harmony: improved standards to support affirmative care of gender-marginalized people through inclusive gender and sex representation. J Am Med Inform Assoc 2021; 29:354-363. [PMID: 34613410 PMCID: PMC8757317 DOI: 10.1093/jamia/ocab196] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Revised: 08/04/2021] [Accepted: 09/05/2021] [Indexed: 11/13/2022] Open
Abstract
Objective Accurate representation of clinical sex and gender identity in interoperable clinical
systems is a major challenge for organizations intent on improving outcomes for sex- and
gender-marginalized people. Improved data collection has been hindered by the historical
approach that presumed a single, often binary, datum was sufficient. We describe the
Health Level Seven International (HL7) Gender Harmony logical model that proposes an
improved approach. Materials and Methods The proposed solution was developed via an American National Standards Institute
(ANSI)-certified collaborative balloted process. As an HL7 Informative Document, it is
an HL7 International-balloted consensus on the subject of representing sex and
representing gender in clinical systems based on work of the gender harmony project led
by the HL7 Vocabulary Work Group. Results The Gender Harmony Model is a logical model that provides a standardized approach that
is both backwards-compatible and an improvement to the meaningful capture of gender
identity, recorded sex or recorded gender, a sex for clinical use, the name to use, and
pronouns that are affirmative and inclusive of gender-marginalized people. Conclusion Most clinical systems and current standards in health care do not meaningfully address,
nor do they consistently represent, sex and gender diversity, which has impeded
interoperability and led to suboptimal health care. The Gender Harmony Project was
formed to create more inclusive health information exchange standards to enable a safer,
higher-quality, and embracing healthcare experience. The Gender Harmony Model provides
the informative guidance for standards developers to implement a more thorough technical
design that improves the narrow binary design used in many legacy clinical systems.
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Affiliation(s)
| | | | - Clair Kronk
- Department of Biomedical Informatics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | | | | | - Roz Queen
- School of Health Information Science, University of Victoria, Victoria, BC, Canada
| | - Steven Posnack
- US Department of Health and Human Services, Office of the National Coordinator for Health IT, Washington, District of Columbia, USA
| | - Kelly Davison
- Canada Health Infoway, Toronto, ON, Canada.,School of Health Information Science, University of Victoria, Victoria, BC, Canada
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O'Kane M, Agrawal S, Binder L, Dzau V, Gandhi TK, Harrington R, Mate K, McGann P, Meyers D, Rosen P, Schreiber M, Schummers D. An Equity Agenda for the Field of Health Care Quality Improvement. NAM Perspect 2021; 2021:202109b. [PMID: 34901779 PMCID: PMC8654470 DOI: 10.31478/202109b] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
| | | | | | | | | | | | | | | | | | - Paul Rosen
- Centers for Medicare & Medicaid Services
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40
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Bowleg L, Landers S. The Need for COVID-19 LGBTQ-Specific Data. Am J Public Health 2021; 111:1604-1605. [PMID: 34436923 PMCID: PMC8589062 DOI: 10.2105/ajph.2021.306463] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/17/2021] [Indexed: 11/04/2022]
Affiliation(s)
- Lisa Bowleg
- Lisa Bowleg is with the Department of Psychological and Brain Sciences, George Washington University, Washington, DC, and is an associate editor of AJPH. Stewart Landers is with US Health Services, John Snow, Inc., Boston, MA, and is an associate editor of AJPH
| | - Stewart Landers
- Lisa Bowleg is with the Department of Psychological and Brain Sciences, George Washington University, Washington, DC, and is an associate editor of AJPH. Stewart Landers is with US Health Services, John Snow, Inc., Boston, MA, and is an associate editor of AJPH
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Drysdale K, Cama E, Botfield J, Bear B, Cerio R, Newman CE. Targeting cancer prevention and screening interventions to LGBTQ communities: A scoping review. HEALTH & SOCIAL CARE IN THE COMMUNITY 2021; 29:1233-1248. [PMID: 33316150 DOI: 10.1111/hsc.13257] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Revised: 10/13/2020] [Accepted: 11/19/2020] [Indexed: 06/12/2023]
Abstract
Although some people within LGBTQ communities are at risk of developing some cancers at higher rates than non-LGBTQ people, there is limited evidence of the outcomes of targeted cancer prevention and screening interventions for these communities. This scoping review examined key findings regarding the feasibility, acceptability and efficacy of evaluated intervention studies conducted in high income settings and published in peer reviewed literature (2014-2020) by combining evidence of both cancer risk-reducing behavioural interventions and screening and preventative practice interventions. While there is limited evidence of stronger outcomes from targeted interventions with cohorts of gender and sexuality diverse communities, compared with the use of mainstream or untailored interventions, there is stronger evidence that targeted interventions are more acceptable to these communities and may be more feasible in some contexts. Thus, there is benefit in understanding what targeting entails in these interventions, and to understand what influences acceptability, to inform the design and delivery of such interventions.
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Affiliation(s)
- Kerryn Drysdale
- Centre for Social Research in Health, UNSW Sydney, Sydney, Australia
| | - Elena Cama
- Centre for Social Research in Health, UNSW Sydney, Sydney, Australia
| | - Jessica Botfield
- Centre for Social Research in Health, UNSW Sydney, Sydney, Australia
| | | | | | - Christy E Newman
- Centre for Social Research in Health, UNSW Sydney, Sydney, Australia
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Loo S, Almazan AN, Vedilago V, Stott B, Reisner SL, Keuroghlian AS. Understanding community member and health care professional perspectives on gender-affirming care-A qualitative study. PLoS One 2021; 16:e0255568. [PMID: 34398877 PMCID: PMC8366980 DOI: 10.1371/journal.pone.0255568] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Accepted: 07/16/2021] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Transgender and gender diverse (TGD) people experience significant barriers to accessing affirming health services. There is a paucity of literature examining how both community members and health care professionals (HCPs) understand potential causes and solutions for these barriers, particularly in non-urban settings. OBJECTIVE We present the first systematic examination of perspectives from community members and HCPs regarding barriers to and solutions for promoting access to gender-affirming health care. DESIGN Study activities were conducted through the Plan and Act for Transgender Health (PATH) Project, a health needs assessment of TGD people. Community members in the catchment area were recruited to participate in focus group discussions about access to gender-affirming health care and optimal health service delivery models in March-October 2019. HCPs were recruited to participate in focus group discussions or in-depth interviews about experiences working with TGD clients. Data were analyzed using an inductive grounded theory approach. SETTING 25 rural counties in Massachusetts, New York, Connecticut, Vermont, and New Hampshire. PARTICIPANTS Study participants included 61 adult TGD community members and 23 HCPs working in the catchment area. RESULTS Both community members and HCPs spoke of the need for connectedness and linkages among disparate health system components for gender-affirming health care. Participants expressed this priority through calls for systems-level improvements within existing services (e.g., expanded data collection, expanded mental health services, inclusive and affirming health care environments, and TGD staff). They also expressed the need for expanded TGD community outreach and engagement (e.g., incorporation of a patient feedback process, TGD health navigators, and resource mapping). LIMITATIONS Findings specifically reflect the perspectives of community members and HCPs in the rural New England area. Furthermore, the study sample was predominantly White non-Hispanic. CONCLUSION Interventions to achieve accessible gender-affirming health care must address the diverse perspectives and needs of both community members and HCPs.
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Affiliation(s)
- Stephanie Loo
- The Fenway Institute, Fenway Health, Boston, Massachusetts, United States of America
- Department of Health Law, Policy and Management, Boston University School of Public Health, Boston, Massachusetts, United States of America
| | | | - Virginia Vedilago
- The Fenway Institute, Fenway Health, Boston, Massachusetts, United States of America
| | - Brooke Stott
- The Fenway Institute, Fenway Health, Boston, Massachusetts, United States of America
| | - Sari L. Reisner
- The Fenway Institute, Fenway Health, Boston, Massachusetts, United States of America
- Harvard Medical School, Boston, Massachusetts, United States of America
- Division of Endocrinology, Diabetes, and Hypertension, Brigham and Women’s Hospital, Boston, Massachusetts, United States of America
- Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, Massachusetts, United States of America
| | - Alex S. Keuroghlian
- The Fenway Institute, Fenway Health, Boston, Massachusetts, United States of America
- Harvard Medical School, Boston, Massachusetts, United States of America
- Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts, United States of America
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43
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Freestone J, Mooney-Somers J, Hudson S. The sector is ready, and the community needs Australian alcohol and other drug treatment services to ask about sexuality and gender identity. Drug Alcohol Rev 2021; 41:39-42. [PMID: 34370883 DOI: 10.1111/dar.13367] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Revised: 07/05/2021] [Accepted: 07/16/2021] [Indexed: 11/30/2022]
Abstract
Sexuality and gender diverse Australians are a priority population in federal and state-based alcohol and other drug (AOD) strategies. Research evidence shows higher prevalence of AOD use by lesbian, gay, bisexual, transgender and queer (LGBTQ) people, riskier use and a higher proportion have accessed AOD treatment. Despite these disparities, Australian AOD treatment services do not routinely collect data on sexuality or gender identity. As a result, the treatment needs, experiences and outcomes of LGBTQ people remain largely invisible. The Australian Bureau of Statistics' recently released standardised indicators for the recording of sex, gender, variations of sex characteristics and sexual orientation presents an opportunity for the AOD sector to implement inclusive data collection as a foundational step towards achieving policy priorities for LGBTQ people. This commentary includes an implementation case study from the New South Wales non-government AOD treatment sector, where sexuality and gender identity indicators have been collected since 2016.
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Affiliation(s)
- Jack Freestone
- Alcohol and Other Drug Research and Development, ACON, Sydney, Australia
| | - Julie Mooney-Somers
- Sydney Health Ethics, School of Public Health, University of Sydney, Sydney, Australia
| | - Suzie Hudson
- Network of Alcohol and Other Drug Agencies, Sydney, Australia
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44
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Obra JK, Lin B, Đoàn LN, Palaniappan L, Srinivasan M. Achieving Equity in Asian American Healthcare: Critical Issues and Solutions. JOURNAL OF ASIAN HEALTH 2021; 1:e202103. [PMID: 37872960 PMCID: PMC10593109 DOI: 10.59448/jah.v1i1.3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/25/2023]
Abstract
Equity is a fundamental goal of the US health care system. Asians comprise 6% of the US population, and 60% of the world's population. Less than 1% of National Institutes of Health funding is directed toward Asian health. Asian health outcomes are often worse than non-Hispanic Whites (NHWS) in America. Increasing federal and foundation resources and funding toward Asian health research could illuminate these risks and develop precision interventions to reduce known health disparities. When disaggregated by race/ethnicity, Asian health risks are even more apparent. Here, we discuss critical health outcome differences between the six major Asian American subgroups (Asian Indian, Chinese, Filipino, Japanese, Korean, and Vietnamese) comprising 80% of the US Asian population, highlighting demographic, pharmacologic, disease prevalence, and mortality outcomes. We then outline seven critical issues contributing to Asian American health disparities, including aggregated Asian health data, undersampling, invalid extrapolations, underrepresentation in clinical trials, lack of funding and awareness of disparities, and the model minority myth. Building on the successes of national public health initiatives, we propose nine leverage points to improve Asian American health including the following: obtaining disaggregated Asian health data, improved Asian health research (oversampling Asians, improving clinical trial participation, and increasing research funding), stakeholder collaboration (national and with Asian nations), community engagement, providing culturally precise health care, and expansion of the Asian American research ecosystem. Achieving health equity takes deliberate practice and does not occur by accident. By addressing critical issues that perpetuate Asian health disparities, we grow closer to understanding how to effectively improve Asian health and build a nationally unified mindset toward action that emphasizes equitable care for all.
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Affiliation(s)
- Jed Keenan Obra
- Stanford Center for Asian Research and Education, Stanford University School of Medicine; Palo Alto, CA
- Department of Neurobiology, Physiology, and Behavior, University of California Davis; Davis, CA
| | - Bryant Lin
- Stanford Center for Asian Research and Education, Stanford University School of Medicine; Palo Alto, CA
- Department of Medicine, Stanford University School of Medicine; Palo Alto, CA
| | - Lan N. Đoàn
- Department of Population Health, NYU Grossman School of Medicine; New York, NY
| | - Latha Palaniappan
- Stanford Center for Asian Research and Education, Stanford University School of Medicine; Palo Alto, CA
- Department of Medicine, Stanford University School of Medicine; Palo Alto, CA
| | - Malathi Srinivasan
- Stanford Center for Asian Research and Education, Stanford University School of Medicine; Palo Alto, CA
- Department of Medicine, Stanford University School of Medicine; Palo Alto, CA
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45
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Grasso C, Goldhammer H, Thompson J, Keuroghlian AS. Optimizing gender-affirming medical care through anatomical inventories, clinical decision support, and population health management in electronic health record systems. J Am Med Inform Assoc 2021; 28:2531-2535. [PMID: 34151934 DOI: 10.1093/jamia/ocab080] [Citation(s) in RCA: 35] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Revised: 04/12/2021] [Accepted: 05/03/2021] [Indexed: 01/26/2023] Open
Abstract
Recent advances in electronic health records and health information technology are providing new opportunities to improve the quality of care for transgender and gender diverse people, a population that experiences significant health disparities. This article recommends changes to electronic health record systems that have the potential to optimize gender-affirming care. Specifically, we discuss the importance of creating an anatomical inventory form that captures organ diversity, and of developing clinical decision support tools and population health management systems that consider each patient's gender identity, sex assigned at birth, and anatomy.
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Affiliation(s)
- Chris Grasso
- The Fenway Institute, Fenway Health, Boston, Massachusetts, USA
| | - Hilary Goldhammer
- National LGBTQIA+ Health Education Center at The Fenway Institute, Fenway Health, Boston, Massachusetts, USA
| | - Julie Thompson
- Transgender Health Program, Medical Department, Fenway Health, Boston, Massachusetts, USA
| | - Alex S Keuroghlian
- Department of Psychiatry, Massachusetts General Hospital/Harvard Medical School, Boston, Massachusetts, USA.,National LGBTQIA+ Health Education Center at The Fenway Institute, Fenway Health, Boston, Massachusetts, USA
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46
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Sokkary N, Awad H, Paulo D. Frequency of Sexual Orientation and Gender Identity Documentation After Electronic Medical Record Modification. J Pediatr Adolesc Gynecol 2021; 34:324-327. [PMID: 33333261 DOI: 10.1016/j.jpag.2020.12.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Revised: 12/06/2020] [Accepted: 12/08/2020] [Indexed: 01/02/2023]
Abstract
STUDY OBJECTIVE Documentation of sexual orientation (SO) and gender identity (GI) is crucial to identify lesbian, gay, bisexual, and transgender youth and perform meaningful research to improve health disparities in this community. As a result, some electronic medical records (EMRs) have incorporated SO and GI into part of the provider's workflow for documentation. We aimed to evaluate the effect this modification has had on the frequency of SO and GI documentation. DESIGN, SETTING, PARTICIPANTS, INTERVENTIONS, AND MAIN OUTCOME MEASURES: This was a retrospective chart review of patient encounters from an outpatient pediatric and adolescent gynecology clinical practice. The rate of documentation of SO and GI were compared between encounters that took place before the implementation of the EMR modification and those that took place after. Additionally, we examined rates of GI and SO documentation according to visit type and patient race. RESULTS A statistically significant increase in the frequency of SO and GI documentation after the EMR modification was detected. The documentation rate of SO increased from 10/73 (13.7%) to 32/73 (45.1%) (P < .01) and GI documentation rate went from 1.4% to 46.5% (P < .01) after the EMR changes were implemented. SO or GI was most commonly documented in social history (90%). There were no differences in documentation on the basis of race or type of encounter. CONCLUSION Including a specific tab for SO and GI in the EMR significantly increased the frequency of SO and GI documentation. Despite this increase, frequency of documentation remained at less than 50%, emphasizing the need for further improvement.
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Affiliation(s)
- Nancy Sokkary
- Navicent Health Medical Center, Department of Obstetrics and Gynecology, Macon, Georgia; Mercer University School of Medicine, Macon, Georgia
| | - Hamza Awad
- Mercer University School of Medicine, Macon, Georgia
| | - Dillon Paulo
- Mercer University School of Medicine, Macon, Georgia.
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47
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Lau F, Antonio M, Davison K, Queen R, Devor A. A rapid review of gender, sex, and sexual orientation documentation in electronic health records. J Am Med Inform Assoc 2021; 27:1774-1783. [PMID: 32935124 PMCID: PMC7671624 DOI: 10.1093/jamia/ocaa158] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Revised: 06/19/2020] [Accepted: 07/22/2020] [Indexed: 12/27/2022] Open
Abstract
Objective The lack of precise and inclusive gender, sex, and sexual orientation (GSSO) data in electronic health records (EHRs) is perpetuating inequities of sexual and gender minorities (SGM). We conducted a rapid review on how GSSO documentation in EHRs should be modernized to improve the health of SGM. Materials and Methods We searched MEDLINE from 2015 to 2020 with terms for gender, sex, sexual orientation, and electronic health/medical records. Only literature reviews, primary studies, and commentaries from peer-reviewed journals in English were included. Two researchers screened citations and reviewed articles with help from a third to reach consensus. Covidence, Excel, and Atlas-TI were used to track articles, extract data, and synthesize findings, respectively. Results Thirty-five articles were included. The 5 themes to modernize GSSO documentation in EHRs were (1) creating an inclusive, culturally competent environment with precise terminology and standardized data collection; (2) refining guidelines for identifying and matching SGM patients with their care needs; (3) improving patient-provider relationships by addressing patient rights and provider competencies; (4) recognizing techno-socio-organizational aspects when implementing GSSO in EHRs; and (5) addressing invisibility of SGM by expanding GSSO research. Conclusions The literature on GSSO documentation in EHRs is expanding. While this trend is encouraging, there are still knowledge gaps and practical challenges to enabling meaningful changes, such as organizational commitments to ensure affirming environments, and coordinated efforts to address technical, organizational, and social aspects of modernizing GSSO documentation. The adoption of an inclusive EHR to meet SGM needs is a journey that will evolve over time.
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Affiliation(s)
- Francis Lau
- School of Health Information Science, University of Victoria, Victoria, Canada
| | - Marcy Antonio
- School of Health Information Science, University of Victoria, Victoria, Canada
| | - Kelly Davison
- School of Health Information Science, University of Victoria, Victoria, Canada
| | - Roz Queen
- School of Health Information Science, University of Victoria, Victoria, Canada
| | - Aaron Devor
- Department of Sociology, University of Victoria, Victoria, Canada
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Reisner SL, Deutsch MB, Mayer KH, Potter J, Gonzalez A, Keuroghlian AS, Hughto JM, Campbell J, Asquith A, Pardee DJ, Pletta DR, Radix A. Longitudinal Cohort Study of Gender Affirmation and HIV-Related Health in Transgender and Gender Diverse Adults: The LEGACY Project Protocol. JMIR Res Protoc 2021; 10:e24198. [PMID: 33646126 PMCID: PMC7961399 DOI: 10.2196/24198] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Revised: 11/18/2020] [Accepted: 11/24/2020] [Indexed: 01/19/2023] Open
Abstract
Background Transgender and gender diverse (TGD) adults in the United States experience health disparities, especially in HIV infection. Medical gender affirmation (eg, hormone therapy and gender-affirming surgeries) is known to be medically necessary and to improve some health conditions. To our knowledge, however, no studies have assessed the effects of gender-affirming medical care on HIV-related outcomes. Objective This study aims to evaluate the effects of medical gender affirmation on HIV-related outcomes among TGD primary care patients. Secondary objectives include characterizing mental health, quality of life, and unmet medical gender affirmation needs. Methods LEGACY is a longitudinal, multisite, clinic-based cohort of adult TGD primary care patients from two federally qualified community health centers in the United States: Fenway Health in Boston, and Callen-Lorde Community Health Center in New York. Eligible adult TGD patients contribute electronic health record data to the LEGACY research data warehouse (RDW). Patients are also offered the option to participate in patient-reported surveys for 1 year of follow-up (baseline, 6-month, and 12-month assessments) with optional HIV and sexually transmitted infection (STI) testing. Biobehavioral data from the RDW, surveys, and biospecimen collection are linked. HIV-related clinical outcomes include pre-exposure prophylaxis uptake (patients without HIV), viral suppression (patients with HIV), and anogenital STI diagnoses (all patients). Medical gender affirmation includes hormones, surgeries, and nonhormonal and nonsurgical interventions (eg, voice therapy). Results The contract began in April 2018. The cohort design was informed by focus groups with TGD patients (n=28) conducted between August-October 2018 and in collaboration with a community advisory board, scientific advisory board, and site-specific research support coalitions. Prospective cohort enrollment began in February 2019, with enrollment expected to continue through August 2020. As of April 2020, 7821 patients are enrolled in the LEGACY RDW and 1756 have completed a baseline survey. Participants have a median age of 29 years (IQR 11; range 18-82). More than one-third (39.7%) are racial or ethnic minorities (1070/7821, 13.68% Black; 475/7821, 6.07% multiracial; 439/7821, 5.61% Asian or Pacific Islander; 1120/7821, 14.32% other or missing) and 14.73% (1152/7821) are Hispanic or Latinx. By gender identity, participants identify as 33.79% (2643/7821) male, 37.07% (2900/7821) female, 21.74% (1700/7821) nonbinary, and 7.39% (578/7821) are unsure or have missing data. Approximately half (52.0%) of the cohort was assigned female sex at birth, and 5.4% (421/7821) are living with HIV infection. Conclusions LEGACY is an unprecedented opportunity to evaluate the impact of medical gender affirmation on HIV-related health. The study uses a comprehensive research methodology linking TGD patient biobehavioral longitudinal data from multiple sources. Patient-centeredness and scientific rigor are assured through the ongoing engagement of TGD communities, clinicians, scientists, and site clinical staff undergirded by epidemiological methodology. Findings will inform evidence-based clinical care for TGD patients, including optimal interventions to improve HIV-related outcomes. International Registered Report Identifier (IRRID) DERR1-10.2196/24198
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Affiliation(s)
- Sari L Reisner
- Division of Endocrinology, Diabetes and Hypertension, Brigham and Women's Hospital, Boston, MA, United States.,Harvard Medical School, Boston, MA, United States
| | - Madeline B Deutsch
- University of California San Francisco, San Francisco, CA, United States
| | - Kenneth H Mayer
- Harvard Medical School, Boston, MA, United States.,Harvard TH Chan School of Public Health, Boston, MA, United States.,The Fenway Institute, Boston, MA, United States.,Beth Israel Deaconess Medical Center, Boston, MA, United States
| | - Jennifer Potter
- Harvard Medical School, Boston, MA, United States.,The Fenway Institute, Boston, MA, United States.,Beth Israel Deaconess Medical Center, Boston, MA, United States
| | - Alex Gonzalez
- Harvard Medical School, Boston, MA, United States.,The Fenway Institute, Boston, MA, United States.,Beth Israel Deaconess Medical Center, Boston, MA, United States
| | - Alex S Keuroghlian
- Harvard Medical School, Boston, MA, United States.,The Fenway Institute, Boston, MA, United States.,Massachusetts General Hospital, Boston, MA, United States
| | - Jaclyn Mw Hughto
- Brown University School of Public Health, Providence, RI, United States.,Center for Health Promotion and Health Equity, Brown University, Providence, RI, United States
| | | | | | | | | | - Asa Radix
- Callen-Lorde Community Health Center, New York, NY, United States
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Chittalia AZ, Marney HL, Tavares S, Warsame L, Breese AW, Fisher DL, Stoppie ME, Coen D, Zikowski KA, Shapiro AW, Vawdrey DK. Bringing Cultural Competency to the EHR: Lessons Learned Providing Respectful, Quality Care to the LGBTQ Community. AMIA ... ANNUAL SYMPOSIUM PROCEEDINGS. AMIA SYMPOSIUM 2021; 2020:303-310. [PMID: 33936402 PMCID: PMC8075512] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
The lesbian, gay, bisexual, transgender, queer (LGBTQ) community is vulnerable to healthcare disparities. Many healthcare organizations are contemplating efforts to collect sexual orientation and gender identity in the electronic health record (EHR), with a goal of providing more respectful, inclusive, high-quality care to their LGBTQ patients. There are significant human and technical barriers that must be overcome to make these efforts successful. Based on our four-year experience at Geisinger (an integrated health system located in a rural, generally conservative area), we provide insights to overcome challenges in two critical areas: 1) enabling the EHR to collect and use information to support the healthcare needs of LGBTQ patients, and 2) building a culture of awareness and caring, empowering members of the healthcare team to break down barriers of misunderstanding and mistrust.
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Affiliation(s)
| | | | | | | | | | | | | | - D Coen
- Geisinger Health System, Danville, PA
| | | | | | - David K Vawdrey
- Geisinger Health System, Danville, PA
- Columbia University, New York, NY
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50
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Kannan V, Wilkinson KE, Varghese M, Lynch-Medick S, Willett DL, Bosler TA, Chu L, Gates SI, Holbein MEB, Willett MM, Reimold SC, Toto RD. Count me in: using a patient portal to minimize implicit bias in clinical research recruitment. J Am Med Inform Assoc 2021; 26:703-713. [PMID: 31081898 DOI: 10.1093/jamia/ocz038] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2019] [Revised: 03/04/2019] [Accepted: 03/08/2019] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVE Determine whether women and men differ in volunteering to join a Research Recruitment Registry when invited to participate via an electronic patient portal without human bias. MATERIALS AND METHODS Under-representation of women and other demographic groups in clinical research studies could be due either to invitation bias (explicit or implicit) during screening and recruitment or by lower rates of deciding to participate when offered. By making an invitation to participate in a Research Recruitment Registry available to all patients accessing our patient portal, regardless of demographics, we sought to remove implicit bias in offering participation and thus independently assess agreement rates. RESULTS Women were represented in the Research Recruitment Registry slightly more than their proportion of all portal users (n = 194 775). Controlling for age, race, ethnicity, portal use, chronic disease burden, and other questionnaire use, women were statistically more likely to agree to join the Registry than men (odds ratio 1.17, 95% CI, 1.12-1.21). In contrast, Black males, Hispanics (of both sexes), and particularly Asians (both sexes) had low participation-to-population ratios; this under-representation persisted in the multivariable regression model. DISCUSSION This supports the view that historical under-representation of women in clinical studies is likely due, at least in part, to implicit bias in offering participation. Distinguishing the mechanism for under-representation could help in designing strategies to improve study representation, leading to more effective evidence-based recommendations. CONCLUSION Patient portals offer an attractive option for minimizing bias and encouraging broader, more representative participation in clinical research.
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Affiliation(s)
- Vaishnavi Kannan
- Information Resources Department, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Kathleen E Wilkinson
- Center for Translational Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Mereeja Varghese
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | | | - Duwayne L Willett
- Center for Translational Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA.,Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Teresa A Bosler
- Information Resources Department, University of Texas Southwestern Medical Center, Dallas, TX, USA.,Center for Translational Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Ling Chu
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Samantha I Gates
- Information Resources Department, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - M E Blair Holbein
- Center for Translational Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA.,Department of Population and Data Sciences, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Mallory M Willett
- College of Liberal Arts, University of Texas at Austin, Austin, TX, USA
| | - Sharon C Reimold
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Robert D Toto
- Center for Translational Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA.,Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA
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