Collecting sexual orientation and gender identity information in the emergency department : the divide between patient and provider perspectives - PubMed (original) (raw)

. 2019 Mar;36(3):136-141.

doi: 10.1136/emermed-2018-207669. Epub 2019 Jan 10.

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Collecting sexual orientation and gender identity information in the emergency department : the divide between patient and provider perspectives

Lisa M Kodadek et al. Emerg Med J. 2019 Mar.

Abstract

Background: In the USA, The Joint Commission and Institute of Medicine have called for collection of patient sexual orientation (SO) and gender identity (GI) information in healthcare. In a recent study, we reported that ED clinicians believe patients will refuse to provide this information; however, very few patients say they would refuse to provide SO/GI. As part of this study, we interviewed patients and providers regarding the importance of collecting this information. While these interviews were briefly summarised in our prior report, the qualitative data warranted a more thorough analysis and exposition to explore provider and patient views as well as risks and benefits of collecting SO/GI.

Methods: A purposive sample of 79 participants was recruited for semi-structured interviews between August 2014 and January 2015. Participants included community members who had a previous ED encounter and ED providers from 3 community and 2 academic centres in a major US metropolitan area. Interviews were conducted one-on-one in person, audio-recorded and transcribed verbatim. Data were analysed using the constant comparative method.

Results: Fifty-three patients and 26 ED providers participated. Patients perceived collection of SO/GI to be important in most clinical circumstances because SO/GI is relevant to their identity and allows providers to treat the whole person. However, many providers felt SO/GI was not relevant in most clinical circumstances because similar care is provided to all patients regardless of SO/GI. Patients and providers agreed there are risks associated with collecting SO/GI in the ED.

Conclusions: ED clinicians do not perceive routine collection of SO/GI to be medically relevant in most circumstances. However, patients feel routine SO/GI collection allows for recognition of individual identity and improved therapeutic relationships in the ED. These discordant perspectives may be hindering patient-centred care, especially for sexual and gender minority patients.

Keywords: emergency department; qualitative research; research, epidemiology.

© Author(s) (or their employer(s)) 2019. No commercial re-use. See rights and permissions. Published by BMJ.

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Conflict of interest statement

Competing interests: BDL is supported by the Institute for Excellence in Education Berkheimer Faculty Education Scholar Grant, a contract (CE-12-11-4489) from PCORI entitled ’Preventing Venous Thromboembolism: Empowering Patients and Enabling Patient-Centered Care via Health Information Technology', a contract (DI-1603-34596) from PCORI ’Preventing Venous Thromboembolism (VTE): Engaging Patients to Reduce Preventable Harm from Missed/Refused Doses of VTE Prophylaxis' and a grant from the AHRQ (1R01HS024547) entitled ’Individualized Performance Feedback on Venous Thromboembolism Prevention Practice', a grant from the NIH/NHLBI (R21HL129028) entitled ’Analysis of the Impact of Missed Doses of Venous Thromboembolism Prophylaxis', and a grant from the Department of Defense entitled The Pathogenesis of Post-Traumatic Pulmonary Embolism: A Prospective Multicenter Investigation by the CLOTT Study Group. AHH is PI on a Health Services Grant from the Department of Defense through the Henry M Jackson Foundation entitled ’Epidemiology and Provider Induced Collaboration'. AHH is co-founder and equity holder in Patient Doctor Technologies Incorporated which owns and operates the website www.doctella.com.

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