Expert: Having Conversations and Practicing Cultural Competency With LGBTQIA+ Patients

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HOPA’s DEI Advisory Board Chair discusses how creating safe environments, using correct pronouns, and being willing to talk about patients’ mental and physical needs are significant when providing care to LGBTQIA+ patients.

For Pride Month, Pharmacy Times interviewed Tad Autry, PharmD, hematology/oncology clinical pharmacist at OU Health Stephenson Cancer Center and chair of the Hematology/Oncology Pharmacy Association’s DEI Advisory Board. During the discussion, Autry discusses the importance of creating a safe and inclusive environment for patients in the LGTBQIA+ community and provides his personal experiences working in oncology pharmacy. He also stresses the need for health care providers to continue to educate themselves and practice cultural competency, while not being afraid to have any necessary and difficult conversations with patients.

Pharmacy Times: Can you introduce yourself?

Tad Autry: My name is Ted Autry, and I am the clinical pharmacy manager for adult cancer services and a clinical practitioner in malignant hematology and transplant and cellular therapies at OU Health Stephenson Cancer Center in Oklahoma City, Oklahoma. I actually kind of come from a non-traditional background into oncology pharmacy, I didn't do a PGY2 in oncology, I actually did my residency in ambulatory care...I loved oncology in pharmacy school and I always had this feeling that I wanted to practice oncology, and so, at the end of my residency, I was in a position that didn't really fit me so well, and I decided to reach out to a mentor who happened to be the director of pharmacy at our cancer center at time. And I said, "Hey, Pat, do you happen to have any jobs?" And he was like, "Come on over and come take your pick." And I essentially ended up in the malignant hematology clinic because they were the nicest people I had ever met; the physicians were great, the nurses were great, everyone was just lovely.

For my actual practice now, when I see patients...Oklahoma is an interesting mix of both urban and rural settings, I know a lot of people just when they think of Oklahoma they think of cowboys and cowboy boots, and I absolutely see that in my day practice when people come in, but I also see people who are living in a large metropolitan area. And so, I have to kind of go back and forth between different environments and what their different understanding is where they come from. What helps me out [is] my history of growing up in a small rural town in western Oklahoma, [it] actually helps out a lot with that because I can relate to some of those patients who are from a small town that is a 3-hour drive from here.

Outside of my work, I am involved in HOPA and the DEI Advisory Group, I am the chair this year, but I've been with the DEI group since it was first started by HOPA.

LGBTQIA+ pride -- Image credit: lazyllama | stock.adobe.com

Image credit: lazyllama | stock.adobe.com

Pharmacy Times: What are some unique health care challenges that people in the LGBTQ+ community face, and how do these impact their well-being and overall health?

Autry: So, there are numerous challenges in health care disparities for people who are in the queer community, and those range from tobacco and alcohol and drug abuse, to increased risk of sexually transmitted infections, to increased risk of mental health problems, including depression and suicidal ideation. And so much of that is exacerbated by—particularly in certain states—lack of access to health care, discrimination by the health care system, many people feel misunderstood and unheard, so that prevents them from seeking medical care.

What I like to think about is many people, just everyday people, are nervous going to see a doctor for any kind of health care concern, but it can be so much worse for someone who is part of the queer community. It's a little hard to describe, but if you imagine [that] you had to explain who you were—your core identity—to others all day and every day, you're literally having justify your existence, and at other times you feel like you have to hide who you are. And now imagine you're doing all of that, or sorting through all that, in a doctor's office and you might be wearing a hospital gown, and sometimes you might have 30 minutes to have that visit with them, and then you have to decide what are you going to do if they misgender you. Are you going to tell them? Are you going to correct them? Are you just going to move on with it? That puts so much anxiety on the individual patient.

[On a personal note,] I am a 34 year-old gay man and I came out when I was 22 years old, and I established care with my first primary care doctor when I was 30. And I will tell you, I was shaking, scared to come out of the closet to this doctor. Now, I am a cisgender White male with a background in medical care. Essentially, I can speak the same language that that doctor speaks and I am still scared to come out of the closet to them, I'm still scared to discuss what health care needs I might have. I cannot even imagine at times how hard it might be to somebody who is transgender, who is bisexual, or maybe is part of another discriminated group, and that's when we kind of start talking about intersectionality. How do you talk about the needs of somebody who looks different than you?

Pharmacy Times: Can you discuss cultural competency in the context of LGBTQ+ health care?

Autry: If you go out there and Google "cultural competency in health care" you're going to see a lot of different definitions for it. But what it comes down to, at its core, it is being respectful and responsive for the patients' needs and beliefs, what they actually need out of you as the care provider, it's understanding and practicing the evidence-based medicine that they need, and it's having empathy for their experience. You don't have to understand everything about their experience, but it's being able to see like, wow, it is probably really tough for them.

On a practical level, what practitioners can do is they can actually go and read about cultural competent health care for queer individuals, there are many, many good resources out there, I really liked the National LGBTQIA+ Health Education Center's website, they have some excellent resources for cultural competent health care. In some cases, it can be as simple as just using the right pronouns, asking somebody, "What are your pronouns, what would you like to be called?" If [patients] marked it when they checked in into your electronic health record system, keep their pronouns accurate and use that accordingly. And then [cultural competency is] being willing to have some difficult, crucial conversations with patients about their mental and physical health needs and coming to a decision together.

[For example] in oncology, there's just a lot of—I think—empathy already built into oncology, because for at least, in my case, I've never had cancer [or] I haven't had a family member with cancer, so I don't necessarily know what they're going through, but I do know the science and the care behind it and I need to find a way to get this to the patient. And that's where the cultural competency piece comes in.

Key Takeaways

  1. Challenges Faced by LGBTQ+ Patients: LGBTQ+ individuals face numerous health care challenges, including higher rates of substance abuse, mental health issues, and sexually transmitted infections, which are exacerbated by discrimination and the overall lack of access to health care. These challenges create significant anxiety and barriers to seeking health care, which can impact their overall health and well-being.
  2. Importance of Cultural Competency: Cultural competency involves being respectful and responsive to the needs and beliefs of LGBTQ+ patients. Providers can improve care by educating themselves about LGBTQ+ health care needs, using correct pronouns, and fostering empathetic communication. Other steps include reading resources—such as those from the National LGBTQIA+ Health Education Center—and engaging in ongoing education to stay updated on guidelines and best practices.
  3. Role of Pharmacists: Pharmacists play a crucial role in supporting LGBTQ+ patients due to their accessibility. They can provide assistance with smoking cessation, counseling on PrEP and hormone therapies, as well as create a welcoming environment by using inclusive language and ensuring patients feel comfortable. Pharmacists can also educate patients and their families, facilitate medication access, and influence peers to adopt inclusive practices.

Pharmacy Times: What specific role do pharmacists have when treating patients in the LGBTQ+ community?

Autry: I think a lot of people when we start having conversations about how to care for people who are LGBTQIA+, they start thinking about the patient-physician relationship, but pharmacists are still the most accessible health care provider out there. And so, they can have a huge impact on these individuals. They can offer assistance with smoking cessation, they can help with counseling patients on their PrEP medications and the interactions with them, and they can help patients deal with the [adverse effects] from hormonal medications used in gender-affirming care. Even small things, like if you own your own independent pharmacy or you work at a large retail chain, asking if there's a gender-neutral restroom for people to use, that can make an environment feel so much more comfortable and accepting to somebody who's a member of the queer community.

And for me—from my perspective, in the oncology setting—it's patient education, medication access, and in some cases, influencing your peers. You know, a lot of times when I go into patient rooms, it's not just the patient, it's their family member in there, and it's their family, it's their spouse, their significant other, their best friend, and I'm not just educating that patient, I'm educating everybody. And so, recognizing that there are people in that room who are different than me, makes a big difference in how I educate those people. Medication access is always just a huge issue in our current health care system, so working with patients to make sure they get the medications they need. And then, influencing your peers. I feel like it's probably true for a lot of clinical pharmacists out there working with oncologists, we are very well respected by them, we are listened to them, we are leaders in our field and oncology, and so instead of...if you call somebody into a conversation—instead of calling them out—you call him in about how to use the right pronouns with the patient or help them understand that, yes, that is 2 women in the room together and they are in a relationship, that is using your leadership and your power to for good, that is using your influence to change the perspective of others.

Pharmacy Times: How does ongoing education and/or training help pharmacists and providers improve the quality of care these patients receive?

Autry: I feel like any pharmacist can identify with this: the pace of health care and medicine is changing all the time. There are new drugs, new guidelines [that are] always coming out, and this is especially important for those within the queer community because we are learning more and more every day about what these patients need. So, taking some time to learn about cultural competency for the LGBTQIA+ community is huge, taking a moment and reading about the most updated PrEP guidelines about what should be offered, or even just knowing what groups the HPV vaccine should be discussed with can make a huge impact on this patient population.

When it comes to HOPA, I'm part of the DEI Advisory Group and I would really recommend to people that they take a look at the DEI Toolkit that's on the website. It is a fantastic resource for oncology pharmacy practitioners to start developing cultural competency in many different areas, not just for queer individuals, but for many different groups. It can help them identify and eliminate microaggressions and really take a look at themselves and see what they reflect back to the communities. I think that is a fantastic resource for ongoing education for people.

Pharmacy Times: How does HOPA provide support and care to members of the LGBTQ+ community? What resources are available and what do you do differently?

Autry: So, I think I would mention and highly recommend everyone go and look at our DEI statement. The committee at the time worked really hard on preparing that statement and we were so proud to see its acceptance by the Board of Directors and be [put] front and center on the HOPA website so people can see this. It means a lot to us, especially [as] somebody from the queer community, it means a lot. The DEI Toolkit, we are adding more to that throughout the advisory groups here, and some of the final pieces of that will be coming out this year. So, please keep going back in there to take a look at what's available.

Pharmacy Times: What would you like to see studied in clinical trials and future research focused on this patient population? What gaps are there, and how can they be addressed?

Autry: I think one of the biggest critical gaps when it comes to oncology research in the LGBTQIA+ community and cancer is there's just a lot of poor data collection when it comes to sexual orientation and gender identity. Depending upon what state you're in, what community you're in, what health care system...when a patient checks in for a visit, some of this data may or may not be collected, and that means that there's these big databases out there full of data about patients that could be tapped by researchers that they can't distinguish out of there, who is a member of the queer community and who is not. And so, I would really like to see more work go into that so that we can have a more standardized, streamlined process for how we identify these individuals, so that we can...understand and see the effects of cancer on this community.

And I also read recently that HOPA is also working on a campaign to help diversity in clinical trials, and I'm really excited to see where HOPA goes with this. I think that is really exciting and a great thing to be working on.

Pharmacy Times: Any final/closing thoughts?

Autry: I thought about this a little bit, and I just wanted to say to anybody who's going to watch this video or read this transcript, nobody expects you to be the perfect health care provider for the queer community. You are going to make mistakes with someone, you are going to misgender somebody. I have. You're going to not know how to discuss sexual health with a queer oncology patient. You may not know how to process some of the feelings you're going through as you start to learn about your own blind spots when it comes to microaggressions or to cultural[ly] competent health care. But I really believe if you go into this, to your patients' rooms, to these patient interactions with an open heart and an open mind, you are already setting the stage for a wonderful patient-provider relationship, and that is something that will really help push the care for we're queer individuals.

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