Agency And Resistance Strategies Among Black Primary Care Patients

Research has identified marginalized and minority patients as displaying fewer participatory behaviors during the clinical interaction. Using a culture-centered framework, this study examines the process by which patients with a previous history of discrimination employed agency and resistance strategies in order to influence the outcome of their clinical interactions. This study conducted a secondary analysis of the video taped interactions of 25 black primary care patients in an urban low-income clinic. Using qualitative content analysis, I identified five emergent themes for patient agency: interrupting the physician, stating observations of care, expressing needs and desires, constructing identity, and agenda/goal management. Participants also used both active and passive forms of resistance tactics in an effort to influence the diagnosis and treatment plan, including questioning the diagnosis/treatment plan, proposing a new diagnosis/treatment plan, providing values and beliefs, questioning the physician’s competence and refusing to endorse the treatment plan. Results from this study indicate that black primary care patients with a history of previous discrimination displayed highly participatory behaviors during the clinical interaction, with displays of patient agency and, in some instances, patient resistance. Future research should examine the role of patient resistance as an attempt to negotiate within the interaction

Proceedings of the Working Group Session on Fertility Preservation for Individuals with Gender and Sex Diversity

Children and adolescents with gender and sex diversity include (1) gender-nonconforming and transgender individuals for whom gender identity or expression are incongruent with birth-assigned sex (heretofore, transgender) and (2) individuals who have differences in sex development (DSD). Although these are largely disparate groups, there is overlap in the medical expertise necessary to care for individuals with both gender and sex diversity. In addition, both groups face potential infertility or sterility as a result of desired medical and surgical therapies. The Ann and Robert H. Lurie Children's Hospital of Chicago (Lurie Children's) gender and sex development program (GSDP) provides specialized multidisciplinary care for both transgender and DSD patients. In response to patient concerns that recommended medical treatments have the potential to affect fertility, the Lurie Children's GSDP team partnered with experts from the Oncofertility Consortium at Northwestern University to expand fertility preservation options to gender and sex diverse youth. This article summarizes the results of a meeting of experts across this field at the annual Oncofertility Consortium conference with thoughts on next steps toward a unified protocol for this patient group.Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/140296/1/trgh.2016.0008.pd

The primary care provider (PCP)‐cancer specialist relationship: A systematic review and mixed‐methods meta‐synthesis

Although they are critical to models of coordinated care, the relationship and communication between primary care providers (PCPs) and cancer specialists throughout the cancer continuum are poorly understood. By using predefined search terms, the authors conducted a systematic review of the literature in 3 databases to examine the relationship and communication between PCPs and cancer specialists. Among 301 articles identified, 35 met all inclusion criteria and were reviewed in‐depth. Findings from qualitative, quantitative, and disaggregated mixed‐methods studies were integrated using meta‐synthesis. Six themes were identified and incorporated into a preliminary conceptual model of the PCP‐cancer specialist relationship: 1) poor and delayed communication between PCPs and cancer specialists, 2) cancer specialists’ endorsement of a specialist‐based model of care, 3) PCPs’ belief that they play an important role in the cancer continuum, 4) PCPs’ willingness to participate in the cancer continuum, 5) cancer specialists’ and PCPs’ uncertainty regarding the PCP’s oncology knowledge/experience, and 6) discrepancies between PCPs and cancer specialists regarding roles. These data indicate a pervasive need for improved communication, delineation, and coordination of responsibilities between PCPs and cancer specialists. Future interventions aimed at these deficiencies may improve patient and physician satisfaction and cancer care coordination. CA Cancer J Clin 2017;67:156–169. © 2016 American Cancer Society.Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/136438/1/caac21385_am.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/136438/2/caac21385.pd

Culturally Competent Care for Sexual and Gender Minority Patients at National Cancer Institute-Designated Comprehensive Cancer Centers

Purpose: This study sought to identify the policies and guidelines regarding culturally competent care of sexual and gender minority (SGM) cancer patients and survivors at National Cancer Institute (NCI)-Designated Comprehensive Cancer Centers. Methods: This study used an in-depth interview qualitative approach. Semistructured interviews were conducted via telephone with representatives from 21 of the 45 NCI-Designated Comprehensive Cancer Centers in 2015. Verbatim transcripts were created from the audiotapes for content analysis. Results: Two main themes were identified as follows: (1) patient-focused experiences and support and (2) organization-focused development activities. Most of the cancer centers in this study had an advisory committee to assist with SGM policies and guidelines. Despite the existence of these committees, the majority of centers did not have explicit policies, guidelines, or routine practices addressing the following issues: the collection and integration of sexual orientation and gender identity information in the medical record, gender-neutral language on patient forms, patient educational materials with SGM-specific health concerns, SGM-specific support for cancer survivors, or required SGM-specific cultural competency trainings for medical and nonmedical staff. Conclusion: In general, the cancer centers in this study lacked institutional policies, guidelines, and practices focused on patient-centered cancer care for SGM populations. Coordinated efforts are needed to systemically improve patient-centered cancer care for these populations