Is It Okay To Ask: Transgender Patient Perspectives on Sexual Orientation and Gender Identity Collection in Healthcare

Abstract

Objective: The National Academy of Medicine and Joint Commission recommend routine documentation of sexual orientation (SO) and gender identity (GI) in healthcare to address lesbian, gay, bisexual, or transgender (LGBT) health disparities. We explored transgender patient-reported views on the importance on SO/GI collection, their willingness to disclose, and their perceived facilitators of SO/GI collection in primary care and emergency department (ED) settings. Methods:We recruited a national sample of self-identified transgender patients. Participants completed demographic questions, survey questions, and free-response comments regarding their views on SO/GI collection. Data were analyzed using descriptive statistics; inductive content analysis was conducted with openended responses.Results: Patients mostly self-identified as male gender (54.5%), white (58.4%), and SO other than heterosexual or LGB (33.7%; N = 101). Patients felt that it was more important for primary care providers to know their GI than SO (89.1% vs. 57%; p < 0.001); there was no difference among reported importance for ED providers to know the patients' SO versus GI. Females were more likely than males to report medical relevance to chief complaint as a facilitator to SO disclosure (89.1% vs. 80%; p = 0.02) and less likely to identify routine collection from all patients as a facilitator to GI disclosure (67.4% vs. 78.2%; p = 0.09). Qualitatively, many patients reported that medical relevance to chief complaint and an LGBT-friendly environment would increase willingness to disclose their SO/GI. Patients also reported need for educating providers in LGBT health prior to implementing routine SO/ GI collection. Conclusions:Patients see the importance of providing GI more than SO to providers; nonetheless they are willing to disclose SO/GI in general.. Findings also suggest that gender differences may exist in facilitators of SO/ GI disclosure. Given the underrepresentation of transgender patients in healthcare, it is crucial for providers to address their concerns with SO/GI disclosure, which include LGBT education for medical staff and provision of a safe environment.

Surveillance of cancer among sexual and gender minority populations: Where are we and where do we need to go?

“…A national study showed that 78% of clinicians felt that their patients would refuse to disclose their SGM status, in stark contrast to only 10% of patients reporting that they would refuse to disclose their status, citing improved individualized care as a benefit to disclosure. [10][11][12] In a recent national survey of nearly 150 oncologists from National Cancer Institute-designated cancer centers across the United States, Schabath and colleagues measured the attitudes, knowledge, institutional practice behaviors, and interest in education on the care of LGBTQ patients with cancer. 13 They found that although a majority of oncologists, approximately two-thirds, felt that it was important to know a patient's gender identity, only about one-third felt that it was relevant to them to know of the patient's sexual orientation.…”

Patients want us to ask about their sexuality and gender

“…They desire a relationship with us; seeking trust, mutual respect and empathy 2. Disclosing GI and SO can be a nerve-wracking moment for a patient.…”

Improving Care of Transgender Patients

“…The recent publication, “Is It Okay To Ask: Transgender Patient Perspectives on Sexual Orientation and Gender Identity Collection in Healthcare,” is significant in its discussion of circumstances affecting willingness of transgender patients to disclose gender identity and sexual orientation as well as the participants’ focus on the need for improved LGBT education for medical staff. The authors also emphasize the importance of safe environments in primary care settings and emergency departments where providers may pose questions regarding intimate issues.…”

“…The recent publication by Maragh‐Bass et al . provides valuable insight into willingness of transgender patients to disclose issues of sexual identity and gender orientation as well as feelings that inadequate current medical training and comfort of healthcare professionals cannot ensure their community receives welcoming and thoughtful care . Maragh‐Bass et al.…”

“…Maragh‐Bass et al. lend credence to the need to improve LGBT medical education so that patients with gender dysphoria receive knowledgeable, empathetic, and sensitive care . VA has instituted policies to ensure that transgender veterans receive such care to reduce healthcare disparities .…”