Interactions Between Health Professionals and Lesbian, Gay and Bisexual Patients in Healthcare Settings: A Systematic Review

Abstract

The ways in which health professionals (HPs) interact with individuals from sexual minorities can impact their perception of the health service and influence engagement. This systematic literature review aimed to identify and synthesize the qualitative literature exploring interactions between HPs and lesbian, gay and bisexual (LGB) patients in healthcare settings. A search strategy was developed and applied to CINAHL and Medline, inclusion criteria were then applied to results by two screeners with good agreement. Thematic analysis was carried out on papers meeting the inclusion criteria in three stages, beginning with coding the text line-by-line, developing descriptive themes and finally, analytical themes. Electronic searches identified 348 papers with 20 of these meeting the inclusion criteria. Thematic analysis found five themes; HPs' lack of knowledge regarding LGB specific issues, identification of sexual orientation, discomfort in interactions, LGB patients' experience of heteronormative attitudes and perceived judgment or other negative attitudes.

Supporting sexual and gender minority health-care workers

“…The potential for negative reactions weighs heavily on SGM HCWs, who often withhold their identities to preserve a therapeutic alliance or avoid discrimination from patients 4 . Alternatively, correcting a patient’s assumptions about a SGM HCW’s spouse or family structure can feel damaging to the therapeutic relationship, as the SGM HCW may feel they are causing an awkward interaction with a patient who is coming to them for help.…”

“…An analysis from 2018 found that up to 38% of SGM HCWs had not disclosed their identity in the workplace, owing to fears of job loss, potential harassment or discrimination 3 . Specific concerns included discomfort, heteronormative and cisnormative attitudes, use of inappropriate pronouns, delay of academic promotion, refusal of tenure and loss of patients 4 . Institution-mediated discrimination and professional isolation have been identified as reasons for SGM HCWs to leave practice environments or relocate 5 .…”

Attitudes of Physical Therapy Students in Israel toward People Identifying as Lesbian, Gay, or Bisexual: A Cross-Sectional Survey

“…Te frequently inadequate quality of healthcare provided to sexual minorities is often the result of lack of knowledge among healthcare professionals, insensitivity to the unique needs of this community, and a high prevalence of negative attitudes and stigmatic behavior [6]. A recent systematic review of the qualitative studies demonstrated the following fve themes in the interactions between health professionals and LGB patients in healthcare settings [7]: (1) lack of knowledge regarding LGB-specifc health issues, (2) inadequate disclosure of sexual orientation, (3) mutual discomfort (patients and healthcare providers) during interactions, (4) patients' experience of negative/heteronormative attitudes, and (5) patients' experience of negative behavior. Similar results were reported in a systematic review of the experience of sexual minority women concerning healthcare services in the UK, who experienced heteronormative attitudes, ignorance, and prejudice from healthcare professionals [5].…”

Primary Healthcare Nurse’s Barriers and Facilitators to Providing Sexual and Reproductive Healthcare Services of LGBTQI Individuals: A Qualitative Study

“…However, generally, nurses in South Africa are faced with skills, knowledge, and training challenges when providing SRHS to patients [ 2 ]. Specifically, studies conducted overseas have shown that nurses lack foundational knowledge and expertise in LGBTQI health needs [ 3 , 4 , 5 , 6 ]. This is because nurses were not taught during their studies about LGBTQI health needs [ 7 ].…”