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LGBT patients may prefer to report sexual orientation in writing

(Reuters Health) – LGBT patients treated in the emergency room (ER) are more comfortable reporting their sexual orientation on a medical form rather than in a discussion with a health care provider, a new study shows.

Patients in the study were two and a half times more likely to say they were comfortable reporting their orientation if it was done on a form rather than an interview with a nurse, researchers report in JAMA Network Open.

As of 2016, 12 million Americans, or four percent of the U.S. population, identified as sexual and gender minorities, according to a recent Gallup poll.

The new findings show that having people report their sexual orientation on a form during registration “is the best patient-centered way to collect sexual orientation and gender identity information in emergency rooms,” said study coauthor Adele Levine, a researcher at the Center for Surgery and Public Health at Brigham and Women’s Hospital. “We should collect these data like we do other demographic information, such as race, age and ethnicity.”

Her conclusions are drawn from a two-part experiment conducted at four ERs. In the first part, her team asked nurses to query patients about sexual orientation and gender identity as a component of the social history portion of the patient assessment. In the second part – which was run several months later – patients were asked to fill out a demographics information form that included sexual orientation and gender identity questions.

Patients who identified themselves as a sexual or gender minority (SGM) were invited to fill out a satisfaction survey. The researchers gave the same survey to non-SGM patients who were matched according to age and illness severity to those in the SGM group and also to a group that didn’t provide sexual orientation and gender identity information in the earlier part of the study. Overall, 540 patients ended up participating, with 180 in each of the three groups.

The satisfaction data showed that SGM patients were 2.57 times more likely to be satisfied with reporting their sexual orientation and gender identity on a form as compared to verbally.

Finding out the best way to ask the question is important because “healthcare organizations have been recommending collecting sexual orientation and gender identity information from patients,” Levine said. “From a population health standpoint, collecting these data can help identify if there are disparities in care and direct efforts to address these inequities. On a patient level, it can create a dialogue between patients and clinicians and promote a welcoming, inclusive environment.”

That SGM patients would prefer to report their orientation/identity in writing wasn’t a complete surprise to Joanne Goodall, a nurse practitioner with the Gender and Sexual Development Program at the Children’s Hospital of Pittsburgh at the University of Pittsburgh Medical Center.

One barrier to asking patients about their sexual orientation and gender identity is that “people don’t know how to address this,” said Goodall, who was not involved in the new study. What will make everyone more comfortable is “making it a normal part of the conversation,” she added. “Just as you’d ask: Do you have any allergies? Are you on any medications?”

And while this kind of information wouldn’t impact how a sprained ankle was treated, there are situations in which it would make a difference. Goodall remembers a colleague trying to figure out why a male patient seemed to have low lung function. When the patient revealed he’d transitioned from being female 20 years earlier everything became clear. He was born with smaller lungs and so, there was no problem, Goodall said.

In the end, Goodall said, “it comes down to respecting others and treating them in a humane way.”

SOURCE: JAMA Network Open, online December 28, 2018.

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