Perspectives of LGBTQ Youth and Pediatricians in the Primary Care Setting: A Systematic Review

Optimizing Sexual and Gender Minority Adolescent Health: Putting Evidence into Practice

INTRODUCTION

Sexual and gender minority (SGM) adolescents are at higher risk for adverse health outcomes compared to their cisgender and heterosexual peers.

METHODS

Guided by the EPQA standardized reporting system, we implemented an evidence-based practice (EBP) initiative centered on affirmative healthcare for adolescents in two pediatric primary care sites. This initiative revolved around: (1) provider training on healthcare needs of SGM adolescents, (2) the use of two new EHR charting tools for SGM needs, and (3) examination of the EBP initiative using quantitative and qualitative analyses.

RESULTS

Quick-texts tools were used 165 times in 3 months (20.4% compliance). Findings also show providers screened Hispanic patients at a proportionately lower rate (p = .043) as compared to other races and ethnicity. Providers perceived the EBP initiative as informative, feasible, without workflow disruption with suggestions for improvement.

DISCUSSION

This EBP initiative has implications for advanced nursing practice, organizational policy, and health equity.

It's a Start: An Online, On-Demand LGBTQ+ Mental Health Training Session for Providers Nationwide

OBJECTIVE

The purpose of this study was to determine whether an online, on-demand, and publicly accessible mental health training session on care for lesbian, gay, bisexual, transgender, queer, and all sexual-diverse and gender-diverse (LGBTQ+) individuals could improve providers' preparedness, attitudes, and knowledge regarding care for LGBTQ+ patients.

METHODS

Between January and June 2022, participating mental health providers completed the Lesbian, Gay, Bisexual, and Transgender Development of Clinical Skills Scale (LGBT-DOCSS) before and after training.

RESULTS

Participants (N=322) represented various mental health specialties and all U.S. regions. LGBT-DOCSS scores significantly increased after training: for overall LGBT-DOCSS, Cohen's d=0.77 (p<0.001); for clinical preparedness, Cohen's d=0.68 (p<0.001); for attitudinal awareness, Cohen's d=0.14 (p=0.014); and for basic knowledge, Cohen's d=0.62 (p<0.001).

CONCLUSIONS

Although participating mental health providers had improvements in the parameters assessed, small but notable gaps in their LGBTQ+ health awareness and practice remained, suggesting that LGBTQ+ education requires motivated, longitudinal, ongoing, and lifelong learning approaches.

Sexual Minorities and Loneliness: Exploring Sexuality through Social Media and Gender-Sexuality Alliance (GSA) Supports

We examined online and offline social supports for sexual minority adolescents, underscoring the understudied developmental period of early adolescence and the mental outcome of loneliness. Stemming from a larger study in the northeast U.S., 967 youth participants were 26% sexual minority, 53% female, 45% male, and 2% other/nonbinary (mean age = 13.1, SD = 1.52). LGBTQ+ youth reported significantly higher levels of loneliness compared to their heterosexual counterparts. To understand potential sources of social support while exploring their sexual identities, we compared the experiences of LGBTQ+ youth at both ends of the loneliness spectrum. Gaining knowledge about their sexual orientation from LGBTQ+ organization websites, participating in gender-sexuality alliances, and using TikTok or Instagram were associated with lower levels of loneliness. Providing social support to online friends was associated with lower loneliness; however, receiving online support was not associated with lower loneliness. Furthermore, proactive social media engagement such as posting uplifting content, joining online communities, or raising awareness about social issues were associated with lower levels of loneliness. The results provide guidance on specific youth behaviors and online communities beyond a focus on screen time while highlighting the continued need for social support to ameliorate loneliness, such as gender-sexuality alliance networks.

Evidence-based sexual healthcare for the LGBTQIA2+ patient across the lifespan

ABSTRACT

People who identify as lesbian, gay, bisexual, transgender, queer/questioning, intersex, asexual, two-spirit, or other minority sexual and gender identities (LGBTQIA2+) often avoid seeking healthcare due to social discrimination and stigma. Clinical education in LGBTQIA2+-affirming care is essential but often lacking across disciplines. Provider acceptance, awareness of personal biases, and understanding of microaggressions affecting LGBTQIA2+ people can improve access, outcomes, and survival for this population. Expertise in caring for LGBTQIA2+ people in rural and suburban communities, for people who are transgender, and for people who have undergone or are in the process of undergoing gender-affirming surgeries is essential to offer best-practice healthcare.

Provider perspectives on clinical decision support to improve HIV prevention in pediatric primary care: a multiple methods study

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.

LGBTQ+ Youth Health: An Unmet Need in Pediatrics

At present, lesbian, gay, bisexual, transgender, queer and intersex people (LGBTQ+) are increasingly being empowered to freely express themselves, particularly young people and rising generations. Although data underline the trend of more open expression of different sexual orientations and gender identities, LGBTQ+ adolescents still suffer discrimination in the health care framework. Inclusive care by providers to look after the health of LGBTQ+ indiviuals is needed. Pediatricians are often the first health care providers for LGBTQ+ youth facing their sexual and gender identities. Unfortunately, pediatricians have limited knowledge about LGBTQ+ issues, which keeps them from fulfilling the specific needs of LGBTQ+ youth. The purpose of this review is to frame the most important aspects of LGBTQ+ youths’ lives, including risks, difficulties and needs, that pediatricians should investigate and meet to provide these youth with better and more individualizedassistance regarding their health. A literature analysis showed that pediatricians have insufficient knowledge of and comfort with several items regarding the management of LGBTQ+ youths. Increased awareness and knowledge of the specific and exclusive needs of LGBTQ+ adolescents are mandatory, including dedicated pediatric LGBTQ+ health care training. This would give them the opportunity to forward an inclusive health care system, thus reducing the risks related to stigma, bullying and family rejection and promoting sex education. Further studies are needed to better evaluate the prevalence of LGBTQ+ youths, gender-based medicine in pediatrics and the effects of COVID-19 on the LGBTQ+ younth population due to increased risks of psychosocial suffering, isolation and mental diseases.

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

Background

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

Methods

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

Results

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

Conclusion

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

Towards an International Consensus on the Prevention, Treatment, and Management of High-Risk Substance Use and Overdose among Youth

Background and Objectives: Now more than ever, there is an obvious need to reduce the overall burden of disease and risk of premature mortality that are associated with mental health and substance use disorders among young people. However, the current state of research and evidence-based clinical care for high-risk substance use among youth is fragmented and scarce. The objective of the study is to establish consensus for the prevention, treatment, and management of high-risk substance use and overdose among youth (10 to 24 years old). Materials and Methods: A modified Delphi technique was used based on the combination of scientific evidence and clinical experience of a group of 31 experts representing 10 countries. A semi-structured questionnaire with five domains (clinical risks, target populations, intervention goals, intervention strategies, and settings/expertise) was shared with the panelists. Based on their responses, statements were developed, which were subsequently revised and finalized through three iterations of feedback. Results: Among the five major domains, 60 statements reached consensus. Importantly, experts agreed that screening in primary care and other clinical settings is recommended for all youth, and that the objectives of treating youth with high-risk substance use are to reduce harm and mortality while promoting resilience and healthy development. For all substance use disorders, evidence-based interventions should be available and should be used according to the needs and preferences of the patient. Involuntary admission was the only topic that did not reach consensus, mainly due to its ethical implications and resulting lack of comparable evidence. Conclusions: High-risk substance use and overdoses among youth have become a major challenge. The system’s response has been insufficient and needs substantial change. Internationally devised consensus statements provide a first step in system improvement and reform.