Asking patients about sexual orientation, gender identity

Patients are open to being asked about their sexual orientation and gender identity in primary care, which can help make health care more welcoming, although the stage should be set for these questions and they should include a range of options, found a study published in CMAJ (Canadian Medical Association Journal).

"Understanding the social determinants of health, including gender identity and sexual orientation, is important for providing better health care as these are linked with outcomes," says Dr. Andrew Pinto, The Upstream Lab, St. Michael's Hospital, Toronto, Ontario. "Many transgender and gender-diverse people have negative experiences in health care that affect their health."

During the study, conducted at the St. Michael's Hospital Academic Family Health Team between Dec. 1, 2013, and Mar. 31, 2016, researchers asked questions on sexual orientation and gender identity. They offered a survey to 15 221 patients. A total of 90% of 14 247 respondents answered questions about sexual orientation and gender identity. The researchers also interviewed 27 patients of diverse age, gender identity, education level, language and immigration status to fully understand their reactions to these questions. Several themes emerged:

• Patients appreciated the variety of options on the surveys to indicate gender identity and sexual orientation
• Some LGBTQ2S (lesbian, gay, bisexual, queer, two-spirited) patients were uncomfortable answering the questions, as they recalled previous negative experiences related to gender or sexual orientation. Some cisgender and heterosexual patients were also uncomfortable.
• Despite a variety of responses provided on the survey, some patients did not see their identities reflected and suggested additional terms to include in future surveys.

"Our findings can inform health care organizations that wish to characterize their patients through routine collection of sociodemographic data," says Dr. Pinto. "Questions on gender identity and sexual orientation should include a range of flexible response options and definitions for clarity."