The 2011 film titled Gen Silent focuses on the needs and issues of six aging lesbian, gay, bisexual, and transgender (LGBT) people, at least two of whom had cancer. One of the issues made apparent in the film was the lack of trust in the healthcare system and the discrimination these individuals faced at a time when their needs were growing and they were increasingly vulnerable. It was sad and caused us to reflect on what we, as oncology nurses, are doing to meet the needs of LGBT individuals faced with a cancer diagnosis.
The 2011 film titled Gen Silent (http://gensilent.com) focuses on the needs and issues of six aging lesbian, gay, bisexual, and transgender (LGBT) people, at least two of whom had cancer. One of the issues made apparent in the film was the lack of trust in the healthcare system and the discrimination these individuals faced at a time when their needs were growing and they were increasingly vulnerable. It was sad and caused us to reflect on what we, as oncology nurses, are doing to meet the needs of LGBT individuals faced with a cancer diagnosis.
Many of us have learned to provide culturally competent cancer care to our patients. We have focused our efforts on learning more about and being sensitive to patients with different ethnic and socioeconomic backgrounds and patients whose language is not the same as ours. But how many of us feel prepared to provide the same high-quality care to LGBT individuals? Was it even covered in your nursing curriculum when you were in school?
An estimated 5%–10% of the U.S. population considers themselves LGBT (Grant, 2010). According to Healthy People 2020 (U.S. Department of Health and Human Services [USDHHS], 2015), LGBT individuals face health disparities associated with societal stigma, discrimination, denial of their civil and human rights, and frequent experiences of violence and victimization. Personal, familial, and social lack of acceptance of sexual orientation and gender identity negatively affects the mental health and personal safety of LGBT individuals (USDHHS, 2015). In addition, the LGBT community experiences disparities related to healthcare access; higher rates of depression, anxiety, and suicide; higher levels of sexually transmitted diseases; a greater propensity for cigarette smoking and drug and alcohol abuse; and lower rates of cancer screening and higher rates of some cancer diagnoses (Joint Commission, 2014; Quinn, Schabath, Sanchez, Sutton, & Green, 2014). The fear of discrimination or stigmatization may reflect the discomfort and negative attitudes many healthcare providers, including nurses, experience and convey when working with LGBT patients (Dorsen, 2012; Institute of Medicine, 2011).
In 2014, the Joint Commission released the field guide titled Advancing Effective Communication, Cultural Competence, and Patient- and Family-Centered Care for the Lesbian, Gay, Bisexual, and Transgender (LGBT) Community. In this document, focus was placed on patient and family engagement, effective communication between healthcare providers and LGBT patients; a checklist for leadership to use to implement changes to LGBT approach; and provisions of care, treatment, and services (see Figure 1). In addition, the American Academy of Nursing ([AAN], 2012) developed position statements opposing discrimination based on sexual orientation or gender identify and to enhance the health of this population. They also encourage hospital visitation rights for the partners and children of LGBT individuals (AAN, 2015). The Oncology Nursing Society (2015) endorsed this position.
Our readers may want to learn more to address the disparities experienced by and the unique needs of the LGBT community throughout the cancer continuum; therefore, two Oncology Essentials feature columns in the Clinical Journal of Oncology Nursing provide basic information about LGBT issues (Levitt, 2015; Margolies, 2014). Other resources are also available, and oncology nurses should become familiar with them to provide the quality of cancer care we want for all patients (see Figure 2).
One of the goals of Healthy People 2020 is to improve the health, safety, and well-being of LGBT individuals. We encourage oncology nurses to create an environment that does that. We challenge you to learn more by talking to one another about this. Have one of your LGBT colleagues or patients talk with you about this issue. And then keep learning. Being afraid of being discriminated against or not having your needs met adds an additional burden while facing a cancer diagnosis. Having cancer is bad enough.
American Academy of Nursing. (2012). Position statement on health care for sexual minority and gender diverse populations. Retrieved from http://www.aannet.org/assets/lgbtq%20overachstatement%20final%207%2011%2...
American Academy of Nursing. (2015). American Academy of Nursing announces strong support for the rights of LGBT individuals who are hospitalized. Retrieved from http://www.aannet.org/index.php?option=com_content&view=article&id=778:p...
Dorsen, C. (2012). An integrative review of nurse attitudes towards lesbian, gay, bisexual, and transgender patients. Canadian Journal of Nursing Research, 44(3), 18–43.
Grant, J. (2010). Outing age 2010: Public policy issues affecting lesbian, gay, bisexual and transgender elders. New York, NY: National Gay and Lesbian Task Force Policy Institute. Retrieved from http://www.thetaskforce.org/static_html/downloads/reports/reports/outing...
Institute of Medicine. (2011). The health of lesbian, gay, bisexual, and transgender people: Building a foundation for better understanding. Retrieved from http://www.iom.edu/Reports/2011/The-Health-of-Lesbian-Gay-Bisexual-and-T...
Joint Commission. (2014). Advancing effective communication, cultural competence, and patient- and family-centered care for the lesbian, gay, bisexual, and transgender (LGBT) community. Retrieved from http://www.jointcommission.org/assets/1/18/LGBTFieldGuide.pdf
Levitt, N. (2015). Clinical nursing care for transgender patients with cancer. Clinical Journal of Oncology Nursing, 19, 362–366. doi:10.1188/15.CJON.362-366
Margolies, L. (2014). The psychosocial needs of lesbian, gay, bisexual, or transgender patients with cancer. Clinical Journal of Oncology Nursing, 18, 462–464. doi:10.1188/14.CJON.462-464
Oncology Nursing Society. (2015). ONS endorses the American Academy of Nursing policy brief on support for the rights of LGBT individuals who are hospitalized. Retrieved from https://www.ons.org/newsroom/news/ons-endorses-american-academy-nursing-...
Quinn, G.P., Schabath, M.B., Sanchez, J.A., Sutton, S.K., & Green, B.L. (2014). The importance of disclosure: Lesbian, gay, bisexual, transgender/transsexual, queer/questioning, and intersex individuals and the cancer continuum. Cancer, 121, 1160–1163. doi:10.1002/cncr.29203
U.S. Department of Health and Human Services. (2015). Healthy People 2020: Lesbian, gay, bisexual, and transgender health. Retrieved from http://www.healthypeople.gov/2020/topics-objectives/topic/lesbian-gay-bi...
About the Author(s)
Carlton G. Brown, PhD, RN, AOCN®, NEA-BC, FAAN, is a director of Professional Services at the Oregon Nurses Association in Portland, and Deborah K. Mayer, PhD, RN, AOCN®, FAAN, is a professor in the School of Nursing at the University of North Carolina (UNC)–Chapel Hill and director of Cancer Survivorship at the UNC Lineberger Comprehensive Cancer Center. The authors take full responsibility for the content of the article. No financial relationships relevant to the content of this article have been disclosed by the editorial staff. Brown can be reached at firstname.lastname@example.org, with copy to editor at CJONEditor@ons.org.