Care of Sexual and Gender Minorities in the Emergency Department: A Scoping Review

Kruse, Michael; Voloshin, Daniel; Wan, Melissa; Clarizio, A V; Bigham, Blair L.; Upadhye, Suneel

doi:10.1016/j.annemergmed.2021.09.422

Cited by 14 publications

(11 citation statements)

References 157 publications

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“…These data build on prior literature noting that, when ED HCPs are uncomfortable having sensitive conversations, such as those regarding sexual identity and HIV testing, they are more likely to be avoided. 26,27 The third stage that influenced the conduction of confidential conversations involved considerations regarding what needed to occur after the conversation, such as follow-up care and additional ED resources.…”

Section: Discussionmentioning

confidence: 99%

Factors influencing the conduction of confidential conversations with adolescents in the emergency department: A multicenter, qualitative analysis

Chernick

Bugaighis

Britton

et al. 2023

Academic Emergency Medicine

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Background Health care providers (HCPs) in the emergency department (ED) frequently must decide whether to conduct or forego confidential conversations with adolescent patients about sensitive topics, such as those related to mental health, substance use, and sexual and reproductive health. The objective of this multicenter qualitative analysis was to identify factors that influence the conduct of confidential conversations with adolescent patients in the ED. Methods In this qualitative study, we conducted semistructured interviews of ED HCPs from five academic, pediatric EDs in distinct geographic regions. We purposively sampled HCPs across gender, professional title, and professional experience. We used the Theoretical Domains Framework (TDF) to develop an interview guide to assess individual and system‐level factors affecting HCP behavior regarding the conduct of confidential conversations with adolescents. Enrollment continued until we reached saturation. Interviews were recorded, transcribed, and coded by three investigators based on thematic analysis. We used the coded transcripts to collaboratively generate belief statements, which are first‐person statements that reflect shared perspectives. Results We conducted 38 interviews (18 physicians, 11 registered nurses, five nurse practitioners, and four physician assistants). We generated 17 belief statements across nine TDF domains. Predominant influences on having confidential conversations included self‐efficacy in speaking with adolescents alone, wanting to address sexual health complaints, maintaining patient flow, experiencing parental resistance and limited space, and having inadequate resources to address patient concerns and personal preconceptions about patients. Perspectives divided between wanting to provide focused medical care related only to their chief complaint versus self‐identifying as a holistic medical HCP. Conclusions The factors influencing the conduct of confidential conversations included multiple TDF domains, elucidating how numerous intersecting factors influence whether ED HCPs address sensitive adolescent health needs. These data suggest methods to enhance and facilitate confidential conversations when deemed appropriate in the care of adolescents in the ED.

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Section: Discussionmentioning

confidence: 99%

Factors influencing the conduction of confidential conversations with adolescents in the emergency department: A multicenter, qualitative analysis

Chernick

Bugaighis

Britton

et al. 2023

Academic Emergency Medicine

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“…This is a novel review of sexual health promotion interventions for sexual and gender minorities specifically within primary care settings. This review fits into broader work, including scoping reviews around general healthcare for adolescent sexual and gender minority populations in primary care,41 integration of sex and gender considerations in health policymaking,42 care of sexual and gender minority populations in the emergency department43 and how COVID-19 impacted sexual health for marginalised groups, including sexual and gender minorities 44. Primary care represents a key setting of inquiry because it captures many socioecological levels of influence for positive and sustainable sexual health outcomes, ranging from individual to relational policy 16–19.…”

Section: Discussionmentioning

confidence: 99%

Sexual health promotion for sexual and gender minorities in primary care: a scoping review protocol

et al. 2023

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IntroductionSexual and gender minorities (SGMs) face health disparities related to systemic discrimination and barriers to sexual health. Sexual health promotion encompasses strategies that enable individuals, groups and communities to make informed decisions regarding their sexual well-being. Our objective is to describe the existing sexual health promotion interventions tailored for SGMs within the primary care context.Methods and analysisWe will conduct a scoping review and search for articles in 12 medical and social science academic databases on interventions that are targeted towards SGMs in the primary care context in industrialised countries. Searches were conducted on 7 July 2020 and 31 May 2022. We defined sexual health interventions in the inclusion framework as: (1) promote positive sexual health, or sex and relationship education; (2) reduce the incidence of sexually transmitted infections; (3) reduce unintended pregnancies; or (4) change prejudice, stigma and discrimination around sexual health, or increase awareness surrounding positive sex. Two independent reviewers will select articles meeting inclusion criteria and extract data. Participant and study characteristics will be summarised using frequencies and proportions. Our primary analysis will include a descriptive summary of key interventional themes from content and thematic analysis. Gender-based Analysis Plus will be used to stratify themes based on gender, race, sexuality and other identities. The secondary analysis will include the use of the Sexual and Gender Minority Disparities Research Framework to analyse the interventions from a socioecological perspective.Ethics and disseminationNo ethical approval is required for a scoping review. The protocol was registered on the Open Science Framework Registries (https://doi.org/10.17605/OSF.IO/X5R47). The intended audiences are primary care providers, public health, researchers and community-based organisations. Results will be communicated through peer-reviewed publication, conferences, rounds and other opportunities to reach primary care providers. Community-based engagement will occur through presentations, guest speakers, community forums and research summary handouts.

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Section: Sexually Transmitted Infectionsmentioning

confidence: 99%

“…Human Immunodeficiency Virus (HIV) is also often delayed in diagnosis amongst sexual and gender minorities [23 ▪ ]. Recent literature suggests that transgender women are at highest risk for new HIV infections [6,23 ▪ ]. It is important to maintain a low threshold to screen and test pediatric patients given TGD youth tend to engage in higher risk sexual behaviors than providers may assume [22].…”

Section: Sexually Transmitted Infectionsmentioning

confidence: 99%

Emergency care considerations for transgender and gender diverse youth: a review to improve health trajectories

Lillemoe

Holmstrom

Sojar

2023

Current Opinion in Pediatrics

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Purpose of reviewTransgender and Gender Diverse (TGD) youth represent a growing subset of pediatric patients who are at increased risk for harmful health outcomes. Consideration of these risks during emergency encounters may decrease these undesired, sometimes fatal, adverse events. Recent findingsGender affirmative care of TGD youth is considered a basic healthcare right as noted by several academic societies including the American Academy of Pediatrics, the American Academy of Child and Adolescent Psychiatry, and the American Psychological Association [1--3] (Table 1). Withholding gender affirmative care can lead to undesired health outcomes including but not limited to an increased incidence of mood disorders, self-injurious behavior, suicidal ideation, sexually transmitted diseases, and delayed presentations of treatable illness. TGD youth often access acute care settings, yet many feel apprehensive due to prior negative experiences or fear of discrimination. Practitioners are also often unaware as to how to effectively provide this type of healthcare.

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Care of Sexual and Gender Minorities in the Emergency Department: A Scoping Review

Cited by 14 publications

References 157 publications

Factors influencing the conduction of confidential conversations with adolescents in the emergency department: A multicenter, qualitative analysis

Factors influencing the conduction of confidential conversations with adolescents in the emergency department: A multicenter, qualitative analysis

Sexual health promotion for sexual and gender minorities in primary care: a scoping review protocol

Emergency care considerations for transgender and gender diverse youth: a review to improve health trajectories

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