Patients Seeking Care in Emergency Departments Prefer to Nonverbally Disclose Sexual Orientation and Gender Identity—Are We Ready to Act?
Year: 2018
Type: article
Abstract: The health needs of sexual and gender minority (SGM) individuals have increased to national attention and recognized as a health disparity population by the National Institutes of Health.The ability to progress in research, policy, and the provision of evidence-based care for SGMs has been limited by the lack of routine collection of sexual orientation and gender identity (SOGI) data in health care settings.The Institute of Medicine and The Joint Commission have recommended the collection of SOGI information, mandated per the Meaningful Use Stage 3 Guidelines, 1,2 for health systems that use electronic health records.While both SGM and heterosexual and cisgender patients have indicated they are comfortable disclosing their SOGI information, 3 significant barriers remain for the universal implementation of SOGI data collection, and the most effective methods to collect this information across health care settings have not yet been validated or mandated in state and national registries.Haider and colleagues 4 report on phase 3 of their Emergency Department Query for Patient-Centered Approaches to Sexual Orientation and Gender Identity (EQUALITY) Study to identify the best patient-centered approach for SOGI data collection in emergency departments (EDs).Identifying an efficient and culturally sensitive method for collecting SOGI information in the ED is particularly relevant because, as the authors note, it is a frequent source of care for uninsured and underinsured patients and SGMs are at greater risk for being uninsured compared with their cisgender and heterosexual counterparts.4,5 The authors found SGM patients reported significantly greater satisfaction when SOGI information was collected nonverbally compared with verbally.Why does this matter?To reduce health disparities among SGM individuals and improve population health surveillance and clinical care, clinicians and health systems must work to provide a safe and welcoming place in which patients feel comfortable sharing their SOGI information.Complex individual, interpersonal, and systemic barriers affect willingness to disclose and willingness to collect SOGI information.Patients have real fears of discrimination, physical safety, and privacy concerns, which can prevent disclosure of sexual orientation, gender identity, or risk behaviors, 5,6 particularly in the setting of EDs.Sexual and gender minorities are more likely than their heterosexual and cisgender counterparts to visit the ED for reasons such as intimate partner violence, mental health concerns, substance abuse, and lack of insurance for general preventive health care.7 Lack of culturally sensitive and knowledgeable clinicians can influence patients' perceptions of safety and confidentiality and impede their ability to discuss all aspects of their health.8 Precision-based, or patient-centered, approaches have shown the efficacy of treating the whole patient and not just the symptoms or the disease.Haider and colleagues 4 showed the importance of a patient-centered approach in identifying optimal and evidence-based methods to collect patient SOGI information.Universal implementation of SOGI data collection remains a challenge in the ED.The collection of SOGI data are not universally mandated and thus was not mandatory for the study sites, and only 18% of patients in the verbal mode and 4% of patients in the nonverbal mode were asked to disclose SOGI information.In addition to patient fears surrounding disclosure, physician and institutional factors often limit the ability to implement SOGI data collection.Clinicians and registrars may assume +
Source: JAMA Network Open
Language: English
Subfield: Social Psychology
Field: Psychology
Domain: Social Sciences
Open Access status: gold
Estimated APC paid: $3,000
Funder: National Cancer Institute
OpenAlex ID: W2907308785