Assistant Professor, Department of Community and Population Health, College of Nursing, University of Tennessee Health Science Center, Memphis, Tennessee.
Medical Student, College of Medicine, University of Tennessee Health Science Center, Memphis, Tennessee.
Semin Oncol Nurs. 2023 Aug;39(4):151452. doi: 10.1016/j.soncn.2023.151452. Epub 2023 Jun 17.
Few studies examine sexual orientation disclosures (SODs) among women with breast cancer; fewer examine the impact of culture and geography on disclosure processes. This study explores how sexual minority women (SMW) in the Southern United States engage in SODs with oncology clinicians.
We conducted in-depth interviews with SMW (eg, lesbian, bisexual) treated for early-stage (stages I-III), hormone receptor-positive breast cancer (N = 12), using a semistructured interview guide. Participants completed an online survey prior to the 60-minute interview. Data was analyzed using an adapted pile sorting approach and thematic analysis conventions.
Average age of participants was 49.5 years (range: 30-69), all self-identified as cisgender; 83.3% as lesbian, 58.3% were married, 91.7% had completed a 4-year college degree or higher, 66.7% identified as non-Hispanic White, 16.7% as Black, and 16.7% as Hispanic/Latina. Half of the sample had not engaged in SODs with an oncology clinician. Key themes were: (1) religious and political conservatism in the South create SOD barriers; (2) oncologist-specific barriers to SODs; (3) "straight passing" as a discrimination mitigation strategy; and (4) SOD facilitators in oncology settings (ie, strategic disclosures, medical privilege, and lesbian, gay, bisexual, and transgender-friendly branding of oncology centers).
SMW with breast cancer living in the U.S. South navigate unique interpersonal barriers to SODs in oncology settings. Clinicians could encourage SODs by fostering inclusive environments via nonheteronormative language, inclusive intake forms, and respect for SMW's SOD navigation processes. Oncology clinicians require culturally relevant, geographic-specific communication training to facilitate SODs among SMW.
很少有研究调查乳腺癌女性的性取向披露（SOD）情况；更少的研究探讨文化和地理对披露过程的影响。本研究探讨了美国南部的性少数女性（SMW）如何与肿瘤临床医生进行 SOD。
我们对 12 名接受早期（I-III 期）、激素受体阳性乳腺癌治疗的 SMW（例如女同性恋、双性恋）进行了深入访谈，使用半结构化访谈指南。参与者在 60 分钟访谈前完成了在线调查。使用改编的堆积排序方法和主题分析惯例对数据进行分析。
参与者的平均年龄为 49.5 岁（范围：30-69 岁），均自我认同为顺性别；83.3%为女同性恋，58.3%已婚，91.7%完成了四年制大学学位或更高，66.7%为非西班牙裔白人，16.7%为黑人，16.7%为西班牙裔/拉丁裔。样本中有一半人尚未与肿瘤临床医生进行 SOD。主要主题包括：（1）南方的宗教和政治保守主义造成 SOD 障碍；（2）肿瘤学家特定的 SOD 障碍；（3）“异性恋伪装”作为一种减轻歧视的策略；（4）肿瘤学环境中的 SOD 促进因素（即策略性披露、医疗特权以及肿瘤中心对同性恋、双性恋、变性者友好的品牌）。
居住在美国南部的乳腺癌 SMW 在肿瘤学环境中面临独特的人际 SOD 障碍。临床医生可以通过使用非异性恋语言、包容的入组表格以及尊重 SMW 的 SOD 导航过程，营造包容的环境来鼓励 SOD。肿瘤学临床医生需要进行具有文化相关性和地理位置特异性的沟通培训，以促进 SMW 之间的 SOD。
