Experiences of Inclusion and Exclusion Across the Gynaecological Cancer Continuum for Individuals With Diverse Gender and Sexuality Backgrounds: A Systematic Review

OBJECTIVE: Despite growing research on cancer care and survivorship among LGBTQIA+ populations, studies specific to gynaecological cancer care remain limited. This review explores experiences of inclusion and exclusion in gynaecological cancer care services for LGBTQIA+ individuals. METHODS: A systematic search was conducted in August 2024, retrieving 4000 results, of which 15 met the inclusion criteria. Critical appraisal was conducted using the Mixed Methods Appraisal Tool, and a convergent integrated approach was applied with narrative synthesis of findings according to the socio-ecological model of health. RESULTS: All articles focussed on cervical screening. Experiences of inclusion and exclusion across intrapersonal, interpersonal, and organisational levels related to the socio-ecological model. At the intrapersonal level, lack of individual knowledge and gender dysphoria contributed to exclusion, while access to information and supportive screening experiences fostered inclusion. Interpersonal factors associated with exclusion were inadequate provider knowledge, poor communication, lack of sensitivity and fear of speculum insertion due to experiences of pain, while inclusion was associated with strong patient-provider relationships and knowledgeable, affirming care. At the organisational level, exclusion stemmed from binary intake forms, gendered environments, insurance issues, and absence in heath resources, while inclusive strategies, such as non-gendered waiting rooms, inclusive materials, and appropriate insurance coverage supported engagement. CONCLUSION: Improved health literacy, healthcare provider knowledge, and welcoming clinical environments are key to inclusive cervical screening experiences for LGBTQIA+ individuals. Despite the initial aim to review care across the gynaecological cancer continuum, available studies focussed only on cervical screening. Research is urgently needed to inform inclusive practices across all tumour types and stages of gynaecological cancer care.