Patients who are sexual or gender minorities feel more comfortable and are more forthcoming when sexual orientation and gender identity information is collected using nonverbal self-report, according the results of the EQUALITY study published in JAMA Network Open.
Healthcare disparities exist among the 4% of the US population that identifies as a sexual or gender minority. Better recognition of this population may facilitate improved access and care, and so some have called for routine collection of sexual orientation and gender identity information.
Adil Haider, MD, MPH, of the Center for Surgery and Public Health at Brigham & Women’s Hospital, Harvard Medical School, and the Harvard T.H. Chan School of Public Health in Boston, Massachusetts, and colleagues tested 2 sexual orientation and gender identity collection approaches (nurse verbal collection during the clinical encounter and nonverbal collection during patient registration) to determine the optimal patient-centered approach to be used in the emergency department (ED) setting. The sexual orientation and gender identity collection was followed by a detailed survey, which included a modified Communication Climate Assessment Toolkit (CCAT) score and additional patient satisfaction measures.
The investigators analyzed data from patients enrolled in the EQUALITY study in 4 EDs on the East Coast between February 2016 and March 2017. They initially enrolled 213 patients who identified as sexual or gender minorities and who completed the outcome surveys. The investigators matched 208 individuals who did not identify as a sexual or gender minority individuals and 213 who left the field blank to the enrolled sexual or gender minority patients. Of the patients in the matched groups, the investigators included 540 patients who had complete survey data in the final analyses.
Although no significant differences occurred between the 2 approaches for non-sexual or gender minority patients, among sexual or gender minority patients, mean modified CCAT scores were 6 points higher for those whose sexual or gender identity information was collected nonverbally during registration compared with nurse verbal collection during the clinical encounter. The odds of having a higher CCAT score for sexual or gender minority patients were 1.98 using the nonverbal collection method compared with the nurse verbal collection method. After adjusting for age, race, illness severity, and site, sexual or gender minority patients increased their odds of a better CCAT score by 2.57 with nonverbal sexual orientation and gender identity collection.
Study limitations included the low sexual orientation and gender identity collection rates for both approaches among the study population of 23,372 patients because of the non-compulsory nature of the collection, the ED setting, and the answer options that each hospital system chose for the sexual orientation and gender identity questions, which may have resulted in missed patients. Furthermore, patients with a psychiatric diagnosis were not eligible for study inclusion. As sexual or gender minority patients have a disproportionate incidence of poor mental health, sexual or gender minority patients who may have benefitted most from a more sensitive approach may have been missed.
The authors suggested that for many sexual or gender minority patients, disclosing sexual orientation and gender identity to a clinician may be very difficult, and they argue that implementing sexual orientation and gender identity collection in a patient-centered manner is crucial.
Haider A, Adler RR, Schneider E, et al. Assessment of patient-centered approaches to collect sexual orientation and gender identity information in the emergency department. The EQUALITY Study. JAMA Netw Open. 2018;1(8):e186506.