According to Gallup research, 9.3% of US adults identify as LGBTQIA+. That’s more than 31.6 million people who have very real health needs but may face stigma and other barriers to care. The American College of Cardiology recently presented a webinar to raise awareness about the needs of LGBTQIA+ patients and professionals in cardiovascular care and research.
ACC moderators Dr. Matthew Carazo and Dr. Melvin Echols joined panelists Dr. Stephen Cook of Franciscan Health, Dr. Megan Coylewright of Essentia Health and Dr. Kadijah Porter of the University of Colorado. The panel examined existing barriers, spoke about solutions and emphasized the importance of supporting clinicians and patients so all members of the community get the compassionate care they need. The ACC wants to level the playing field so all patients and clinicians feel welcome and supported in care environments, moderators said.
Data as a starting point for improvement
Cook emphasized the importance of collecting sexual orientation and gender identity data to improve care. He pointed out that low sexual and gender diversity in the cardiology workforce can lead to cardiovascular disparities and negative health outcomes for LGBTQIA+ patients.
Cook has been involved in survey research to assess workplace mistreatment of LGBTQIA+ professionals in cardiology, with results showing that LGBTQIA+ respondents tend to experience higher levels of gender policing and heterosexist harassment than non-LGBTQIA+ respondents. Unwanted behaviors came most often from attending physicians, fellows and residents, but physician leadership, cardiovascular support staff and patients were also significant sources, the data showed. Cook pointed out the negative mental health consequences of such mistreatment, including staff burnout and depression.
Fair treatment in specialty areas
Coylewright spoke about her research in cardiac catheterization care for transgender and gender diverse individuals. Drawing on her own experiences as an LGBTQIA+ cardiologist, Coylewright said gender policing and other types of discrimination make it “very difficult to think about how we can embrace our diverse patients and their needs, if we’re on alert for how we’re being perceived with regard to gender.”
Coylewright said gender policing and other discriminatory behaviors are often an issue in high-pressure environments like the catheterization lab. She noted that there are often “microcultures” that may not be conducive to fair treatment for all, but the situation is improving. Coylewright said she is involved in a working group to foster supportive culture and allow clinicians to care more sensitively for diverse cath lab patients.
Asking for patients’ preferred names and pronouns, making it easy for them to identify as they choose, understanding their hormonal therapy and possible drug interactions, obtaining consent before physical exams and giving advance notice of procedures involving sensitive body areas are some of the solutions Coylewright suggested. Improvements in this area can’t help but elevate the patient experience, she said.
Shifting the research culture
Porter spoke about her work to better understand sex and gender differences in cardiovascular research. She said a “systemic shift” is needed to make SOGI reporting more equitable so researchers can produce data that give a better picture of the population.
Porter offered appropriate questions to ask study participants about their sexual orientation, sex assigned at birth and gender identity so they can be more accurately represented. She noted that some electronic medical record platforms have these questions built in, and intake forms can be designed with “write-in” fields for those who identify differently.
“You have to create a safe space, especially in this day and age and climate, for patients to want to identify,” Porter said. “As physicians, we always have to increase our knowledge. The only way we are going to get rid of stigma is to ensure safety.”
The panelists emphasized the importance of inclusive language, culturally sensitive training, mentoring and further SOGI data collection to counteract discrimination and advance LGBTQIA+ patient care.
“There is no doubt that we need to start working on creating safe environments,” Cook said. “We have to normalize LGBTQ+ identities, and by doing so, we can start decreasing harassment – and increasing the visibility of LGBTQ+ cardiovascular health team members.”
Want to know more?
- The ACC’s CardioSmart initiative provides key facts, advice and resources.
- The American Heart Association’s “Pride with Heart” initiative focuses on LGBTQ+ cardiovascular health, including educational materials and research efforts.
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