What Exactly Are We Measuring?

Evaluating Sexual and Gender Minority Cultural Humility Training for Oncology Care Clinicians

Ash Alpert, MD; Charles Kamen, PhD; Matthew B. Schabath, PhD; Lauren Hamel, PhD; Julia Seay, PhD; Gwendolyn P. Quinn, PhD


J Clin Oncol. 2020;38(23):2605-2609. 

In This Article

Frameworks for SGM-focused Training in Oncology

Training programs designed to enhance clinicians' ability to work with minority and other underserved patients often draw on one of several interrelated frameworks.[18] Historically, training programs have referenced the framework of cultural competency. With regard to SGM patients, cultural competency encompasses a requisite understanding of cultural and social influences that affect the ability of healthcare professionals to provide appropriate care for patients with diverse sexual orientations and gender identities.[18–20] This framework has been criticized for the assumption that a person can ever be competent in the diverse experiences of another culture. Cultural humility incorporates a lifelong commitment to self-evaluation and critique, to redressing the power imbalances in the physician-patient dynamic, and to developing mutually beneficial and nonpaternalistic partnerships with communities on behalf of individuals and defined populations.[21(p123)] Cultural humility training emphasizes understanding the influence of systemic oppression on the health of people with multiple, intersecting stigmatized identities.[22–24] Given that SGM individuals come from every cultural background and therefore have multiple intersecting identities, we advocate using the framework of cultural humility to guide SGM-focused training in oncology. Other distinct but conceptually related frameworks are defined in Table 1.

SGM-focused cultural competency/humility training for health care clinicians has proved efficacious in improving clinician knowledge about SGM patients' needs.[24,25] To date, no studies have examined whether such training improves SGM patient outcomes. Parallel studies of racial and ethnic cultural competency/humility training demonstrate a moderate effect on satisfaction with care, trust in physicians, and access to health care.[25–28] Other studies have shown little to no effect on patient outcomes.[29,30] The quality of evidence arising from these studies is generally low because of methodologic issues, including lack of validated measurement strategies.[25,31]