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FORS: Can you discuss other distinctive challenges and stressors, and how professionals can recognize and address them?
DR DAMASKOS: Consider past and present experiences with discrimination or insensitivity and how that can lead to mistrust. Stigma, anxieties about discrimination, expectations of not being supported are all stressors that lesbians may face, and may not be present in the same way for heterosexual women. There has been research that points to high minority stress levels in LGBT populations. Living with this constant stress can cause people to experience more vulnerability in crisis situations such as a cancer diagnosis.
Being aware of stressors and how they are managed in other life circumstances is crucial. It is important to meet patients from a strengths-based perspective. What coping mechanisms have they used in the past? Who are their supports and how reliable are they during a crisis such as cancer? For some lesbians, there could be an increased history of trauma. A cancer diagnosis may resurface that vulnerability unexpectedly within interactions with their medical team.
FORS: How can we be more inclusive in the way we support lesbians with breast cancer, their families, and loved ones?
DR DAMASKOS: Use language that reflects understanding and inclusivity, and understanding of family dynamics. Again, don’t make assumptions. Ask questions that do not assume the gender of someone’s spouse/partner, and don’t put limitations on how patients can identify significant caregivers and partners. It is up to the individual to decide how they identify themselves and who they identify as family. The key is to be accepting and curious in a way that allows practitioners to provide more holistic care that is understanding of the individual within their whole environment. It is up to us to educate ourselves and utilize resources designed for LGBT practitioner education through professional associations for nurses, social workers, and physicians. Professionals can seek information and guidance from many LGBT resources, including the Gay and Lesbian Medical Association and National LGBT Cancer Network.
FORS: I would like to extend my extreme gratitude to Dr Damaskos for her contribution to this dialogue and commitment to increasing awareness on such an important issue.
Recognizing these factors for lesbians with breast cancer is just the beginning. Healthcare professionals must apply this knowledge in their practice and make it a priority to create safe environments, free of stigma, marginalization, and oppression. When our focus shifts to building practices that are inclusive, accepting, and supportive, we create atmospheres that are safe for all patients to receive the care they need and deserve.
Marissa Fors is director, Susan G. Komen® Breast Care Helpline at CancerCare.
References
1. van Dam MA, Koh AS, Dibble SL. Lesbian disclosure to health care providers and delay of care. J Gay Lesbian Med Assoc. 2001;5(1):11-19.
