"A sweating moment": impact of disclosure in cancer care on LGBTQI patient satisfaction

Purpose: Lesbian, gay, bisexual, trans, queer, and intersex (LGBTQI) people face unique challenges in cancer care. This mixed methods study examined LGBTQI patients' satisfaction with cancer care and factors associated with satisfaction, including experiences of LGBTQI disclosure. The study also explored what helps to facilitate safe disclosure and improve satisfaction with care for this population. Methods: We used a mixed methods approach, involving 430 surveys and 104 semi-structured interviews with LGBTQI people with cancer (16-92 years) with various cancer types, sexuality and gender identities, ages, and people with intersex variations. Results: Most participants reported being satisfied with their cancer care (n = 300, 76.3%) and had disclosed their LGBTQI sexuality or gender identity or intersex variations to at least some of their cancer healthcare professionals (HCPs) (n = 357, 87.1%). Satisfaction with care was higher with more disclosure to HCPs, HCP acknowledgment of partner/s and support people, and the ability to find LGBTQI specific information about cancer; it was lower with reports of discrimination in cancer care. Qualitative analysis identified that some participants were always out to HCPs, but others felt burdened with the responsibility and emotion work of disclosure and feared negative responses. Same-gender intimate partners facilitated disclosure and need to be respected within cancer care. Conclusions: HCPs need to take the lead in facilitating LGBTQI disclosure in cancer care. Targeted interventions and training for HCPs, including reception and administration staff, are crucial to ensure equitable, affirming cancer care for all LGBTQI patients, ultimately leading to improved satisfaction with cancer care. Implications for Cancer Survivors: Creating safe and inclusive environments for LGBTQI cancer patients is essential to encourage disclosure and improve satisfaction with cancer care.