Step 9: Strategies for increasing participation in cancer screening among the LGBTIQ+ community

steps This section covers the following steps:

Step 9.1 Audit barriers to cancer screening for LGBTIQ+ patients in your health service
Step 9.2 Implement your improvement ideas
Step 9.3 Use resources and programs designed for the LGBTIQ+ community
Audit table Audit barriers to cancer screening for LGBTIQ+ patients in your health service
The LGBTIQ+ community

The LGBTIQ+ community

The letters LGBTI refer collectively to lesbian, gay, bisexual, trans, and intersex people. It is important to recognise that the letters in LGBTI represent broad categories of experience and not necessarily identities; thus, many people who would be considered trans identify simply as women, men, or another gender and do not necessarily have a ‘trans identity’. Although these groups are distinct, they can overlap (e.g. some intersex women are also lesbians).

Q stands for ‘queer’ – A feature of this term is that it is used in a wide variety of highly personal ways. When a person uses this term to describe themselves or others, it is often helpful to speak with them about what ‘queer’ means for them. Queer is not an umbrella term that can be applied to all people who are represented by the ‘LGBTI’ acronym.

- Extract from ‘QLife Guides Glossary’[70]

The information below provides a range of suggestions on actions that can be taken to support increased participation in cancer screening by the LGBTIQ+ community.

These strategies should be used in addition to strategies described in:

  • Step 2: Use good practice strategies for increased participation in cancer screening
  • Step 3: Address health literacy as a barrier to screening.

Use the Action plan template to implement the actions your team decides to undertake.

Cancer screening among LGBTIQ+ communities

  • People in LGBTIQ+ communities may have lower breast screening rates.10
  • Due to the unique ‘clustering’ of risk factors that people in LGBTIQ+ communities experience, they may be at higher risk of breast cancer.10
  • LGBTIQ+ people are less likely than the general population to attend cervical screening.2

'Out United Front'

Visit ‘Our United Front’ to learn more about:

  • the unique cluster of risk factors that put people from the LGQTIQ+ community at increased risk of breast cancer
  • the structural and social barriers to cancer screening for members of the LGBTIQ+ community.

Our United Front is produced by ACON in partnership with the NSW Government and the Cancer Institute NSW.

Step 9.1 Audit barriers to cancer screening for LGBTIQ+ patients in your health service

The audit table below will support your practice to identify:

  • barriers to cancer screening for LGBTIQ+ patients that exist within your practice
  • improvement ideas that will support your practice to enable LGBTIQ+ patients to participate in cancer screening.

Download Audit table

Audit table

Barriers/enablers

Reflection question/processes

Improvement ideas/follow-up actions Note: Use the Action plan template to implement your ideas

Poor understanding of, or lack of confidence about, terminology and health issues relating to the LGBQTI+ community impedes open discussion between health professionals and LGBTIQ+ patients

  • Has your clinical team reflected on their own cultural biases and assumptions that may affect the care they provide to LGBTIQ+ patients?
     
  • Is your practice team confident using terminology relevant to the LGBTIQ+ community? QLife provides a range of ‘QGuides’ for health professionals. QGuides describe and discuss a range of common (often complex) topics to help people feel confident to work with all people on LGBTIQ+ matters. This includes a ‘glossary’ resource to explain different terms.
     
  • Is your practice team aware of breast cancer screening eligibility for transgender and intersex patients? Contact BreastScreen NSW for more information.
     
  • Is your practice team familiar with the health inequalities and health issues faced by the LGBTIQ+ community? RACGP’s ‘Curriculum for Australian General Practice’ contextual unit on ‘Sex, sexuality, gender diversity and health’ provides evidence-based information about health equity and health issues faced by LGBTIQ+ patients.
     
  • Has your practice team undertaken cultural-sensitivity training relating to the LGBTIQ+ community?15 ACON offers ‘Pride in Health + Wellbeing’, which a national membership program that provides year-round support in the provision of LGBTIQ+ inclusive services for those working within the health and wellbeing sector.

 

Avoid making assumptions

  • Does your clinical team consistently recommend cervical screening to all eligible patients regardless of their sexual practice, history or orientation?
     
  • Does your practice team avoid communicating in a manner that is based on assumptions? (See ‘communicate effectively’ below for more information.)
     
  • Does your team understand common barriers to screening for LGBTIQ+ patients? The Toolkit for engaging under-screened and never-screened people in the National Cervical Screening Program outlines the barriers to cervical screening and engagement strategies for people who identify as lesbian, gay, bisexual, transgender or intersex and have a cervix. Some of these strategies also apply to bowel and breast cancer screening.

 

Communicate effectively

Is your clinical team aware of, and committed to, using good practice strategies when communicating with LGBTIQ+ patients? Strategies include:

  • employing a nonjudgmental and open-minded approach (e.g. don’t assume that everyone is heterosexual)
     
  • don’t assume everyone is cisgender (i.e. not transgender)
     
  • using terminology that encompasses all sexual orientations (e.g. asking about a patient’s partner/significant other instead of their husband)
     
  • acknowledging the patient’s same-sex partner and including them in conversations
     
  • advising lesbian, bisexual and same-sex attracted women, transgender men and non-binary people who have a cervix, that they are at risk of cervical cancer and recommend that screening is appropriate for them
     
  • reflecting patients’ use of language and self-identification. If in doubt, ask what terms they prefer for their:
    • anatomy
    • pronouns
    • name (which may differ from their Medicare registered name)
  • using gender-neutral language on intake forms and giving patients appropriate choices when documenting next of kin, relationship status and sexual orientation. Allow free text fields for people to write in their own answers.

These strategies are extracted from the Toolkit for engaging under-screened and never-screened people in the National Cervical Screening Program.

 

Does your practice actively create a supportive environment for LGBTIQ+ people?

Does your practice:

  • display cancer screening promotional materials that are inclusive of the LGBTIQ+ community (see Step 3 for links)
     
  • see LGBTIQ+ patient feedback on their perceptions of inclusivity and opportunities for improvement
     
  • participate in programs, such as ‘Welcome here’ or ‘Rainbow tick’ (see Step 3 for more information)?

 

Note: The barriers and improvement ideas in the audit table above were guided by the following resources:

Step 9.2 Implement your improvement ideas

Use the Action plan template to:

  • document which of the improvement ideas identified in Step 1 that your team will implement
  • plan the implementation of your ideas
  • track progress and identify follow-up actions.

Step 9.3 Use resources and programs designed for the LGBTIQ+ community