LGBT Best and Promising Practices Throughout the Cancer Continuum

Explore the best and promising practices, understand cross-cutting issues, and filter the strategies throughout the stages of the cancer continuum.

To learn about the people involved, the methodology employed, and, of course, the more than 100 Best and Promising Practices, download the full report.

Prevention/Health Promotion

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Best and Promising Practices Cross-Cutting Issues

Recognize that disclosure of layered and intersectional identities is complicated for LGBT individuals seeking health prevention services. They must negotiate whether and how to come out to multiple providers about being LGBT.

Cross-Cutting Issues
  • Icon for Workforce
  • Icon for Systems
  • Icon for Diversity

Provide ongoing education on LGBT cultural competence to the entire health care work force, especially those that interact with LGBT patients, their family, and their chosen support person(s).

Cross-Cutting Issues
  • Icon for Workforce
  • Icon for Diversity

Develop and implement effective guidelines, interventions, and programs aimed at decreasing the cancer burden for LGBT populations, with intentional and careful adaptation for all segments of the LGBT communities.

Cross-Cutting Issues
  • Icon for Systems
  • Icon for Information
  • Icon for Diversity

Develop and/or implement LGBT-specific health education and prevention messages, materials (print and online), and resources, developed in consultation with community advisory boards and other consumer groups.

Cross-Cutting Issues
  • Icon for Information
  • Icon for Diversity
Public Health Department Recommendation:

Collaborate with community partners on LGBT-tailored prevention and health promotion activities.

Cross-Cutting Issues
  • Icon for Workforce
  • Icon for Diversity
Public Health Department Recommendation:

Include LGBT communities in state cancer plans.

Cross-Cutting Issues
  • Icon for Systems
  • Icon for Information
  • Icon for Diversity
Public Health Department Recommendation:

Include LGBT community-based organizations in state cancer coalitions.

Cross-Cutting Issues
  • Icon for Systems
  • Icon for Diversity

Screening

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Best and Promising Practices Cross-Cutting Issues

Develop and/or use LGBT-tailored cancer screening guidelines for LGBT communities.

Cross-Cutting Issues
  • Icon for Workforce
  • Icon for Information
  • Icon for Diversity

Engage culturally competent patient navigators for LGBT patients from the time of screening through the cancer care continuum.

Cross-Cutting Issues
  • Icon for Workforce
  • Icon for Information
  • Icon for Diversity

Include LGBT individuals’ support networks (i.e., family of choice) whenever possible during screening process and procedures.

Cross-Cutting Issues
  • Icon for Systems
  • Icon for Diversity

Tailor screening messages and utilize effective media with particular attention to diverse sub-groups within LGBT communities.

  • For example, involve screening messengers, ambassadors, and witnesses known as credible in their respective communities
Cross-Cutting Issues
  • Icon for Information
  • Icon for Diversity

Educate the LGBT communities about the importance of cancer screening, with emphasis on malignancies that disproportionately affect LGBT individuals, using a variety of media and campaigns shown to be effective or promising with LGBT communities in general and/or with specific sub-groups.

Cross-Cutting Issues
  • Icon for Information
  • Icon for Diversity
Public Health Department Recommendation:

Support culturally competent delivery of services that increase access to and utilization of cancer screening.

Cross-Cutting Issues
  • Icon for Systems
  • Icon for Diversity
Public Health Department Recommendation:

Support recruitment and utilization of patient navigators that are culturally competent and sensitive to the disparities and needs of the LGBT population.

Cross-Cutting Issues
  • Icon for Systems
  • Icon for Diversity

Diagnosis

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Best and Promising Practices Cross-Cutting Issues

Train all staff who interact with patients/caregivers (including clerical, technicians, patient navigator, pharmacy, housekeeping, food service, etc.) in LGBT cultural competence.

Cross-Cutting Issues
  • Icon for Workforce
  • Icon for Diversity

Eliminate discriminatory and arbitrary exclusion from diagnostic testing, (e.g., due to discordance between gender markers and anatomy).

Cross-Cutting Issues
  • Icon for Systems
  • Icon for Information
  • Icon for Diversity

Anticipate, identify, and eliminate barriers to diagnostic procedures for LGBT individuals and communities.

Cross-Cutting Issues
  • Icon for Systems
  • Icon for Diversity

Include patients’ support networks (i.e., family of choice) during diagnosis and decision making.

Cross-Cutting Issues
  • Icon for Systems
  • Icon for Diversity

Treatment

 info
Best and Promising Practices Cross-Cutting Issues

Include LGBT topics in all cultural competence training across the health care treatment workforce (including clerical, technicians, patient navigator, pharmacy, housekeeping, food service, etc.).

Cross-Cutting Issues
  • Icon for Workforce
  • Icon for Diversity
Public Health Department Recommendation:

Create and/or expand culturally competent LGBT provider listings/registries.

Cross-Cutting Issues
  • Icon for Systems
  • Icon for Information
  • Icon for Diversity

Survivorship

 info
Best and Promising Practices Cross-Cutting Issues

Train all staff who interact with LGBT patients/caregivers (including clerical, technicians, patient navigator, social work, pharmacy, housekeeping, food service, etc.) in culturally competent language and LGBT survivorship issues.

Cross-Cutting Issues
  • Icon for Workforce
  • Icon for Diversity

Provide cultural and age appropriate cancer services to LGBT youth survivors.

Cross-Cutting Issues
  • Icon for Workforce
  • Icon for Diversity

Recognize the complexity of disclosure for LGBT survivors who must negotiate whether and how to come out to multiple providers about being SOGI and to potential sexual partners about their cancer status. Respect that sometimes withholding is safer.

Cross-Cutting Issues
  • Icon for Workforce
  • Icon for Diversity

Palliative Care & End Of Life

 info
Best and Promising Practices Cross-Cutting Issues

Conduct research on the end-of-life/chronic illness experiences of LGBT patients and their caregivers, including the development of LGBT-specific psychosocial, spirituality, and existential distress measures.

Cross-Cutting Issues
  • Icon for Data
  • Icon for Diversity

Address the complex spiritual needs of LGBT patients and families of choice with awareness of the fear and distrust of faith-based communities experienced by many LGBT communities. This includes respecting the choice of not wanting spiritual/pastoral care.

Cross-Cutting Issues
  • Icon for Workforce
  • Icon for Diversity

At the end-of-life, dignified death is a priority for LGBT patients. Unique topics such as continuation of hormone therapy for transgender patients as well as respect for patient choice of burial and death rituals need to be addressed.

Cross-Cutting Issues
  • Icon for Systems
  • Icon for Information
  • Icon for Diversity

Include psychosocial distress, suicide risk, financial planning, relationship with family of origin, and current families of choice when performing screening and intake of LGBT cancer patients.

Cross-Cutting Issues
  • Icon for Systems
  • Icon for Diversity

Discuss and formalize surrogate decision-making during initial patient encounter, including medical proxy documentation, formalization of custody of dependent children, and hospital visitation forms. Recognize that it is a patient’s legal right to include family of choice. These discussions must reflect rapidly changing laws, regulations, and accrediting standards at the national, state, and institutional levels. Advance directives and Physician Orders for Life Sustaining Treatment (POLST) should follow patients across multiple care settings.

Cross-Cutting Issues
  • Icon for Systems
  • Icon for Diversity
Public Health Department Recommendation:

Support training for palliative care and hospice providers on LGBT cultural competence.

Cross-Cutting Issues
  • Icon for Workforce
  • Icon for Diversity
Public Health Department Recommendation:

Support LGBT-tailored interventions and health promotion.

Cross-Cutting Issues
  • Icon for Information
  • Icon for Diversity

Prevention/Health Promotion

 info
Best and Promising Practices Cross-Cutting Issues

Recognize that disclosure of layered and intersectional identities is complicated for LGBT individuals seeking health prevention services. They must negotiate whether and how to come out to multiple providers about being LGBT.

Cross-Cutting Issues
  • Icon for Workforce
  • Icon for Systems
  • Icon for Diversity

Provide ongoing education on LGBT cultural competence to the entire health care work force, especially those that interact with LGBT patients, their family, and their chosen support person(s).

Cross-Cutting Issues
  • Icon for Workforce
  • Icon for Diversity

Develop and implement effective guidelines, interventions, and programs aimed at decreasing the cancer burden for LGBT populations, with intentional and careful adaptation for all segments of the LGBT communities.

Cross-Cutting Issues
  • Icon for Systems
  • Icon for Information
  • Icon for Diversity

Develop and/or implement LGBT-specific health education and prevention messages, materials (print and online), and resources, developed in consultation with community advisory boards and other consumer groups.

Cross-Cutting Issues
  • Icon for Information
  • Icon for Diversity
Public Health Department Recommendation:

Collaborate with community partners on LGBT-tailored prevention and health promotion activities.

Cross-Cutting Issues
  • Icon for Workforce
  • Icon for Diversity
Public Health Department Recommendation:

Include LGBT communities in state cancer plans.

Cross-Cutting Issues
  • Icon for Systems
  • Icon for Information
  • Icon for Diversity
Public Health Department Recommendation:

Include LGBT community-based organizations in state cancer coalitions.

Cross-Cutting Issues
  • Icon for Systems
  • Icon for Diversity

Screening

 info
Best and Promising Practices Cross-Cutting Issues

Develop and/or use LGBT-tailored cancer screening guidelines for LGBT communities.

Cross-Cutting Issues
  • Icon for Workforce
  • Icon for Information
  • Icon for Diversity

Engage culturally competent patient navigators for LGBT patients from the time of screening through the cancer care continuum.

Cross-Cutting Issues
  • Icon for Workforce
  • Icon for Information
  • Icon for Diversity

Include LGBT individuals’ support networks (i.e., family of choice) whenever possible during screening process and procedures.

Cross-Cutting Issues
  • Icon for Systems
  • Icon for Diversity

Tailor screening messages and utilize effective media with particular attention to diverse sub-groups within LGBT communities.

  • For example, involve screening messengers, ambassadors, and witnesses known as credible in their respective communities
Cross-Cutting Issues
  • Icon for Information
  • Icon for Diversity

Educate the LGBT communities about the importance of cancer screening, with emphasis on malignancies that disproportionately affect LGBT individuals, using a variety of media and campaigns shown to be effective or promising with LGBT communities in general and/or with specific sub-groups.

Cross-Cutting Issues
  • Icon for Information
  • Icon for Diversity
Public Health Department Recommendation:

Support culturally competent delivery of services that increase access to and utilization of cancer screening.

Cross-Cutting Issues
  • Icon for Systems
  • Icon for Diversity
Public Health Department Recommendation:

Support recruitment and utilization of patient navigators that are culturally competent and sensitive to the disparities and needs of the LGBT population.

Cross-Cutting Issues
  • Icon for Systems
  • Icon for Diversity

Diagnosis

 info
Best and Promising Practices Cross-Cutting Issues

Train all staff who interact with patients/caregivers (including clerical, technicians, patient navigator, pharmacy, housekeeping, food service, etc.) in LGBT cultural competence.

Cross-Cutting Issues
  • Icon for Workforce
  • Icon for Diversity

Eliminate discriminatory and arbitrary exclusion from diagnostic testing, (e.g., due to discordance between gender markers and anatomy).

Cross-Cutting Issues
  • Icon for Systems
  • Icon for Information
  • Icon for Diversity

Anticipate, identify, and eliminate barriers to diagnostic procedures for LGBT individuals and communities.

Cross-Cutting Issues
  • Icon for Systems
  • Icon for Diversity

Include patients’ support networks (i.e., family of choice) during diagnosis and decision making.

Cross-Cutting Issues
  • Icon for Systems
  • Icon for Diversity

Treatment

 info
Best and Promising Practices Cross-Cutting Issues

Include LGBT topics in all cultural competence training across the health care treatment workforce (including clerical, technicians, patient navigator, pharmacy, housekeeping, food service, etc.).

Cross-Cutting Issues
  • Icon for Workforce
  • Icon for Diversity
Public Health Department Recommendation:

Create and/or expand culturally competent LGBT provider listings/registries.

Cross-Cutting Issues
  • Icon for Systems
  • Icon for Information
  • Icon for Diversity

Survivorship

 info
Best and Promising Practices Cross-Cutting Issues

Train all staff who interact with LGBT patients/caregivers (including clerical, technicians, patient navigator, social work, pharmacy, housekeeping, food service, etc.) in culturally competent language and LGBT survivorship issues.

Cross-Cutting Issues
  • Icon for Workforce
  • Icon for Diversity

Provide cultural and age appropriate cancer services to LGBT youth survivors.

Cross-Cutting Issues
  • Icon for Workforce
  • Icon for Diversity

Recognize the complexity of disclosure for LGBT survivors who must negotiate whether and how to come out to multiple providers about being SOGI and to potential sexual partners about their cancer status. Respect that sometimes withholding is safer.

Cross-Cutting Issues
  • Icon for Workforce
  • Icon for Diversity

Palliative Care & End Of Life

 info
Best and Promising Practices Cross-Cutting Issues

Conduct research on the end-of-life/chronic illness experiences of LGBT patients and their caregivers, including the development of LGBT-specific psychosocial, spirituality, and existential distress measures.

Cross-Cutting Issues
  • Icon for Data
  • Icon for Diversity

Address the complex spiritual needs of LGBT patients and families of choice with awareness of the fear and distrust of faith-based communities experienced by many LGBT communities. This includes respecting the choice of not wanting spiritual/pastoral care.

Cross-Cutting Issues
  • Icon for Workforce
  • Icon for Diversity

At the end-of-life, dignified death is a priority for LGBT patients. Unique topics such as continuation of hormone therapy for transgender patients as well as respect for patient choice of burial and death rituals need to be addressed.

Cross-Cutting Issues
  • Icon for Systems
  • Icon for Information
  • Icon for Diversity

Include psychosocial distress, suicide risk, financial planning, relationship with family of origin, and current families of choice when performing screening and intake of LGBT cancer patients.

Cross-Cutting Issues
  • Icon for Systems
  • Icon for Diversity

Discuss and formalize surrogate decision-making during initial patient encounter, including medical proxy documentation, formalization of custody of dependent children, and hospital visitation forms. Recognize that it is a patient’s legal right to include family of choice. These discussions must reflect rapidly changing laws, regulations, and accrediting standards at the national, state, and institutional levels. Advance directives and Physician Orders for Life Sustaining Treatment (POLST) should follow patients across multiple care settings.

Cross-Cutting Issues
  • Icon for Systems
  • Icon for Diversity
Public Health Department Recommendation:

Support training for palliative care and hospice providers on LGBT cultural competence.

Cross-Cutting Issues
  • Icon for Workforce
  • Icon for Diversity
Public Health Department Recommendation:

Support LGBT-tailored interventions and health promotion.

Cross-Cutting Issues
  • Icon for Information
  • Icon for Diversity
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