Egalitarian, inclusive, or hostile? Healthcare professional perspectives on LGBTIQ+ people with cancer

This chapter explores how oncology health care professionals (HCPs) understand and position themselves in relation to the care of LGBTIQ+ people with cancer. Drawing on interview data from the Out with Cancer Study, it examines how clinicians’ beliefs, values, and assumptions shape their interactions with LGBTIQ+ patients and carers, and how these subject positions influence the provision of inclusive and affirming care. The analysis identifies three key subject positions adopted by HCPs: inclusive and reflective practitioners, egalitarian practitioners, and anti-inclusive practitioners. Inclusive and reflective practitioners acknowledged the specific needs of LGBTIQ+ people, recognised systemic barriers to care, and actively worked to provide safe and affirming environments. Egalitarian practitioners took a “treat everyone the same” approach, often aiming to avoid discrimination but unintentionally overlooking the importance of identity-specific care. Anti-inclusive practitioners expressed resistance to, or discomfort with, the relevance of LGBTIQ+ identities in clinical care, sometimes drawing on heteronormative or cisnormative beliefs. These positions were shaped by broader institutional cultures, personal and professional experiences, and access to training in LGBTIQ+ health. The chapter highlights the emotional, ethical, and relational dynamics involved in providing cancer care to a population historically marginalised within health systems. It also considers how organisational support, peer dialogue, and reflective practice can enable clinicians to move towards more inclusive approaches. Rather than framing inclusivity as a fixed competency, the chapter argues for a relational and contextual understanding of LGBTIQ+ cancer care. Supporting HCPs to engage in critical reflection, ongoing learning, and culturally safe practice is essential to reducing disparities and improving outcomes for LGBTIQ+ patients and their carers.