Sexual and gender minority cultural humility training for oncology settings: An example of iterative adaptation and implementation

Charles S Kamen; Melhaney Reichelt; Porooshat Dadgostar; Ash B Alpert; Christopher Doucette; Phillip Vaughan; Alex S Keuroghlian; Reza Yousefi-Nooraie

doi:10.3389/frhs.2022.958274

Sexual and gender minority cultural humility training for oncology settings: An example of iterative adaptation and implementation

Front Health Serv. 2022 Nov 10:2:958274. doi: 10.3389/frhs.2022.958274. eCollection 2022.

Authors

Charles S Kamen¹, Melhaney Reichelt¹, Porooshat Dadgostar¹, Ash B Alpert², Christopher Doucette¹, Phillip Vaughan¹, Alex S Keuroghlian³, Reza Yousefi-Nooraie¹

Affiliations

¹ University of Rochester, Rochester, NY, United States.
² Brown University School of Public Health, Providence, RI, United States.
³ The Fenway Institute, Boston, MA, United States.

Abstract

Background: Multiple national organizations recommend that cancer care providers and oncology practices be responsive to the needs of sexual and gender minority (SGM) patients. Oncology practices have attempted to incorporate this recommendation through SGM-focused cultural humility training interventions. It is unclear how best to adapt and implement such training across practices. This manuscript outlines one process for adapting a widely-used SGM training from The Fenway Institute to the context of oncology settings using the Framework for Reporting Adaptations and Modifications-Enhanced (FRAME) model.

Methods: We conducted training sessions in two oncology care settings: a breast oncology center and a radiation oncology department. Subsequently, we conducted in-depth interviews with the three trainers involved in adapting The Fenway Institute's training to these two practices. Two independent investigators coded the interviews using components of the FRAME model as an analytic guide.

Results: Training team members described the mechanisms by which FRAME adaption occurred both proactively and reactively; the importance of involving SGM-identified trainers of diverse backgrounds as well as champions from within oncology practices in which trainings were conducted; the importance of adapting both the context and content of training to be relevant to oncology audiences; and the ways in which fidelity to the core principles of improving health care for SGM patients was maintained throughout the process.

Discussion: SGM cultural humility training for oncology providers and staff must undergo iterative adaptation to address the political and social context of specific practice environments and advocate for broader institutional culture change to achieve responsiveness to SGM health needs.

Keywords: cancer; cultural humility; gender identity; health disparities; sexual and gender minorities; sexual orientation.