title: Social support, self-rated health, and lesbian, gay, bisexual, and transgender identity disclosure to cancer care providers.
abstract: OBJECTIVE
  To describe factors related to diagnosis, identity disclosure, and social support among lesbian, gay, bisexual, and transgender (LGBT) patients with cancer, and to explore associations between these factors and self-rated health.
  
  
  METHODS
  Cross-sectional self-report survey design using descriptive and exploratory multivariate statistical approaches.
  
  
  METHODS
  Online, Internet-based.
  
  
  METHODS
  291 LGBT patients (89% Caucasian; 50% gay, 36% lesbian, 7% bisexual, 3% transgender) with mixed cancers.
  
  
  METHODS
  Participants completed a researcher-designed online survey assessing experiences of cancer diagnosis among LGBT patients at a single time point.
  
  
  METHODS
  Demographics, which provider(s) delivered the patients' cancer diagnoses, to whom patients had disclosed their LGBT identity, how they disclosed, who was on their social support team at the time of diagnosis, and current self-rated health.
  
  
  RESULTS
  79% of participants reported disclosing their identities to more than one cancer care provider. Participants most commonly introduced the topic of LGBT identity themselves, sometimes as a way to correct heterosexual assumptions (34%). Friends were the most common members of LGBT patients' support teams (79%). Four disclosure and support factors were consistently associated with better self-rated health.
  
  
  CONCLUSIONS
  Disclosure of LGBT identity is a common experience in the context of cancer care, and disclosure and support factors are associated with better self-reported health among LGBT patients.
  
  
  CONCLUSIONS
  Creating safe environments for LGBT patients to disclose could improve cancer care delivery to this underserved population. Nurses and other providers should acknowledge and include diverse support team members in LGBT patients' care.
authors.affiliation: Department of Surgery, University of Rochester Medical Center in New York.
authors.forename: Charles S
authors.initials: CS
authors.lastname: Kamen
authors.affiliation: Department of Nursing, California State University, San Bernardino.
authors.forename: Marilyn
authors.initials: M
authors.lastname: Smith-Stoner
authors.affiliation: Department of Surgery, University of Rochester.
authors.forename: Charles E
authors.initials: CE
authors.lastname: Heckler
authors.affiliation: Department of Nursing, University of Rochester.
authors.forename: Marie
authors.initials: M
authors.lastname: Flannery
authors.affiliation: National LGBT Cancer Network, New York, NY.
authors.forename: Liz
authors.initials: L
authors.lastname: Margolies
mesh_terms: D001727:Bisexuality; D003430:Cross-Sectional Studies; D003663:Decision Trees; D005260:Female; D018452:Homosexuality, Female; D018451:Homosexuality, Male; D006801:Humans; D008297:Male; D009369:Neoplasms; D057566:Self Report; D012944:Social Support; D063106:Transgender Persons; D014342:Truth Disclosure
keywords: cancer; health disparities; sexual orientation; social support