Disparities in breast cancer screening by race, and separately, by sexual orientation are documented; however, few studies have explored how the intersection of race and sexual identity contribute to breast cancer disparities for Black sexual minority women (SMW). We employed constructs from Self-Determination Theory (SDT; autonomy and relatedness) to explore the nature of healthcare provider interactions in breast cancer screening and care among Black SMW.

Participants were sampled nationally through Facebook posts and targeted emails via organizations serving Black SMW. We conducted qualitative in-depth interviews with 15 Black cisgender SMW, ages 38-64, who had a breast cancer diagnosis or abnormal mammogram. Interviews were conducted face-to-face or online, audio-recorded, and transcribed verbatim. Two analysts coded the interviews. Codes were analyzed across interviews to identify themes salient to SDT.

Themes aligned with the SDT constructs of relatedness and autonomy. Some participants discussed feeling most understood by Black and/or female providers who shared at least one of their identities. Feeling related through shared identity made patients feel seen and heard by their providers. Participants who discussed negative experiences with providers believed that the provider made negative assumptions about the participant based on her race and/or sexual orientation.

When interacting with healthcare providers for breast cancer screening, Black SMW face specific challenges related to their multiply marginalized social position. Reducing healthcare provider bias toward Black SMW may improve patients’ desires to continue in care. Providing equitable care while acknowledging and respecting women with multiply marginalized identities may improve the nature of these interactions.