Review of a Medical Pre-Clinical Curriculum for Competencies in Caring for Patients Who Are LGBT, Gender Nonconforming, or Born with DSD

This review aimed to assess whether the George Washington University medical, pre-clinical curriculum met any of the Association of American Medical College’s (AAMC) 30 professional competencies to improve health care for people who are lesbian, gay, bisexual, transgender (LGBT), gender nonconforming, or born with disorders of sex development (DSD). Methods: Relevant sessions were reviewed based on instructors’ PowerPoint slides, audio recording of sessions (when available), assigned pre-session material, and notes taken by a student. Content and objectives from each session were mapped to corresponding AAMC competencies, and each competency was qualitatively graded as completely met, partially met, or unmet. Results: This review found that 18 of the 30 AAMC competencies were completely or partially met. Of the 12 competencies that were unmet, the majority fell into the domains of professionalism, systems-based practice, inter-professional collaboration, and personal/professional development. Mandatory sessions specific to LGBT/DSD health care totaled 7.5 hours, and an additional 13 hours addressed broader topics of sexual health. Conclusions: Strengths of the curriculum included greater than the national average of 5 hours of LGBT-related content, access to LGBT patients on panels, and inclusion of gay and lesbian patients in standardized patient exercises. While psychological and social determinants of health for LGBT patients were addressed, the curriculum lacked similar material for patients who are gender nonconforming or born with DSD

Cancer patient and provider responses to companion scales assessing experiences with LGBTQI-affirming healthcare

BackgroundSexual and gender minority (SGM) persons are at a higher risk for some cancers and may have poorer health outcomes as a result of ongoing minority stress, social stigma, and cisnormative, heteronormative healthcare environments. This study compared patient and provider experiences of affirming environmental and behavioral cues and also examined provider-reported knowledge, attitudes, behaviors, and clinical preparedness in caring for SGM patients among a convenience sample.MethodsNational convenience samples of oncology providers (n = 107) and patients (n = 88) were recruited separately via snowball sampling. No incentives were provided. After reverse coding of appropriate items for unidirectional analysis, lower scores on items indicated greater knowledge, more affirming attitudes or behaviors, and greater confidence in clinical preparedness to care for SGM patients. Pearson chi-square tests compared dichotomous variables and independent samples t-tests compared continuous variables. Other results were reported using descriptive frequencies.ResultsBoth patient and provider samples were predominantly female sex assigned at birth, cisgender, and heterosexual. Providers were more likely than patients to report affirming cues in clinic, as well as the ability for patients to easily document their name in use and pronouns. Providers were more likely to report asking about patient values and preferences of care versus patients’ recollection of being asked. Patients were more likely to report understanding why they were asked about both sex assigned at birth and gender identity compared to providers’ perceptions that patients would understand being asked about both. Patients were also more likely to report comfort with providers asking about sex assigned at birth and gender identity compared to providers’ perceptions of patient comfort. SGM providers had greater knowledge of SGM patient social determinants of health and cancer risks; felt more prepared to care for gay patients; were more likely to endorse the importance of knowing patient sexual orientation and gender identity; and were more likely to indicate a responsibility to learn about SGM patient needs and champion positive system changes for SGM patients compared to heterosexual/cisgender peers. Overall, providers wished for more SGM-specific training.ConclusionDifferences between patient and provider reports of affirming environments as well as differences between SGM and heterosexual/cisgender provider care support the need for expanded professional training specific to SGM cancer care

Cancer Patient and Provider Responses to Companion Scales Assessing Experiences With LGBTQI-Affirming Healthcare

Background: Sexual and gender minority (SGM) persons are at a higher risk for some cancers and may have poorer health outcomes as a result of ongoing minority stress, social stigma, and cisnormative, heteronormative healthcare environments. This study compared patient and provider experiences of affirming environmental and behavioral cues and also examined provider-reported knowledge, attitudes, behaviors, and clinical preparedness in caring for SGM patients among a convenience sample. Methods: National convenience samples of oncology providers (n = 107) and patients (n = 88) were recruited separately via snowball sampling. No incentives were provided. After reverse coding of appropriate items for unidirectional analysis, lower scores on items indicated greater knowledge, more affirming attitudes or behaviors, and greater confidence in clinical preparedness to care for SGM patients. Pearson chi-square tests compared dichotomous variables and independent samples t-tests compared continuous variables. Other results were reported using descriptive frequencies. Results: Both patient and provider samples were predominantly female sex assigned at birth, cisgender, and heterosexual. Providers were more likely than patients to report affirming cues in clinic, as well as the ability for patients to easily document their name in use and pronouns. Providers were more likely to report asking about patient values and preferences of care versus patients’ recollection of being asked. Patients were more likely to report understanding why they were asked about both sex assigned at birth and gender identity compared to providers’ perceptions that patients would understand being asked about both. Patients were also more likely to report comfort with providers asking about sex assigned at birth and gender identity compared to providers’ perceptions of patient comfort. SGM providers had greater knowledge of SGM patient social determinants of health and cancer risks; felt more prepared to care for gay patients; were more likely to endorse the importance of knowing patient sexual orientation and gender identity; and were more likely to indicate a responsibility to learn about SGM patient needs and champion positive system changes for SGM patients compared to heterosexual/cisgender peers. Overall, providers wished for more SGM-specific training. Conclusion: Differences between patient and provider reports of affirming environments as well as differences between SGM and heterosexual/cisgender provider care support the need for expanded professional training specific to SGM cancer care

Developing Standards for Cultural Competency Training for Health Care Providers to Care for Lesbian, Gay, Bisexual, Transgender, Queer, Intersex, and Asexual Persons: Consensus Recommendations from a National Panel

Purpose: Lesbian, gay, bisexual, transgender, queer, intersex, and/or asexual and other sexual and gender diverse persons (LGBTQIA + or SGD persons) experience barriers to equitable health care. The purpose of this article is to describe a collaborative process that resulted in core cultural competency recommendations addressing training for those who provide health care and/or social services to LGBTQIA + patients. Methods: In 2018 and 2019, Whitman-Walker Health, a Federally Qualified Community Health Center in Washing- ton, DC, and the National LGBT Cancer Network purposively selected leaders of community clinics and community-based organizations, cultural competency trainers, and clinicians and researchers with expertise in SGD health with diverse lived experiences to develop consensus-based cultural competency recommendations. Recommendations were developed through a synthesis of peer-reviewed studies, publicly accessible curricula, and evaluations of SGD cultural competency trainings; two in-person convenings; and iterative feedback from diverse stakeholders. Results: Five anchoring recommendations emerged: (1) know your audience; (2) develop and fine-tune the curriculum; (3) employ both adult and transformational learning theories; (4) choose multiple effective trainers; and (5) evaluate impact of training. These recommendations promote an ongoing process of individual and organizational improvement and a stance of humility rather than competence to be mastered. Conclusion: By setting core cultural competency standards for all persons involved in health care and social services, these recommendations complement existing clinical competency recommendations to advance SGD health equity

American Cancer Society/American Society of Clinical Oncology Breast Cancer Survivorship Care Guideline

Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/136493/1/caac21319_am.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/136493/2/caac21319-sup-0001-suppinfo1.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/136493/3/caac21319.pd

Learning Outcomes of Diverse Oncology Professionals After the TEAM Cultural Competency Training

Racial, ethnic, sexual, and gender minorities are more likely to report challenges with oncology provider communication and quality of care. The Together-Equitable-Accessible-Meaningful (TEAM) training was developed to improve health equity across cancer care organizations by guiding teams of interprofessional learners through planning and implementation of quality improvements to advance equitable, accessible, and patient-centered cancer care. This study compared changes to self-reported cultural competence as measured by the Cultural Competency Assessment (CCA); Lesbian, Gay, Bisexual, and Transgender Development of Clinical Skills Scale (LGBT-DOCSS); and Interprofessional Socialization and Valuing Scale (ISVS). The primary aim of the study was to assess changes to self-reported cultural competence; the secondary aim was to examine changes to interprofessional valuation from baseline to post-intervention. Results indicated statistically significant improvements in self-reported Cultural Competency Behaviors (p = .055), a subscale of the CCA, and Attitudinal Awareness toward sexual and gender minorities (p = .046), a subscale of the LGBT-DOCSS, using p \u3c .10 as statistically significant. These subscale results drove statistically significant improvements for their respective composite scales. No other statistically significant results were found. This study suggests that cultural competency training among interprofessional oncology health care professionals can be effective. Given the growing diversity within the USA, additional opportunities for cultural competency training are needed

Oncology Patient Navigation Training: Results of a Pilot Study in Nigeria

The purpose of this pilot study was to test the efficacy of an online navigation training designed to improve trainee confidence in performing core patient navigation tasks among Nigerian nurses, patient advocates, and cancer survivors. The online training originally designed for US patient navigators was supplemented by a Nigerian health system interactive session. Nurses, advocates, and cancer survivors (n = 36) were recruited to take a patient navigation training from May-June 2020 that consisted of approximately 10 h of online content and a 2-h online session. Trainees enrolled in the no-cost training and completed all 20 lessons. Post-intervention interviews (n = 10) were conducted to garner feedback from trainees. Trainees reported statistically significant improvements in confidence in performing core competencies for cancer patient navigation across all lessons. Feedback was generally positive with trainees expressing satisfaction and appreciation for the training. Challenges included lack of free, broadband Internet access leading to data streaming costs on the part of trainees. Trainees who were oncology nurses indicated that funding, time, and staffing constraints could impede implementation of patient navigation in practice; but these trainees also expressed new ideas for patient support and advocacy to alleviate some barriers to care for their patients as a result of the training. This study provided preliminary data that supports the feasibility and utility of using the GW Cancer Center online patient navigation training in non-US settings. Small adaptations to training content and technological delivery could improve access to the training experience. Implementation science approaches are needed to inform sustainable patient navigation in low-resource settings

Building implementation science capacity among practitioners of cancer control: development of a pilot training curriculum

PURPOSE: Cancer control interventions are difficult to implement with fidelity, while tailoring to fit contexts. Engaged approaches are suggested to advance equity. On-the-ground practitioners are needed to serve as collaborators in the implementation process with research teams, but few trainings are designed with them in mind. METHODS: The Cancer Control Implementation Science Base Camp (CCISBC) was created to improve capacity among cancer control practitioners when implementing evidence-based cancer screening programs in specific contexts. Development of the curriculum included the following: (1) performing a literature review assessing extant curricula, (2) comparing competencies of these curricula, (3) user-centered design, (4) producing learning materials, (5) recruiting two teams to test a pilot, (6) running the pilot, and (7) evaluating results. RESULTS: Nine competencies overlapped between four of the curricula scanned in this study, all of which served as the basis for learning objectives. Principles that emerged from design sessions included staying clear about terminology, supporting the brokerage of knowledge, reframing theories, models, and frameworks as tools, and including equity in everything. Pilot testing showed that the average learner increased 74.5% in knowledge and 75% in confidence regarding implementing evidence-based cancer screening. Evidence suggests that the training increased the skill of implementing evidence-based interventions (EBIs) with a health equity lens. CONCLUSION: In order to scale practice-based evidence, practitioners will need to be engaged. This engagement is optimized when practitioners are trained to collaborate on implementation research. The CCISBC is a feasible program to develop capacity among practitioners in comprehensive cancer control in order to optimize EBIs tailored to context