Introducing Welcoming Spaces—Q&A with Scout and Allison Asante

Welcoming Spaces: Treating Your LGBTQ+ Patients is SGO’s free LGBTQ+ Cultural Humility training designed for anyone who works in health care and specifically for clinicians and staff members interacting with transgender and gender non-conforming patients. Developed in collaboration with the National LGBT Cancer Network, there are nine courses—a mix of self-study and webinar.

SGO Issues reached out to Scout, MA, PhD, executive director of the National LGBT Cancer Network, and Allison Asante, PA-C, of the SGO Advisory Committee to discuss the program in greater detail.

Allison Asante, PA-C, SGO Advisory Committee

What was the impetus for developing the Welcoming Spaces training program?

It was really the overwhelming need for LGBTQ+ training among healthcare providers. A recent study from New York University found that only half of oncologists were confident in their knowledge of the health needs of lesbian, gay and bisexual people, and only 37% felt confident in their knowledge to treat transgender people. This training is a concise way for providers who have not received LGBTQ+ specific training to become competent and confident in providing affirming cancer care.

How will the Welcoming Spaces training program assist clinicians who treat transgender/gender non-conforming patients with gyn cancers?

Welcoming Spaces is a comprehensive training on LGBTQ+ affirming care. The beginning sessions will provide baseline education on LGBTQ+ identities and social determinants of health. The later sessions build on that to address how being transgender can impact treatment and screening for gyn cancers. While most people taking these trainings have not treated a transgender patient with a gyn cancer diagnosis, Welcoming Spaces provides the information needed to know how this can affect treatment, prognosis, and survivorship. What are some of the specific needs of trans/gender non-conforming patients? The biggest need of trans and gender non-conforming (GNC) patients is to be explicitly welcomed and affirmed by health care providers. For many transgender people, seeking health care means educating your health care provider about your identity, or having your identity ignored completely. Both experiences can make trans/GNC people less likely to seek out

healthcare.

Why is so important that non-clinical staff also receive this training?

It’s important for non-clinical staff to receive this training because everyone in the office plays a role in welcoming patients to your practice. Before a patient is seen by a provider, they have called the office to make an appointment, checked in with the front desk, and been taking to a room by a medical assistant. For a patient that means three opportunities to have a negative experience before you walk into the room. To truly welcome trans and GNC patients, it is important that everyone in the office is knowledgeable.

Scout, MA, PhD, Executive Director of the National LGBT Cancer Network

What is the definition of cultural humility? How does it differ from cultural awareness or cultural competency?

In my experience the big difference between cultural humility and competency or awareness is with cultural humility you’re gaining an understanding of the limits of your own experiential base, skills, insights, and reflexes. Then you’re going beyond those limits to see a little bit of the different types of experiences, skills, insights and reflexes other people might take into otherwise similar situations. That contrast can be very insightful. Then, if cultural humility training is done well, we all should emerge realizing the journey to being more welcoming is just that, a journey. No culture stays static, so the effort to create safe space for different types of people can’t stay static either.

What are some examples of unique situations that trans patients may encounter in a clinical setting, especially as it pertains to gyn/oncology?

There are so many! As I dropped off my Pap smear at the lab the attendant said aloud in front of everyone “Well, I don’t understand why you’re getting a Pap smear.” Same office, one visit earlier, the nurse wouldn’t leave the room when I was asked to change, I’m sure because she was curious. Belatedly I wish I would have said no, but we’re all taught to do what providers say, right? Or what about one of my gyn onc visits, where upon hearing I was not cis straight, the gyn onc and his student were so brutal in their physical exam it took me days to feel normal again. And honestly, while these are all from my own history, I also know I’m privileged compared to many trans people, I’m White, I have great insurance, I’m highly educated, and can leave the providers that physically hurt me.

In addition to receiving this training, what else can health care practitioners and their staff members do to make their practices more welcoming to trans/gender non-conforming patients?

Please understand this training is simply a recipe book for changes and having a recipe book doesn’t mean you’ve cooked any good food. Try out the recipes. Ask your friends to give you some more recipes they like. Ask people to try your creations. Keep going until people assure you that you’re becoming a good cook.

Welcoming Spaces will be available soon, check back often for updates. Learn more about Welcoming Spaces, and share this information with your fellow clinicians and non-clinical staff to improve the experience and outcomes of LGBTQ+ patients in all areas of medicine.