Matthew Schabath, PhD, on Oncology-Specific LGBTQ+ Cultural Sensitivity Training Through COLOR

Matthew Schabath, PhD

Associate member in the Departments of Cancer Epidemiology and Thoracic Oncology

Moffitt Cancer Center

Tampa, Florida

At the 2022 American Society of Clinical Oncology (ASCO) Annual Meeting, Matthew Schabath, PhD, associate member in the Departments of Cancer Epidemiology and Thoracic Oncology at Moffitt Cancer Center in Tampa, Florida, spoke with CancerNetwork^® about the COLOR training, a web-based competency training regarding LGBTQ+ (lesbian, gay, bisexual, transgender, queer or questioning, and others) cultural sensitivity for oncologists.

COLOR, which stands for Curriculum for Oncologists on LGBTQ+ Population to Optimize Relevance and Skills, was developed in tandem with partners in the community, oncologists, and scientific experts to maximize the impact of training through a series of vignettes. The trainings consist of 4, 30-minute modules that oncologists can complete at their own pace.

A Modern Homonegativity Scale was used to measure negative attitudes towards LGBTQ+ individuals, with higher scores correlating to negative attitudes. Prior to training, those taking the COLORS survey had a median score of 24 compared with 22.5 after trainings vs 22.5 and 22, respectively, in the control group. The Gay Affirmative Practice Scale was used to measure providers behaviors and beliefs regarding LGBTQ+ individuals, with a higher score showing greater endorsement of affirmative practices. Pre- and post-training score for the COLORS group were 61 vs 65.5, respectively, compared with 65 vs 67 in the comparator training.

Throughout the interview, Schabath discussed COLORS training, what oncologists can expect from it, and the biggest takeaway from his presentation.

CancerNetwork^®: Can you give a broad overview of your presentation?

Schabath: [I presented] results from a pragmatic randomized trial of this COLORS training that we developed at the Moffitt Cancer Center in collaboration with the University of Miami and the University of Florida. We conducted a randomized trial among oncologists throughout the United States to compare our training vs standard general health care and LGBTQ+ cultural competency training.

What does the COLORS training entail?

The COLORS training is oncology specific. It covers important areas regarding cultural humility and cultural sensitivity training for the care of LGBTQ patients. We get into what I call LGBT 101, about understanding the definitions, the nomenclature, and the disparities that face this population. We get into what their clinic looks like. Is it a warm and inclusive environment? It gets into issues regarding care and survivorship. What’s important about this is that the stakeholders that were involved in the development of this training included members from the LGBTQ+ community, advocacy groups, cancer survivors, LGBTQ+ patients, and oncologists; it was a very iterative process. Through this open process, we developed this training to make sure that it covered the correct content, but did it in a way that wasn’t simply a generic reading of PowerPoint slides or information. It’s interactive. We have this real life, “choose your own adventures” [scenario detailing] an interaction between an LGBTQ+ patient with cancer and an oncologist. These choose your own adventures allow you to go through this pathway of discussions and interactions with a patient. What’s important is that you can go back and choose the other pathway. No pathway is completely right. No pathway is completely wrong. It just shows you the different directions that you can take for having these conversations or discussions about care with an LGBTQ+ patient with cancer.

How effective was this training compared with the standard training?

We used standardized validated measures to assess attitudes, knowledge, and affirming practice behaviors. The reality is both trainings were highly effective. Both showed that there are improvements in knowledge, attitudes, and affirming practice behaviors. We want to emphasize that COLORS is contemporary, it’s oncology specific, and it’s interactive. We also saw a high completion rate with COLORS because there were technological barriers with our comparative training; ours is contemporary because it’s mobile. You can do this on your mobile device, you can do it on the web, on an iPad, or on your computer. We saw a lot of anecdotal evidence that it was an easier platform to use, but most importantly, it’s oncology specific. We didn’t have measures regarding oncology care. It was about general LGBTQ+ attitudes, knowledge, and affirming practice. The important point is that they’re both effective trainings.

Does Moffitt Cancer Center currently have any initiatives underway for LGBTQ+ patients?

At Moffitt, we’re very proud that we are one of the first cancer centers in the country, if not the world, who started collecting sexual orientation and gender identity information as a standard-of-care demographic. What does that mean? It means every patient that comes to Moffitt fills out an electronic patient questionnaire before they [physically] come to Moffitt. If they don’t complete this electronic patient questionnaire [beforehand], that we sit them down at a kiosk or give them an iPad and they can complete this. We included sexual orientation and gender identity in the demographics. We normalize the collection of this information, and what this does is allow us to identify in a real-world setting our SGM, sexual gender minority, patients so our clinicians can use this information to provide personalized care. From a research perspective, we can now look at real world cancer disparities among this population. In fact, we’ve been doing this since 2016. My team has been actively analyzing such data and we’ve been finding, unfortunately, huge real-world disparities. The upside is the fact that we can identify these and we can start intervening and close those gaps, much like we’ve done for decades with racial and ethnic minorities. We still have more work to do among racial and ethnic minorities, but we’re closing the gap. Now we can do the same thing with our sexual gender minority patients. However, it doesn’t start or stop at Moffitt, this is a call for every cancer institute, every university, and every health care clinic to start collecting this information. We need to normalize it so we can understand the needs and disparities that are facing this population and provide culturally sensitive and personalized precision medicine for these patients.

How can other cancer institutions begin to create a better environment for this patient population?

There are many things providers can do and they’re simple. First, collecting sexual orientation and gender identity as a standard care and having this embedded into EMR [electronic medical records] to allow clinicians to have frank conversations about what may face these populations [is a good start]. Secondly, simple things like wearing a pride lapel pin, being part of the Health Equality Index, being listed in the LGBTQ+ friendly providers, or having pride flags in your clinic [is also helpful]. It’s not huge things. These are minor things that we can all do daily in our clinics and they are inexpensive. We could do this immediately, and simple things like lapel pins with pronouns or pride flags are cues that the LGBTQ+ population sees. It allows them to know that they’re in a welcoming environment. These are all subtle cues that the population has been looking for and wants. When they see this, they know they’re in a safe and welcoming environment. They’re going to be more willing to disclose who they are and the concerns and problems they have, which allows the oncologist to then have discussions to provide personalized precision care for this population.

What should your colleague’s takeaway from this presentation?

Ask questions in an open and sensitive way. Be respectful, [foster] inclusive environments. Understand the needs of this population and dig into the literature on health disparities of the LGBTQ+ population. I started looking at this 10 years ago, and [there was lack] of information. Thankfully, the research community and the clinical community has realized that there is a potential epidemic brewing among this population. By conservative estimates, there are 1.5 million cancer survivors who are LGBTQ+ in the United States. We need to do something to intervene. We need to collect those data. We need to provide the welcoming, warm, and inclusive environments in safe spaces, get educated on these needs, and get trained. COLORS is not the only training out there, there are many other trainings. We would love for you to take COLORS, but look at all the options and get trained to find out what you can do to make a warm, welcoming environment to close the gap in disparities [by learning] how to collect sexual orientation and gender identity data and provide culturally sensitive precision care for this population.

Reference

Scabath MB, Perez-Morales J, Hernandez JP, et al. Development and assessment of the effectiveness of an LGBT cultural sensitivity training for oncologists: The COLORS training. J Clin Oncol. 2022;40(suppl 16):11000. doi:10.1200/JCO.2022.40.16_suppl.11000