A Content Analysis of Cancer-Related Changes in Perceptions of Self, Relationships, and Health Among LGBTQI+ Cancer Survivors Across the Life Course: Findings From OUT: The National Cancer Survey.
Austin R Waters, Shaun R Jones, Manuela Uppalapati, Akshay Gududuru, Madeline H Bono, Hillary K Hecht, N F N Scout, Erin E Kent
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Abstract
Background: The LGBTQI+ population makes up at least 7.6% of the US population. LGBTQI+ populations are at increased risk of experiencing LGBTQI+-related discrimination and cis-heteronormativity in healthcare leading to poorer health outcomes throughout the cancer care continuum. We aimed to explore LGBTQI+ cancer survivors' perspectives of how cancer has changed their perceptions of self and relationships using data from OUT: The National Cancer Survey.
Methods: We conducted an inductive qualitative content analysis of responses to four open-ended questions from OUT: The National Cancer Survey. Data were collected from September 2020 to April 2021. Eligible participants were 18 years of age or older at time of survey, had been previously diagnosed with cancer, identified as LGBTQI+, and currently lived in the US. Open-ended survey questions asked about the impact of cancer on LGBTQI+ cancer survivors' perceptions of self and relationships. To maximize inter-rater reliability, 20% of the survey responses were double coded. Chi-squared tests assessed differences in changes across the life-course.
Results: Of the participants in the OUT survey (N = 2382), 86.9% (N = 2069) provided responses to at least one of the four open-ended questions. The content analysis sample participants were primarily aged 40-59 (39.3%) and 60-79 (49.4%), gay (54.7%), cisgender men (59.4), White (89.7%), and not on active treatment (77.4%). A total of 5179 codes were applied to the 2069 responses. A total of 5 overarching categories and 18 sub-categories were identified. Themes included: (1) changes in perceptions of self; (2) changes to relationships; (3) changes to health and (4) LGBTQI+ specific unmet needs. The most commonly reported categories were changes in perceptions of self (77%, n = 1593) and changes to health (47%, n = 972). Most cancer-related changes were more frequently reported by young adult survivors.
Conclusions: This content analysis illuminates the unique challenges that the LGBTQI+ population faces while navigating through the cancer care continuum.
背景：LGBTQI+人口至少占美国人口的7.6%。LGBTQI+人群在医疗保健中遭受LGBTQI+相关歧视和顺式异性恋的风险增加，导致整个癌症治疗连续体的健康结果较差。我们的目的是利用OUT: The National cancer Survey的数据，探讨LGBTQI+癌症幸存者对癌症如何改变他们对自我和人际关系的看法。方法：我们对OUT: The National Cancer Survey中四个开放式问题的回答进行了归纳定性内容分析。数据收集于2020年9月至2021年4月。符合条件的参与者在调查时年满18岁，以前被诊断患有癌症，确定为LGBTQI+，目前居住在美国。开放式调查问题是关于癌症对LGBTQI+癌症幸存者对自我和人际关系的看法的影响。为了最大限度地提高评分者之间的可靠性，20%的调查回答是双重编码的。卡方检验评估了整个生命过程中变化的差异。结果：在OUT调查的参与者中（N = 2382）， 86.9% （N = 2069）至少回答了四个开放式问题中的一个。内容分析样本参与者主要是40-59岁（39.3%）和60-79岁（49.4%），同性恋（54.7%），顺性男性（59.4%），白人（89.7%），未接受积极治疗（77.4%）。总共有5179个代码被应用到2069个响应中。共确定了5个总体类别和18个次级类别。主题包括：(1)自我认知的变化；（二）关系变化；(3)健康的变化和(4)LGBTQI+特定的未满足需求。最常见的报告类别是自我认知的变化（77%,n = 1593）和健康的变化（47%,n = 972）。大多数癌症相关的变化更常发生在年轻的成年幸存者身上。结论：这一内容分析阐明了LGBTQI+人群在癌症治疗过程中所面临的独特挑战。
期刊介绍：
Psycho-Oncology is concerned with the psychological, social, behavioral, and ethical aspects of cancer. This subspeciality addresses the two major psychological dimensions of cancer: the psychological responses of patients to cancer at all stages of the disease, and that of their families and caretakers; and the psychological, behavioral and social factors that may influence the disease process. Psycho-oncology is an area of multi-disciplinary interest and has boundaries with the major specialities in oncology: the clinical disciplines (surgery, medicine, pediatrics, radiotherapy), epidemiology, immunology, endocrinology, biology, pathology, bioethics, palliative care, rehabilitation medicine, clinical trials research and decision making, as well as psychiatry and psychology.
This international journal is published twelve times a year and will consider contributions to research of clinical and theoretical interest. Topics covered are wide-ranging and relate to the psychosocial aspects of cancer and AIDS-related tumors, including: epidemiology, quality of life, palliative and supportive care, psychiatry, psychology, sociology, social work, nursing and educational issues.
Special reviews are offered from time to time. There is a section reviewing recently published books. A society news section is available for the dissemination of information relating to meetings, conferences and other society-related topics. Summary proceedings of important national and international symposia falling within the aims of the journal are presented.
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