Columbia Nursing Dean Urges More LGBT Health Research

Lesbian, gay, bisexual and transgender (LGBT) patients face a variety of difficulties when attempting to access the health care system, from ill-conceived definitions of sexuality and gender identity to discomfort sharing their LGBT status with providers. The scant body of existing research on the distinct health disparities encountered by this population complicates efforts to craft evidence-based treatment guidelines for the wide variety of people within the LGBT community, said Bobbie Berkowitz, PhD, RN, FAAN, dean of Columbia University School of Nursing, during a plenary panel last month at the American Academy of Nursing’s annual policy conference in Washington, DC.

"Understanding the health care needs of the LGBT community has been hard for educators and scientists and practitioners," she said. "There is a need to identify very specifically what the research barriers are and what the priorities should be. We then need to provide a platform for dialog and action.”

Nurses can lead the charge for change, said Berkowitz, the Academy's president-elect. One approach is to get nurses into an environment where they're exposed to the challenges within LGBT populations and that will enable them to collaborate with colleagues to find better ways to improve care for these individuals.

"This is probably not going to surprise those of you who work in this field," she said, addressing an audience of AAN fellows, "but research has been more focused on gay men and lesbians and less on bisexual and transgender individuals. Most of the research has been concentrated on adults, with little attention to adolescents. Also, research hasn’t adequately examined subpopulations such as racial and ethnic minorities."

As a model for advancing research, Berkowitz laid out the key recommendations from a 2011 Institute of Medicine (IOM) report on the health of LGBT people. She helped draft the report as a member of the IOM committee, which also included Walter O. Bockting, PhD, professor of medical psychology at Columbia Nursing and co-director of the LGBT Health Initiative established this year at Columbia University Medical Center.

To start, nurse researchers need to more closely examine the health issues that members of the LGBT community encounter at different stages of their lives, from adolescence through old age, she said. Studies should also delve into the social factors that can impact well-being such as crime victimization, housing, family structure and economic status. And, research should probe how health challenges play out within various subpopulations within the LGBT community.

The National Institutes of Health (NIH), sponsors of the IOM study on LGBT health, should support the development and standardization of sexual orientation and gender identity measures. Just as the NIH has urged researchers to include women and racial minorities in clinical research, the NIH should now encourage grant applicants to address their rationale for including or excluding sexual and gender minorities in clinical trials.

Within the nursing community, education and research also need to evolve to address the needs of LGBT patients, Berkowitz said.

"How do nurses get ideas for research that will pave the way to improve the health care of the patients we serve?" Berkowitz asked. "One way is by exposing ourselves through our educational process, discussions with colleagues and attending professional conferences. We become interested in these challenges from the perspective of research, education or practice. And we have a community around us that encourages us to explore. That’s how we begin."