FEATURE | Posted Dec. 16, 2015

Reducing LGBT cancer health disparities

Nurse helps bridge gaps between patients and providers

Image of cancer nurse Megan Ober © UC Regents
Oncology nurse and LGBT advocate Megan Ober consults with a colleague at UC Davis Comprehensive Cancer Center.

Lesbian, gay, bisexual, transgender, queer or questioning and intersex (LGBTQI) patients are not getting the best health care available because they don’t trust the medical community.

Megan Ober, a UC Davis Comprehensive Cancer Center nurse, has made it her mission to bridge the gap between this group and health-care providers.

“Many of these patients feel judged or not understood, and are reluctant to disclose sexual orientation or gender identity for fear of being treated badly or even turned away from care,” she says. “When patients fail to disclose their sexual identity and related concerns, clinicians may miss opportunities to talk about unique risks and ways to prevent disease.”

The distrust also can hamper the ability of clinicians to provide the most appropriate and well-informed health screenings and care, Ober adds. The problem is exacerbated when clinicians simply don’t know how to care for LGBT patients or don’t feel it’s important.

As a member of the LGBT community, Ober understands the barriers for patients.

“My doctors always assumed I was heterosexual,” she says. “From the start, I was questioned about sexual activity and birth control in heterosexual terms.”

Ober grew uncomfortable discussing her health, developing what she calls a “feeling of exclusion,” which became more pronounced as she pursued a nursing career.

“During my training, there was no discussion about diversity beyond religious and ethnic differences,” she says. The “heterosexual assumption” by co-workers and management remained, creating a lot of anxiety.

Ensuring diversity in health care

Today, Ober’s experiences fuel her passion to ensure LGBT patients at UC Davis have access to the same top-quality cancer care as anyone else, and she’s on a mission to make sure the medical community is discussing all types of diversity.

“My job as a nurse is to take care of patients, and there are many different ways I can do this,” she says. “One is to advocate on behalf of my patients and speak up for them when they may not feel comfortable speaking up for themselves.”
— Megan Ober

“My job as a nurse is to take care of patients, and there are many different ways I can do this,” she says. “One is to advocate on behalf of my patients and speak up for them when they may not feel comfortable speaking up for themselves.”

To help staff at the UC Davis Comprehensive Cancer Center better understand and serve the specific needs and concerns of LGBT patients diagnosed with cancer, Ober created a presentation about cancer health disparities and the disproportionate cancer burden in the LGBT community.

At a recent staff meeting she shared LGBT findings from the LGBTQI Task Force’s regional and state-wide surveys of the community and outlined a unique cluster of risk factors that lead to greater cancer incidence and later-stage diagnosis in the community. These include poor cancer screening rates, lack of cancer knowledge, higher incidence of breast cancer among lesbians and lack of high-quality, patient-centered care.

Ober also talked about barriers to optimal cancer health care, which, in addition to distrust, include a lack of provider knowledge about LGBT issues and culturally appropriate cancer prevention and screening information.

Ober also highlighted some of UC Davis Health System’s efforts to improve health care for the LGBT community, such as establishing a transgender policy, creating the Vice Chancellor’s LGBTQI Advisory Council, participating in Sacramento Pride Parade and hosting the Improving OUTcomes annual conference. She also offered suggestions on what cancer center staff could do individually to improve care for this group.

“Megan’s presentation was very eye-opening,” said Heidi Wieser, assistant nurse manager in the Adult Infusion Center. "She has a deep understanding of the topic and is very knowledgeable about how we as nurses can better educate and support the LGBTQI population."

For more information

About the UC Davis Comprehensive Cancer Center or to join the LGBTQI Cancer Clinic Planning Board, please contact Megan Ober at mnober@ucdavis.edu.

Building trust is key

The UC Davis LGBTQI Cancer Health Disparities Task Force was created in 2011 by the director of the cancer center’s Outreach, Research and Education Program, Marlene M. von Friederichs-Fitzwater. The task force is committed to identifying the determinants of cancer health disparities among the population and developing interventions to reduce those disparities. The task force is working to develop more programs to reduce disparities in smoking, alcohol use, mental health and healthy weight, and hopes to establish a clinic at the cancer center to foster community outreach, education and screening for LGBT individuals.

“The idea is to give this group of patients a safe place where their unique health needs are understood,” Ober says. “If we can gain their trust and build relationships, we hope we can increase screening rates and reduce disparities.”

In addition to serving as task force chair, Ober is helping plan the Improving OUTcomes Conference and has been a member of PRIDE for more than three years.

“Being a nurse is a gift,” she says, grateful for the opportunity to close the gaps she’s observed. “Who better to do that than someone from within both the LGBTQI and medical communities?”

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