Exploring lesbian, gay, bisexual, and queer (LGBQ) people’s experiences with disclosure of sexual identity to primary care physicians: a qualitative study

Abstract

BackgroundIt has been demonstrated that health disparities between lesbian, gay, bisexual and queer (LGBQ) populations and the general population can be improved by disclosure of sexual identity to a health care provider (HCP). However, heteronormative assumptions (that is, assumptions based on a heterosexual identity and experience) may negatively affect communication between patients and HCPs more than has been recognized. The aim of this study was to understand LGBQ patients’ perceptions of their experiences related to disclosure of sexual identity to their primary care provider (PCP).MethodsOne-on-one semi-structured telephone interviews were conducted, audio-recorded, and transcribed. Participants were self-identified LGBQ adults with experiences of health care by PCPs within the previous five years recruited in Toronto, Canada. A qualitative descriptive analysis was performed using iterative coding and comparing and grouping data into themes.ResultsFindings revealed that disclosure of sexual identity to PCPs was related to three main themes: 1) disclosure of sexual identity by LGBQ patients to a PCP was seen to be as challenging as coming out to others; 2) a solid therapeutic relationship can mitigate the difficulty in disclosure of sexual identity; and, 3) purposeful recognition by PCPs of their personal heteronormative value system is key to establishing a strong therapeutic relationship.ConclusionImproving physicians’ recognition of their own heteronormative value system and addressing structural heterosexual hegemony will help to make health care settings more inclusive. This will allow LGBQ patients to feel better understood, willing to disclose, subsequently improving their care and health outcomes.

Shared Decision Making Among Clinicians and Asian American and Pacific Islander Sexual and Gender Minorities: An Intersectional Approach to Address a Critical Care Gap

“…Table 2 offers practical tips and resources for clinics and clinicians to incorporate into their practice with AAPI SGM. [22][23][24][25][26]34,35,[38][39][40][42][43][44][45][46] Interpersonal and structural prejudice or inappropriate care based on the patient's race, ethnicity, gender identity and expression, and sexual orientation can alienate patients and result in poor outcomes. Although the use of ethnicity and gender as visible proxies for behavior can be automatic, 4,64 stereotypes about ethnicity, gender, and sexual orientation can be incorrect and stigmatizing; rather, clinical care must be individualized and appreciative of the intersectional effects of each individual's culture and background.…”

“…38,39 Elicit sexual orientation and gender identity information in a culturally competent manner. 35,40 Avoid assuming an opposite sex partner or spouse. For example, instead of: ''Do you have a boyfriend or husband?''…”

“…We outline potential strategies for clinics and clinicians to improve cultural competency, communication, and SDM (Table 2). [22][23][24][25][26]34,35,[38][39][40][42][43][44][45][46] Finally, we recommend research, policy, community development, and education actions to mitigate SDM barriers for AAPI SGM (Table 3).…”

“…[19][20][21] Guided by a SDM conceptual model, 3 we identify common experiences of AAPI SGM that fall into three themes: (1) AAPI Heterogeneity, (2) SGM Stigma, and (3) Multiple Minority Group Identities and Sources of Discrimination (Table 1). [4][5][6][7][8]10,12,13,18,[22][23][24][25][26][27][28][29][30][31][32][33][34][35][36][37][38][39][40][41] We created three case studies to illustrate the intersectional issues that can occur in reallife patient-provider encounters among AAPI SGM. We outline potential strategies for clinics and clinicians to improve cultural competency, communication, and SDM (Table 2).…”

“…Erroneous presumptions based on race/ ethnicity, gender, and sexuality [4][5][6]33,36,37 Unconscious biases and nonverbal behavior leading to shaming and other discriminatory behavior during interpersonal interactions 25,35,36,[38][39][40] AAPI, Asian American and Pacific Islander; SGM, sexual and gender minorities.…”