An interactive online LGBT cultural competency training program for oncologists may be improve LGBT-related knowledge and clinical practices. This is the preliminary result of a pilot study of oncologists in Florida, supported by a grant from the Florida Academic Cancer Center Alliance, which was presented at the 11th AACR Conference on The Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved, held November 2-5, 2018 in the Sheraton New Orleans Hotel in New Orleans, Louisiana, USA.

The training program was developed via an interdisciplinary collaboration between investigators at the Sylvester Comprehensive Cancer Center in Miami; the H. Lee Moffitt Cancer Center and Research Institute in Tampa; and the University of Florida Cancer Center in Gainesville.

Because a cancer diagnosis may leave an LGBT patient with no choice but to face a system that, historically, has not been very kind to their community, the expectation is that a broader online training may help change attitudes and medical practice.

Such training may facilitate the disclosure of sexual or gender identity which may help LGBT patients with cancer overcome assumptions made by their care team about their identity. [1]

Health disparities
?LGBT people experience substantial health disparities in various cancer survivorship and quality of life outcomes, including reporting more distress, more relationship difficulties, and less satisfaction with their cancer treatment and care than their heterosexual and cisgender counterparts,? said Julia Seay, Ph.D, research assistant professor at the Sylvester Comprehensive Cancer Center.

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… the proportion of physicians who correctly answered more than 90% of questions increased from 33% before training and 85% after training…

?As part of a broader effort to address disparities and improve cancer care and survivorship among LGBT people, we are working to improve LGBT cultural competency among oncologists,? she added.

Knowledge and ability
LGBT competency involves having the knowledge and ability to work effectively with LGBT patients, explained Seay. It is an evolving skill set that involves not only knowledge about the unique care needs of sexual and gender minority individuals, but also the communication skills to effectively provide high-quality, personalized care for LGBT patients.

Seay?s colleagues, Matthew Schabath, PhD, associate member in the Department of Cancer Epidemiology at the H. Lee Moffitt Cancer Center and Research Institute, and Gwendolyn Quinn, PhD, the Livia S. Wan, MD, Professor of Obstetrics and Gynecology in the Department of Obstetrics and Gynecology at New York University Langone Medical Center, previously conducted a national survey of oncologists and found that the overwhelming majority would be willing to receive training on the unique care needs of LGBT patients. This led them to design the interactive online LGBT cultural competency training program.

Online training
The training program comprises four 30-minute modules. Two of the modules cover general topics, such as sexual orientation and gender identity terminology. The other two are oncology-focused; they include topics such as hormone therapy considerations for transgender patients undergoing cancer treatment and discussions of fertility with LGBT patients within the context of cancer care.

To date, Seay and colleagues have recruited 20 oncologists from Sylvester Comprehensive Cancer Center, Moffitt Cancer Center, and UF Health Cancer Center to participate in the online training and provide feedback via self-administered questionnaire. Among the participating oncologists, 75% were heterosexual and cisgender.

Oncologists? LGBT-related knowledge increased after completion of the training. The study results show that the proportion of participants who correctly answered more than 90% of LGBT-related knowledge items was 33% before training and 85% after training.

Improving attitudes
LGBT-related attitudes and clinical practices were also improved after completing the training: 70% of participants reported an increase in favorable perspectives toward LGBT people and 80% reported increasing their endorsement of LGBT-serving clinical practices.

In addition, after completing the training, 90% of the oncologists rated the training as either ?excellent? or ?very good,? and 95% stated that they would refer another oncologist to the training.

?These descriptive data from our pilot study show that this training program is both feasible and acceptable for oncologists,? Seay said.

?The preliminary analyses also showed positive pre-post changes in LGBT-related knowledge and clinical practices. We hope to have the formal significance testing analysis completed in advance of the conference,? she added.

In an ideal world oncologist – and the entire oncology care team – should receive comprehensive training about gender identity and sexual orientation so they can best help their LGBT patients and deliver appropriate, sensitive care. This may include patients who identify as transgender or gender nonconforming. Unfortunately, this is not the case today. Therefore oncologists should feel comfortable using all available resources, including the interactive online LGBT cultural competency training, developed via an interdisciplinary collaboration between investigators at the Sylvester Comprehensive Cancer Center in Miami, the H. Lee Moffitt Cancer Center and Research Institute in Tampa, and the University of Florida Cancer Center in Gainesville, at their disposal to ensure they?re giving all patients the best care possible.[1]

Study limitation
According to Seay, the main limitation of the study is that it is a pilot study that involved a relatively small sample of oncologists from three institutions in the state of Florida. ?This limits our ability to draw conclusions regarding the effectiveness of the training and the findings may not be broadly applicable to oncologists across the United States. However, we are hoping to soon be able to examine the effectiveness of our training among oncologists nationally,? Seay concluded.

[1] Griggs J, Maingi S, Blinder V, et al. American Society of Clinical Oncology position statement: Strategies for reducing cancer health disparities among sexual and gender minority populations. J Clin Oncol. 2017;35:2203-8. Epub 2017 Apr 3.

Last Editorial Review: November 3, 2018

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