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Collecting sexual orientation and gender identity information in the emergency department : the divide between patient and provider perspectives
  1. Lisa M Kodadek1,
  2. Susan Peterson2,
  3. Ryan Y Shields3,
  4. Danielle German4,
  5. Anju Ranjit5,
  6. Claire Snyder6,7,
  7. Eric Schneider8,
  8. Brandyn D Lau9,10,11,12,
  9. Adil H Haider5
  1. 1 Department of Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
  2. 2 Department of Emergency Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
  3. 3 Department of Obstetrics, Gynecology and Reproductive Sciences, Yale School of Medicine, New Haven, Connecticut, USA
  4. 4 Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
  5. 5 Center for Surgery and Public Health, Harvard Medical School and Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
  6. 6 Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
  7. 7 Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
  8. 8 Department of Surgery, University of Virginia, Charlottesville, Virginia, USA
  9. 9 Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
  10. 10 Division of Health Sciences Informatics, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
  11. 11 Armstrong Institute for Patient Safety and Quality, Johns Hopkins Medicine, Baltimore, Maryland, USA
  12. 12 Center for Transgender Health, Johns Hopkins Medicine, Baltimore, Maryland, USA
  1. Correspondence to Dr Lisa M Kodadek, Department of Surgery, Vanderbilt University Medical Center, Nashville TN 37212, USA; lisa.kodadek{at}vumc.org

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.

  • emergency department
  • research, epidemiology
  • qualitative research

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Footnotes

  • Contributors AHH, BDL and SP conceived the study and obtained research funding. DG, CS, ES, BDL and AHH designed and supervised the conduct of the study. LMK, RYS and AR undertook enrolment of participants, data acquisition and data management. LMK, RYS and DG performed data analysis and ensured data quality control. LMK drafted the manuscript, and all authors contributed substantially to its revision. All authors take full responsibility for the paper as a whole.

  • Funding This work is supported by a contract (AD-1306-03980) from the Patient-Centered Outcomes Research Institute (PCORI) entitled ’Patient-Centered Approaches to Collect Sexual Orientation/Gender Identity Information in the ED'.

  • 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.

  • Patient consent Obtained.

  • Ethics approval The Johns Hopkins Medicine Institutional Review Board in Baltimore, Maryland approved this study.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Collaborators Levine, Adele Brigham and Women’s Hospital, Center for Surgery and Public Health One Brigham Circle 1620 Tremont St Boston, Massachusetts, USA 021206175257300.

  • Presented at This work was presented in abstract form at the American College of Emergency Physicians (ACEP) meeting in Boston, Massachusetts in October 2015.

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