Can Asking Sexual Orientation Hurt Patient-Provider Communication?

Questions about patient sexual orientation or gender identity likely will not harm patient-provider communication, according to new research from the Mayo Clinic. Instead, these questions can better inform providers, enhance patient care, and address health inequity.

The benefits of knowing and understanding a patient’s sexual orientation and gender identity are not lost on providers. Healthcare professionals who record this information are better able to understand a patient’s current health status and can help make better considerations for treatment.

Additionally, patients in gender and sexual minorities often experience health inequity. These populations see higher rates of alcohol and tobacco use, as well as mental or behavioral health issues, the researchers explained. Separate research has shown that gender and sexual minorities seek healthcare at disproportionately low rates compared to other patient populations.

Identifying patients who may experience health inequities is one step toward addressing those inequities, healthcare professionals have maintained.

Despite those benefits, some providers have avoided asking patients about their sexual orientation or gender identity. These may be perceived as overly invasive questions, clinicians have reasoned, and asking those questions could harm the patient-provider relationship.

There is substance to provider concern – recent research has shown that patients are aware of provider bias, and may be reluctant to divulge personal information of not entirely necessary.

“In previous studies, there was more concern from health care providers about using the questions, but nobody had asked patients about their thoughts,” said study co-author Joan Griffin, PhD, a health services researcher at Mayo. “Therefore, we were not sure what to expect from patients, but we were not surprised that patients were less concerned about the questions than the providers in other studies thought they would be.”

Mayo Clinic researchers tested patient receptiveness to being asked about sexual and gender preferences during care encounters.

The Clinic introduced sexual and gender preference questions into three of their Minnesota facilities between June 2015 and February 2016. Each site treated a broad range of patients – one focuses on women’s health, another on patients older than 65, and the last on rural patients. The researchers sought a diverse patient panel to yield generalizable results.

Patients were randomly divided into two groups, one receiving traditional patient intake forms and the other receiving the forms with sexual and gender preference questions on it.

After comparing patient attitudes toward either form, the researchers concluded that 97 percent of patients are receptive to being asked about their sexual orientation and gender identity.

“Our results should help ease the concerns of providers who want to deliver the highest-quality care for their patients but may not ask sexual orientation or gender identity questions for fear of distressing or offending their patients,” Griffin reported.

With that support, the Mayo Clinic has decided to fully integrate the following questions into its routine intake forms as a part of a new medical records rollout:

• What sex were you assigned at birth on your original birth certificate? (male, female or choose not to answer)
• What is your current gender identity? (male, female, female-to-male/transgender male/trans man, male-to-female/transgender female/trans woman, gender queer/neither exclusively male nor female, additional gender category/other [describe] or choose not to answer)
• Do you think of yourself as … (lesbian/gay/homosexual, straight/heterosexual, bisexual, something else [describe], don’t know or choose not to answer)
• What is your preferred gender pronoun? (he/him, she/her, something else [describe] or choose not to answer)

The researchers acknowledged that they may need to test their questions on a national patient population before they can draw solid conclusions.

“These findings may generalize to relatively similar areas in the country, especially the Midwest, but there may be differences in other regions in the US or by cultural groups that we did not capture in our sample,” Griffin pointed out.

Additionally, the researchers offered advice for other providers or healthcare organizations considering integrating sexual and gender preference questions into their patient intake forms. Clinicians should explain why they are asking those questions, for example, to give patients context and to garner patient trust. It may also be helpful to remind patients of confidentiality, privacy, and security safeguards in place to protect patient information.

“At Mayo Clinic, the needs of the patient come first,” Griffin concluded. “These questions will help Mayo Clinic identify the unique, unmet needs of LGBTI patients and highlight that equitable care for all people is a top priority.”