When involved in a discussion of potential topics for this publication related to health equity, I listened and tried to find what area was not included in a means to participate. Representation for the LGBTQIA2S+ population was not readily apparent, so I decided to explore some current research and see where it led me. While I may have a familiarity with the needs of this population, my research for this article was eye-opening in regard to healthcare inclusion and safety and is a reminder to do better in staying informed of the needs of people who identify as LGBTQIA2S+.
Access to medical care has arguably improved over time, such as with the creation of telehealth options for homebound patients or individuals living in rural areas. However, access alone does not equate to quality of care and inclusion of all needs. The LGBTQIA2S+ population has been found to be diagnosed with psychological disorders and experience substance abuse issues at a greater frequency than the heterosexual population (Morris et al., 2022; Pratt-Chapman et al., 2022). These conditions can impact several different aspects of an individual’s life including family, work, interpersonal relationships and overall general health. Admitting to needing help with a psychological disorder or substance addiction can be difficult for anyone, but it can be even more challenging for LGBTQIA2S+ individuals due to the lack of mainstream inclusivity for this group.
PERSPECTIVE
Let’s think about this. Have you or someone you know experienced a mental health crisis or struggled with alcohol or other substance dependence? How quick were they to seek help? When they did, how were they treated by their treatment team? There is a vulnerability to asking for help and sharing our weaknesses with others even if they are professionals. There is an even greater vulnerability for an LGBTQIA2S+ person to seek out this help.
Imagine having to worry or have the following thoughts while you sit in the waiting room for those long minutes waiting for your treatment team:
- Will I need to disclose my sexual identity?
- Will the nurse or doctor accept me, or will they judge me?
- Will my sexual identity impact the quality of treatment that I will receive if the doctor does not agree with who I am?
- Will I have to explain what it means to be LGBTQIA2S+ to my provider, or can I just get the help I need?
The list can go on and on, and hopefully the person has not left the provider’s office before the nurse or physician even entered the room!
BARRIERS TO RECEIVING CARE
LGBTQIA2S+ individuals have shared their concerns and opinions on receiving improved care with their providers. According to Morris et al. (2022), common barriers to receiving care include fear of rejection and judgment by their provider, concern of mentioning uncomfortable subjects such as sexual intimacy, physicians’ lack of knowledge and understanding of the population, and providers simply not acknowledging sexual orientation in any capacity. With these barriers to treatment, it places the LGBTQIA2S+ population at a greater risk of delaying seeking help or support. The same study by Morris et al. (2022) found that LGBTQIA2S+ individuals prefer to be treated by a provider who has a shared identity in the population, has a warm and inclusive environment evidenced by visible signs of inclusivity and has participated in sexual minority training.
LGBTQIA2S+ individuals are not the only ones who feel barriers exist. Providers, including physicians, nurses and social workers, share similar concerns in meeting the needs of this population. Sampson et al. (2023) found that almost half of the providers who participated in their study demonstrated low knowledge of the health needs of patients who identify in the LGBTQIA2S+ adolescent population. Providers do not feel readily trained or educated on how to best support this population. Further, electronic medical record (EMR) systems do not readily have options to include preferred pronouns or identified gender other than the sex assigned at birth, which adds frustration to patients and confusion for providers.
The LGBTQIA2S+ population can be considered an invisible population because you cannot look at someone and know that they are not heterosexual. The invisibility of the population is also evident in medical research studies. Studies are not readily asking for sexual orientation or gender identity demographics during intakes, which does not allow for data that is clearly specific to the needs of this population. Pratt-Chapman et al. (2022) point out that not only does the lack of specific data on this population impact scientific research, but non-inclusive language adds additional barriers to LGBTQIA2S+ individuals’ medical treatment such as cancer screenings. Gendered language is used and does not link to the anatomy of the body, which can pose discomfort for someone perhaps who is transgender attempting to have a cervical cancer screening.
MOVING FORWARD
So what can we do to help? While there is a lot of work to be done at a macro practice and policy level, there are things you can do now to help with LGBTQIA2S+ inclusion in healthcare. First, educate yourself. Pratt Chapman et al. (2022) share resources on evidenced-based trainings available for continuing education related to oncology and sexual orientation and gender identity. There are training programs and continuing education that can be attended to assist with building your knowledge and increasing understanding. Aim to combat stereotypes and correct others when they make assumptions about the LGBTQIA2S+ population. Create an inclusive environment. You can show you are a safe space and an accepting provider by having visible signs of support and inclusion to the LGBTQIA2S+ population. You can do this by having materials in waiting rooms or offices that support the population, having signage or known symbols visible (i.e., rainbow or pride flag) and using inclusive language.
As case managers, I think it is important to be mindful of the possibility that every patient or client you interact with could be part of the LGBTQIA2S+ population. The way you speak, behave, and make assumptions can greatly impact the individual not only during your interaction, but for their future interactions with other providers when they are seeking care. I challenge us all to take some time to learn about the needs of this population and develop a better understanding into their experience.
REFERENCES
Morris, D. D. A., Fernandes, V., and Rimes, K. A. (2022). Sexual minority service user perspectives on mental health treatment barriers to care and service improvements. International Review of Psychiatry, 34(3-4), 230-239. https://doi.org/10.0180/09540261.2022.2051445.
Pratt-Chapman, Mandi L., Potter, J., Eckstr, K., Schabath, M. B., Quinn, G. P., Dizon, D. S., and Radix, A. (2022). All Research Is LGBTQI Research: Recommendations for Improving Cancer Care Through Research Relevant to Sexual and Gender Minority Populations. Annals of LGBTQ Public and Populations Health, 3(1), 6-17.
Sampson, A., Block, R., Lake, P. W., Gagliardi, J., Augusto, B., Santiago-Datil, W., Sutter, M., Schabath, M. B., Vadaparampil, S., and Quinn, G. P. (2023). “No one size fits all” A Multi-Method Survey of Oncology Allied Health Professionals Experiences with Lesbian, Gay, Bisexual, Transgender/Queer Questioning Adolescent, and Young Adult Patients with Cancer and Reproductive and Sexual Health. Journal of Adolescent and Young Adult Oncology, 12(2), 250-258.
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