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Massey researcher examines how to reduce cancer disparities and improve quality of care for the LGBTQ+ population

Jun 22, 2021

Richard Brown PH.D.

To commemorate Pride Month 2021, the Biden administration issued a proclamation that celebrates the accomplishments of the LGBTQ+ community but also acknowledges the ongoing struggle to secure equity for this population in many areas impacted by government policy, including health care.

In line with this effort, the National Institute of Health (NIH) Sexual and Gender Minority Research Office’s 2021- 2025 Strategic Plan notes that discrimination and stigma are factors behind health care disparities experienced by LGBTQ+ individuals.

Richard Brown, Ph.D., a member of the Cancer Prevention and Control research program at VCU Massey Cancer Center and the co-director of Massey’s Health Communication and Digital Innovation Shared Resource, hopes to help rectify these issues through several proposed research projects focused on reducing cancer disparities among sexual and gender minority (SGM) groups.

Brown, who is an associate professor in the Department of Health Behavior and Policy at the VCU School of Medicine and director of the Communication Innovations in Health Care Laboratory, has multiple grants pending with the National Cancer Institute (NCI).

Two of the projects under review for funding would evaluate ways to improve sexual orientation and gender identity (SOGI) data collection as an essential first step for reducing SGM-related health disparities.

“The inadequate collection of SOGI data has been a barrier to providing evidence-based, high-quality care for LGBTQ+ individuals,” said Brown. “Poor data also creates obstacles for conducting research related to SGM groups, especially those diagnosed with or at risk for cancer.”

Electronic health records (EHR) are federally mandated to provide the technical capacity to record, modify and access SOGI data. Many institutions are implementing these data fields as part of their EHRs, but with mostly low levels of completion.

“The lack of data leaves researchers and clinicians unable to draw broad conclusions about SGM populations’ cancer experiences – from prevention through survivorship,” said Brown.

For his first project, submitted for an NCI Supplement to Massey Cancer Center’s Cancer Center Support Grant, Brown hopes to assess the language used to collect SOGI data, as well as the completeness and quality of the data collected in hopes of building cross-institutional SGM research through shared knowledge and acquisition.

Through his second project, submitted for a UO1 grant, Brown would address the lack of strategies available to improve or establish routine SOGI data collection from SGM cancer patients.

“The field has been largely stagnant in addressing this issue,” said Brown. “While the number of federally funded databases including SOGI data has increased, the impetus at health care institutions not controlled by the federal government have been slow to respond to the multiple clarion calls since 2011 for improvement in SGM health care, including for cancer.”

Brown aims to develop an intervention by building tools and procedures to activate and monitor SOGI data collection. At an individual level, he hopes to combat reluctance and discomfort related to SOGI data collection and increase awareness of the importance of SOGI data as part of a larger institutional commitment to quality clinical care for all patients.

The study will test the intervention at cancer centers that reflect diversity, including general hospitals affiliated with cancer centers. His goal is to achieve successful implementation of systematic and routine collection of SOGI data at nine institutions by the end of the award.

A third project on Brown’s radar, pending approval of an R21 grant, seeks to better understand barriers to identifying disclosure for SGM breast cancer patients facing surgical treatment decisions and the reluctance of oncologists to inquire about their patients’ SGM identities or engage in decision-making that values these identities.

“Optimal physician-patient communication is a potential pathway to improve health disparities,” said Brown. “Yet, there are gaps in our knowledge about the potential for disparities in surgical treatment decision-making based on poor communication.”

Previous research has focused on post-surgical options such as breast reconstruction. Little is known about pre-surgical decision-making in these patients. Patient-physician interactions have also not been studied, creating a lack of evidence-based specificity about the role of communication in exacerbating disparities.

It is also unclear how specific aspects of communication foster or impede disclosure of sexual or gender identity in health care settings and how intersectionality of multiple minority statuses may impact the decision-making for SGM breast cancer patients.

“SGM individuals often are unwilling to routinely disclose their SOGI in health care settings through fear of discrimination leading to suboptimal care,” said Brown. “These fears are compounded for SGM cancer patients who identify with multiple stigmatized groups.”

Through his work, Brown hopes to gain further knowledge of the experiences of SGM individuals in the health care setting with goals of achieving equity, reducing stigma and discrimination and ameliorating cancer care disparities.

Brown will collaborate on these projects with local clinicians, academics, stakeholders and national LGBTQ+ representatives, including researchers from Memorial Sloan Kettering Cancer Center, MD Anderson Cancer Center, Moffitt Cancer Center and NYU Langone's Perlmutter Cancer Center.

Written by: Melissa Mitchell

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