Keith Stewart
​Dr. Keith Stewart, Vice President Cancer at UHN and Director of Princess Margaret Cancer Centre, (C), gets a guided tour of the new eLearning course by Brendan Lyver as, (L to R), Dr. Gilla Shapiro, Margo Kennedy and Dr. Christian Schulz-Quach look on. (Photo: UHN)

It's a gamified approach to deliver a serious message.

In time for Pride Month, the Sexual and Gender Diversity in Cancer Care (SGDc) Program at Princess Margaret Cancer Centre has launched an eLearning course to help health care providers gain experience in four key topics of inclusion: pronouns, sexual orientation, gender identity and relationship diversity.

It uses avatars that allow learners to assume a variety of roles and choose to interact with patients who have different identities and life stories. The modules offer experience creating an inclusive environment for care providers in any medical program, but are particularly vital for those working with people who have cancer, says Dr. Christian Schulz-Quach, SGDc Program Director and a UHN clinician.

"In cancer care, we have a really significant mortality gap between the general population and some of our patients who are identifying as part of the queer community," says Dr. Schulz-Quach, a psychiatrist in the Department of Supportive Care at the Princess Margaret. “This has to do with barriers in the cancer care system and much work left to be done in creating a background of safety and safe clinical spaces when accessing the cancer care system, as well as creating lived inclusion for SGDc patients within the cancer health care system.

"That's why this is so important. It's not just about fun. It's about using gamifying to change mortality rates and to close the gap between the general population and our queer communities with cancer."

The e-Learning course was two years in development. Members of the SGDc Program collaborated with software developers, design students at OCAD University and patients offering ideas and feedback based on their own lived experience. It was made possible through a Princess Margaret Cancer Centre Young Leaders Program Grant and a UHN Cancer Experience Seed Fund Grant.

The result is an interactive video game design allowing learners to decide what topic to explore further – pronouns, gender identity, sexual orientation or relationship diversity. Once a selection is made, a few sentences of overview on that topic are offered before the learner creates their own health care provider avatar and then interacts with one of four patient avatars, who each have their own situation and identities.

Key contributors to the development of the eLearning course at a launch party in May, (L to R), Lauren Squires, Margo Kennedy, Yen-Ting (Mark) Chen, Yichi Chen, Dr. Christian Schulz-Quach, Samantha Scime, Brendan Lyver, Dr. Gilla Shapiro, Emily Taylor, Dr. Jennifer Croke, Erin Walker. (Photo: UHN)

The game takes learners through a visit with one of the patients – Chetan, Lexy, Max or Ross. The health care provider gets different prompts for conversation, with the patient reacting based on the choices made. If the language used is inclusive, the interaction is positive. If not, the patient becomes visibly upset, disengaged or quietly thinks to themself that they are not going to get the care they need.

"There's no grade or score," says Brendan Lyver, a section editor with the SGDc Program and Administrative Quality Lead, Workplace Violence Prevention at UHN. "It's about letting people practice, and practice getting it wrong, so they can become more inclusive in their communication with patients.

"We know health care providers want to do and say what's right, but they don't necessarily know how.

"We're hoping this new, innovative approach will help them do that."

iowyth hezel ulthiin, a patient liaison on the project, said for a person who is already “incredibly vulnerable" as they go through cancer treatment, "to not be able to be seen for who you are" can impact their ability to turn to health care professionals, which can be a significant barrier to the care they require.

"I hope this new learning module will be the first step of many important steps to making sure cancer care is inclusive of everyone, making sure that we're able to see the full person, and be able to intuit what it is that people actually need in order to feel safe, secure, held and eventually healed," iowth says.

Margo Kennedy, SGDc Clinical Lead and a social worker in the Department of Supportive Care at the Princess Margaret, paid special tribute to all the patients "who have given us really lovely and important feedback" on the eLearning course.

"When you think about going through cancer, that's enough to deal with, without having to educate health care providers along the way," she says. “But that's what we asked them to do, and our patients stepped up to help.

"We hope that in the future this (course) is going to eliminate the need for that."

In addition to the new eLearning course from the SGDc Program at the Princess Margaret, another tool for health care providers has been developed. BOW provides a quick snapshot of key identity factors and an example of how they relate to cancer care. BOW includes a set of slides as well as an infographic.

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