: Beyond the Binary: A Transformative Implementation Science Initiative to Improve LGBTQ+ Cancer Care

This program was designed to identify and address the root causes of disparities in care for patients with cancer who identify as lesbian, gay, bisexual, transgender, queer or questioning and drive system-wide sustainable change to improve health equity in LGBTQ+ cancer care. Measurable outcomes revealed that while 65% of HCPs (n=115) believed that patients feel safe disclosing LGBTQ+ identity, only 24% of patients (n=817) reported feeling comfortable doing so. Additionally, nearly 40% of patients reported increased confidence in care if their healthcare provider shared pronouns or displayed them on their badge. However, 0% of HCPs reported doing this. The baseline data was built into audit-feedback sessions at each clinic to facilitate action plans to advance equitable cancer care, which included improving documentation with EMRs of preferred pronouns, purchasing accessories to display to show acceptance, and providing resources tailored to the needs of LGBTQ+ patients. Furthermore, HCPs significantly improved commitment to discuss gender identity and sexual orientation from very low baseline scores of 12% increasing to 78% among academic HCPs and from only 1% increasing to 68% among community HCPs. As evident from the patient baseline data, these discussions were important to increasing patients' feeling of confidence in care. Our findings demonstrate the impact of building real-world patient insights into provider-facing education to motivate behavior and sustainable clinic practice change.