Trust and communication among sexual and gender minority (SGM) cancer survivors.

Abstract

1611 Background: Trust and effective communication in healthcare are essential for delivering high-quality cancer care, especially for marginalized groups like SGM patients. This study examines the differences in trust and communication among LGBTQIA cancer survivors and those without (w/o) a cancer history to inform strategies for improving cancer care equity. Methods: Data from the nationally representative Health Information National Trends Survey (HINTS) from 2018-2022 was used to evaluate questions on communication, quality of care, and trust in those who self-identified as homosexual, gay, or lesbian, bisexual, or “something else” for sexual orientation. Two cohorts compared SGM participants with prior cancer diagnosis (survivors) and those w/o cancer. Demographic data included: age, gender, race/ethnicity, education, employment, and household income. Analysis was done in STATA with Chi-squared and T-tests testing between SGM survivors and those w/o cancer and multivariate analysis (MVA) focused on SGM survivors. Results: In total, 1,258 SGM participants were included, of which 144 (11.4%) were SGM cancer survivors. SGM survivors were older than those w/o cancer history (median 64 vs. 46, p < 0.001) but had no significant differences in employment (25.0% vs. 47.2%) or race (White: 79.9% vs 69.5%; Black 21.9% vs 19.6%) (p = NS). Less than half of SGM survivors (44.9%) reported they always or usually had the chance to ask all of their health-related questions during provider visits, this was better than SGM w/o cancer (36.8%, p = 0.03). About a third reported that providers always/usually gave adequate attention to their emotions and feelings (37.2% survivors vs 37.5% w/o cancer, p = NS). Most felt they were always/usually adequately involved in decisions about their health care (82.5% survivors vs 82.0% w/o cancer, p = NS). Only 33.1% SGM survivors rated their overall quality of care as excellent/very good within the past year; this was slightly better than surveyed SGM w/o cancer (24.6%, p = NS). Half of SGM survivors (50.9%) trusted information about cancer from doctors, slightly more than for those w/o cancer (46.2%, p = NS). In a MVA limited to SGM survivors, only education was associated with decreased trust of cancer information from a doctor; those with at least some college (OR = 0.51 95%CI 0.26-0.99, p = 0.048) or postgraduate education (OR = 0.36 95%CI 0.14-0.92, p = 0.034) had less trust compared to those with a high school degree or less. Conclusions: This national study shows that patient-reported overall healthcare to SGM survivors is poor. Less than a third of SGM survivors reported good quality of care and less than half felt providers answered all their questions; only half trusted cancer information from a doctor. Concerningly, those with higher education levels were less likely to trust doctors. Future efforts should focus on ensuring that all patients benefit from high quality cancer care and communication.