Melanie Cole, MS (Host): Welcome. We're diving into the creation of the Gay and Bisexual Men's Urology Program at Northwestern Medicine, the first clinic of its kind. Today, on Better Edge, a Northwestern Medicine podcast for physicians. I'm Melanie Cole, and joining me is Dr. Channa Amarasekera. He's an Assistant Professor of Urology at Northwestern Medicine. Dr. Amarasekera, thank you so much for joining us today. Can you explain how the Gay and Bisexual Men's Urology Program at Northwestern Medicine came about? Tell us a little bit about that.

Channa Amarasekera, MD: Thanks for having me, Melanie. The Gay and Bisexual Men's Urology Program came about after we did some research at the Department of Urology at Northwestern. We were looking into what health disparities exist within LGBT populations when it comes to urologic care, and we noticed that a lot of our LGBT-identifying patients did not think that they were getting the type of care that they wanted, and there was a disconnect between what we thought we were providing and what the patients found that they were getting.

So, we wanted to figure out how best to identify what the areas of improvement were and then how to go about implementing that. And we initiated this program where we have a space for gay and bisexual men to discuss their urologic problems. In addition to the Gay and Bisexual Men's Urology Program, there's also a Gender Pathways Program for transgender individuals, and we work in concert with that program.

Melanie Cole, MS: Well, thank you for that. How did the focus groups with gay and bisexual men with prostate cancer survivors at Northwestern Medicine contribute to identifying gaps in that care and inspire that creation of this program?

Channa Amarasekera, MD: Yeah, I think one of the biggest assets of this community is the community itself. community has gone through a great deal of medical stress, particularly when it came to the HIV epidemic of the 1980s. And a lot of those men are now coming to an age where they have to deal with prostate cancer. So, they've helped themselves through this HIV epidemic and there's really nice infrastructure within the community of being really open and connecting with other gay and bisexual men when it comes to other health problems. And we figured it would be a great idea to create a forum for gay and bisexual men with prostate cancer to talk to each other and figure out what they're experiencing, find what works, what doesn't, and sort of create this community for them where they can interact with each other.

Melanie Cole, MS: You mentioned the importance of rectifying barriers in the structural environment and systemic environment for an LGBTQIA+ focused clinic. Can you elaborate a little bit on the specific barriers addressed by your program and how you seek to overcome them?

Channa Amarasekera, MD: I think one of the biggest barriers is identifying patients who identify as LGBTQ. And often, the onus is on these patients to come out to their providers, which can be a very stressful situation for the patients. We eliminate that barrier by giving them the option to identify in the medical record if they identify as LGBTQ+. There's a place where they can tick that box. And so, they don't have to have that stressful conversation. It's already happened before they get to us. So, we can identify who it is that needs perhaps different counseling compared to their heterosexual peers. That's one barrier that we've identified, and it's a really easy thing to fix. But for a long time, that wasn't part of our program at Northwestern. And now, thankfully, we've implemented that.

Another barrier is when it comes to measures of sexual function. Oftentimes, the tools that we have just focus on erectile function, which may or may not be appropriate for men who identify as LGBTQ. So for these men, you know, the mechanics of sexual activity might be a little bit different, and erectile function may not be as important. Rectal health and prostate, health might be a little more important for some of these men. So, creating questionnaires and asking them about what their sexual practices are has been a different approach to these men that is novel, and that's something we pride ourselves on here.

Melanie Cole, MS: What important aspects. And I think another important aspect is how your program integrates psychosocial support with urologic care. Can you speak about the impact that that has on patient satisfaction with posttreatment rehabilitation?

Channa Amarasekera, MD: I think psychosocial care is a big part of oncologic care, and that begins with the time of diagnosis. So, if you counsel these patients with taking into account their sexuality, and in that context, you give them this personalized treatment approach, I think the patients trust their healthcare team a little bit more, and that's everything when it comes to healthcare for cancer patients, because they're much more likely to adhere to your treatment plan and do the things that you need them to do to help them through their prostate cancer recovery.

Melanie Cole, MS: Dr. Amarasekera, how does the program involve the community in intervention design? And how does their input contribute to bridging research and clinical care?

Channa Amarasekera, MD: I think that's a great question. So, one of the things that we noticed is we thought that maybe the questions for sexual function weren't appropriate. But when it comes to figuring out the right questions, you really have to pose the question to the community and see what's important and get a diverse set of members to weigh in on these questionnaires.

So, we had focus groups where we had about 30 LGBTQ+ individuals look at all the questionnaires that we have for assessing sexual function. And then, we ask them what's good about this, what's not, what would you change. And based on their input, we're developing a new sexual health questionnaire to specifically assess this population.

Melanie Cole, MS: As your program looks to the future, how do you plan to ensure that clinical care evolves with new research findings and community needs?

Channa Amarasekera, MD: We're always evolving. You know, we're learning from our patients. And we're also learning from the community of primary care doctors and other physicians who serve this population. So, there's constant feedback from both patients and other clinical members to modify our programs where it's appropriate and sort of fine tune things. So, you know, if we don't change, there's really no growth when it comes to this program. And we're constantly listening figure out how best to optimize things.

Melanie Cole, MS: Dr. Amarasekera, you've given us such great information today. What advice would you like to give other urologists who are treating gay and bisexual male patients?

Channa Amarasekera, MD: I think identifying these patients goes a long way and creating a demographics form that's inclusive of LGBTQ+ patients can help these physicians tailor their discussions to LGBTQ+ patients. And it takes the burden off these patients of having to come out to urologic providers.

There are a great number of resources when it comes to educating doctors about LGBTQ+ issues with urologic care, and our website serves as a great resource. So, if you type in Gay and Bisexual Men Urology Program at Northwestern, there is a link to resources that are available to you.

Melanie Cole, MS: Thank you so much, Dr. Amarasekera, for joining us today, and for telling us about Northwestern Medicine's Gay and Bisexual Men's Urology Program. To refer your patient or for more information, please visit breakthroughsforphysicians.nm.org/urology to get connected with one of our providers. That concludes today's episode of Better Edge, a Northwestern Medicine podcast for physicians. I'm Melanie Cole.