Purpose/Objectives: To describe factors related to diagnosis, identity disclosure, and social support among lesbian, gay, bisexual, and transgender (LGBT) patients with cancer, and to explore associations between these factors and self-rated health.
Design: Cross-sectional self-report survey design using descriptive and exploratory multivariate statistical approaches.
Setting: Online, Internet-based.
Sample: 291 LGBT patients (89% Caucasian; 50% gay, 36% lesbian, 7% bisexual, 3% transgender) with mixed cancers.
Methods: Participants completed a researcher-designed online survey assessing experiences of cancer diagnosis among LGBT patients at a single time point.
Main Research Variables: Demographics, which provider(s) delivered the patients' cancer diagnoses, to whom patients had disclosed their LGBT identity, how they disclosed, who was on their social support team at the time of diagnosis, and current self-rated health.
Findings: 79% of participants reported disclosing their identities to more than one cancer care provider. Participants most commonly introduced the topic of LGBT identity themselves, sometimes as a way to correct heterosexual assumptions (34%). Friends were the most common members of LGBT patients' support teams (79%). Four disclosure and support factors were consistently associated with better self-rated health.
Conclusions: Disclosure of LGBT identity is a common experience in the context of cancer care, and disclosure and support factors are associated with better self-reported health among LGBT patients.
Implications for Nursing: Creating safe environments for LGBT patients to disclose could improve cancer care delivery to this underserved population. Nurses and other providers should acknowledge and include diverse support team members in LGBT patients' care.
Arena, P. L., Carver, C. S., Antoni, M. H., Weiss, S., Ironson, G., & Durán, R. E. (2006). Psychosocial responses to treatment for breast cancer among lesbian and heterosexual women. Women and Health, 44, 81-102.
Bare, M. G., Margolies, L., & Boehmer, U. (2014). Omission of sexual and gender minority patients. Journal of Clinical Oncology, 32, 182-183. doi:10.1200/JCO.2014.55.6126
Boehmer, U., & Case, P. (2004). Physicians don't ask, sometimes patients tell: Disclosure of sexual orientation among women with breast carcinoma. Cancer, 101, 1882-1889. doi:10.1002/cncr.20563
Boehmer, U., Freund, K. M., & Linde, R. (2005). Support providers of sexual minority women with breast cancer: Who they are and how they impact the breast cancer experience. Journal of Psychosomatic Research, 59, 307-314. doi:10.1016/j.jpsychores.2005.06.059
Boehmer, U., Glickman, M., Winter, M., & Clark, M. A. (2013). Lesbian and bisexual women's adjustment after a breast cancer diagnosis. Journal of American Psychiatric Nurses Association, 19, 280-292.
Brotman, S., Ryan, B., & Cormier, R. (2003). The health and social service needs of gay and lesbian elders and their families in Canada. Gerontologist, 43, 192-202.
DeSalvo, K. B., Bloser, N., Reynolds, K., He, J., & Muntner, P. (2006). Mortality prediction with a single general self-rated health question. A meta-analysis. Journal of General Internal Medicine, 21, 267-275. doi:10.1111/j.1525-1497.2005.00291.x
Durso, L. E., & Meyer, I. H. (2013). Patterns and predictors of disclosure of sexual orientation to healthcare providers among lesbians, gay men, and bisexuals. Sexuality Research and Social Policy, 10, 35-42. doi:10.1007/s13178-012-0105-2
Fobair, P., O'Hanlan, K., Koopman, C., Classen, C., Dimiceli, S., Drooker, N., … Spiegel, D. (2001). Comparison of lesbian and heterosexual women's response to newly diagnosed breast cancer. Psycho-Oncology, 10, 40-51. doi:10.1002/1099-1611(200101/02)10:1<40::AID-PON480>3.0.CO;2-S
Glaser, R., & Kiecolt-Glaser, J. K. (2005). Stress-induced immune dysfunction: Implications for health. Nature Reviews. Immunology, 5, 243-251. doi:10.1038/nri1571
Greenesmith, H., Cray, A., & Baker, K. (2013). The Affordable Care Act and LGBT families: Everything you need to know. Retrieved from http://ampr.gs/11szSm1
Grossman, A. H., Daugelli, A. R., & Hershberger, S. L. (2000). Social support networks of lesbian, gay, and bisexual adults 60 years of age and older. Journals of Gerontology, Series B, Psychology and Social Sciences, 55, P171-P179.
Haddock, K. S. (1994). Collaborative discharge planning: Nursing and social services. Clinical Nurse Specialist, 8, 248-252.
Howlader, N., Ries, L. A., Mariotto, A. B., Reichman, M. E., Ruhl, J., & Cronin, K. A. (2010). Improved estimates of cancer-specific survival rates from population-based data. Journal of the National Cancer Institute, 102, 1584-1598. doi:10.1093/jnci/djq366
Institute of Medicine. (2011). The health of lesbian, gay, bisexual, and transgender people: Building a foundation for better understanding. Washington, DC: National Academies Press.
Jabson, J. M., & Blosnich, J. R. (2012). Representation of lesbian, gay, and bisexual people in clinical cancer trials. Annals of Epidemiology, 22, 821-823. doi:10.1016/j.annepidem.2012.08.006
Kamen, C., Palesh, O., Gerry, A.A, Andrykowski, M. A., Heckler, C. E., Mohile, S. G., … Mustian, K. (2014). Disparities in health risk behavior and psychological distress among gay versus heterosexual male cancer survivors. LGBT Health, 1, 86-92. doi:10.1089/lgbt.2013.0022
Katz, A. (2009). Gay and lesbian patients with cancer. Oncology Nursing Forum, 36, 203-207. doi:10.1188/09.ONF.203-207
Kolcaba, K. Y. (1992). Holistic comfort: Operationalizing the construct as a nurse-sensitive outcome. Advances in Nursing Science, 15, 1-10.
Kolcaba, K., & Steiner, R. (2000). Empirical evidence for the nature of holistic comfort. Journal of Holistic Nursing, 18, 46-62.
Labig, C. E., Jr., & Peterson, T. O. (2006). Sexual minorities and selection of a primary care physician in a midwestern U. S. city. Journal of Homosexuality, 51, 1-5. doi:10.1300/J082v51n03_01
Lim, F. A., Brown, D. V., Jr., & Justin Kim, S. M. (2014). Addressing health care disparities in the lesbian, gay, bisexual, and transgender population: A review of best practices. American Journal of Nursing, 114, 24-34. doi:10.1097/01.NAJ.0000450423.89759.36
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
Ryan, C., Huebner, D., Diaz, R. M., & Sanchez, J. (2009). Family rejection as a predictor of negative health outcomes in white and Latino lesbian, gay, and bisexual young adults. Pediatrics, 123, 346-352. doi:10.1542/peds.2007-3524
St Pierre, M. (2012). Under what conditions do lesbians disclose their sexual orientation to primary healthcare providers? A review of the literature. Journal of Lesbian Studies, 16, 199-219. doi:10.1080/10894160.2011.604837
Su, X., Azuero, A., Cho, J., Kvale, E., Meneses, K. M., & McNees, M. P. (2011). An introduction to tree-structured modeling with application to quality of life data. Nursing Research, 60, 247-255. doi:10.1097/NNR.0b013e318221f9bc
White, J. L., & Boehmer, U. (2012). Long-term breast cancer survivors' perceptions of support from female partners: An exploratory study. Oncology Nursing Forum, 39, 210-217. doi:10.1188/12.ONF.210-217