1 Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, Boston, Massachusetts.
2 Department of Pediatrics, Harvard Medical School, Boston, Massachusetts.
LGBT Health. 2019 Feb/Mar;6(2):77-86. doi: 10.1089/lgbt.2018.0203. Epub 2019 Feb 5.
Sexual minority women (SMW) are vulnerable to cervical cancer, yet there is a dearth of research on potential mediators of cervical cancer disparities. Medical heterosexism, which involves sexual orientation-based discrimination in medical contexts, and provider-patient communication quality and trust in providers may be important factors influencing the cancer prevention decisions of SMW. The purpose of this study was to examine how provider-patient communication quality, trust in providers, and perceived medical heterosexism are associated with cervical cancer screening among SMW.
A dual-mode, one-time cross-sectional survey was administered to a community sample of SMW (N = 150), ages 21-53, in Richmond, Virginia, from December 2017 to February 2018.
It was hypothesized that provider-patient communication quality and trust in providers would mediate the relationship between perceived medical heterosexism and cervical cancer screening outcomes. The hypothesis was supported; trust in providers (b = 0.05, p = 0.001, 95% confidence interval [CI] 0.02-0.08) and provider-patient communication quality (b = 0.06, p = 0.003, 95% CI 0.02-0.10) were positively associated with future screening intention, and their total indirect effect mediated the relationship between perceived medical heterosexism and intention (b = -0.03, 95% CI -0.05 to -0.02, β = -0.25, 95% CI -0.39 to -0.15). Similarly, the total indirect effect of provider-patient communication quality mediated the relationship between perceived medical heterosexism and odds of routine screening (b = -0.03, 95% CI -0.06 to -0.01).
These findings point to the need for cancer prevention and control strategies for SMW to target provider education and policy interventions that improve SMW's relationships with their providers and improve cervical cancer screening rates.
性少数群体女性（SMW）易患宫颈癌，但针对导致宫颈癌差异的潜在中介因素的研究却很少。医学异性恋主义涉及医疗环境中的性取向歧视，以及医患沟通质量和对提供者的信任，这些因素可能是影响 SMW 癌症预防决策的重要因素。本研究旨在探讨医患沟通质量、对提供者的信任以及感知到的医学异性恋主义如何与 SMW 的宫颈癌筛查相关。
2017 年 12 月至 2018 年 2 月，在弗吉尼亚州里士满对 150 名年龄在 21-53 岁的社区 SMW 进行了双模式一次性横断面调查。
研究假设医患沟通质量和对提供者的信任可以调节感知到的医学异性恋主义与宫颈癌筛查结果之间的关系。该假设得到了支持；对提供者的信任（b=0.05，p=0.001，95%置信区间[CI]0.02-0.08）和医患沟通质量（b=0.06，p=0.003，95%CI0.02-0.10）与未来筛查意向呈正相关，并且它们的总间接效应调节了感知到的医学异性恋主义与意向之间的关系（b=-0.03，95%CI-0.05 至-0.02，β=-0.25，95%CI-0.39 至-0.15）。同样，医患沟通质量的总间接效应也调节了感知到的医学异性恋主义与常规筛查几率之间的关系（b=-0.03，95%CI-0.06 至-0.01）。
这些发现表明，需要针对 SMW 制定癌症预防和控制策略，以针对提供者教育和政策干预，改善 SMW 与提供者的关系，并提高宫颈癌筛查率。
