Emergency Department Query for Patient-Centered Approaches to Sexual Orientation and Gender Identity

Abstract

and The Joint Commission recommend routine documentation of patients' sexual orientation in health care settings. Currently, very few health care systems collect these data since patient preferences and health care professionals' support regarding collection of data about patient sexual orientation are unknown.OBJECTIVE To identify the optimal patient-centered approach to collect sexual orientation data in the emergency department (ED) in the Emergency Department Query for Patient-Centered Approaches to Sexual Orientation and Gender Identity study. DESIGN, SETTING, AND PARTICIPANTS An exploratory, sequential, mixed-methods design was used first to evaluate qualitative interviews conducted in the Baltimore, Maryland, and Washington, DC, areas. Fifty-three patients and 26 health care professionals participated in the qualitative interviews. Interviews were followed by a national online survey, in which 1516 (potential) patients (244 lesbian, 289 gay, 179 bisexual, and 804 straight) and 429 ED health care professionals (209 physicians and 220 nurses) participated. Survey participants were recruited using random digit dialing and address-based sampling techniques. MAIN OUTCOMES AND MEASURESQualitative interviews were used to obtain the perspectives of patients and health care professionals on sexual orientation data collection, and a quantitative survey was used to gauge patients' and health care professionals' willingness to provide or obtain sexual orientation information.RESULTS Mean (SD) age of patient and clinician participants was 49 (16.4) and 51 (9.4) years, respectively. Qualitative interviews suggested that patients were less likely to refuse to provide sexual orientation than providers expected. Nationally, 154 patients (10.3%) reported that they would refuse to provide sexual orientation; however, 333 (77.8%) of all clinicians thought patients would refuse to provide sexual orientation. After adjustment for demographic characteristics, only bisexual patients had increased odds of refusing to provide sexual orientation compared with heterosexual patients (odds ratio, 2.40; 95% CI, 1.26-4.56). CONCLUSIONS AND RELEVANCEPatients and health care professionals have discordant views on routine collection of data on sexual orientation. A minority of patients would refuse to provide sexual orientation. Implementation of a standardized, patient-centered approach for routine collection of sexual orientation data is required on a national scale to help to identify and address health disparities among lesbian, gay, and bisexual populations.

Patient–Provider Communication Barriers and Facilitators to HIV and STI Preventive Services for Adolescent MSM

“…535429 . In contrast, consistent with surveys of older LGBTQ patients, almost half our participants indicated they would be comfortable answering physician questions regarding their sexual orientation 5556 . Given the increased HIV and STI risk among AMSM, health care providers cannot afford to wait for young patients to raise the subject, since as our study and prior research indicates adolescents often do not disclose information critical to sexual health for fear of practitioner bias and do not view health care providers as a primary source for sexual health information 474557 .…”

Collecting sexual orientation and gender identity information in the emergency department : the divide between patient and provider perspectives

“…Fifty-three patient participants and 26 provider participants were interviewed, details of whom have been reported previously 12. Demographics are provided in table 1.…”

“…However, to ensure successful implementation of SO/GI collection, it is important to understand the perspectives of key stakeholders, which include patients and providers. In a previous report,12 we demonstrated that patients and providers have divergent views on the importance of collecting this information. While we have recently published brief initial qualitative findings from the initial phase used to inform the overall project strategy,12 the purpose of this current report is to provide in-depth exploration of patient and provider perspectives concerning the importance of collection of patient SO/GI in the ED.…”

“…This study is part of a multiphase mixed methods research programme known as Emergency Department Query for Patient-Centred Approaches to Sexual Orientation and Gender Identity,12 which seeks to identify and test the optimal patient-centred way to collect SO/GI data. This study recruited ED providers and adult patients from the greater Baltimore and Washington DC metropolitan area.…”

Patients want us to ask about their sexuality and gender

“…In this edition of EMJ , Kodakek4 and her team from the EQUALITY (Emergency Department Query for Patient Centered Approaches to Sexual Orientation and Gender Identity) mixed methods multiphase study5 in the USA examined the vast discrepancy between patient and healthcare professional attitudes towards routinely collecting information about GI and SO. Their qualitative investigation revealed a majority affirmation by patients that these questions should be asked.…”