P4A225: Asking Adolescents and Young Adults About Their Sexual Orientation and Gender Identity: Lessons for Clinic Staff and EHR Documentation

Background: When healthcare providers make assumptions about patients’ sexual orientation or gender identity (SOGI), they miss opportunities for screening, risk causing distress, and can damage patient-provider relationships. Previous studies of gender diverse (GD) and lesbian, gay, and bisexual (LGB) adults have reported high levels of acceptance with their SOGI data being assessed and documented in the electronic health record (EHR), but less is known about adolescent and young adult (AYA) perspectives. Our study aimed to identify preferred approaches to collecting and documenting SOGI data from AYA.

Methods: This study was conducted at an academic adolescent medicine clinic in the northeastern United States between November 2022 to February 2023. Patients presenting to the clinic, which included four programs (primary care, gender, eating disorder, gynecology/menstrual health), were recruited. Participation was anonymous and voluntary. Paper questionnaires were administered by a medical assistant upon check-in during in-person visits. Demographics included SOGI and age. Likert scales were used to assess perceived importance of provider or staff assessing their SOGI and preferred method of assessment (via tablet, physician, etc.). Responses were entered into a REDCap database. All comparisons were performed using Pearson’s chi-squared or Fisher’s exact test where appropriate. All tests were two-sided; p-values < 0.05 were considered statistically significant. Patients were classified as GD and/or LGB based on responses.

Results: Two hundred and sixty patients completed the survey, ages 10 to 26 (most common age category 18-20, 32%). Fifteen percent of respondents were from the eating disorder program, 43% from gender, 34% from primary care, and 7% from gynecology/menstrual health. Overall, 129 (50%) were GD and 136 (52%) were LGB. Ninety-nine patients (38%) identified as both GD and LGB. Sixty four percent agreed it was important for providers to ask about gender identity, chosen name, and pronouns. More GD youth compared to cisgender youth agreed that asking about this data was important (83% v 45%, p< 0.001). Asking about sexual orientation was perceived as less important compared to gender identity. More LGB youth agreed with the importance of asking about sexual orientation compared to heterosexual youth (56% v 38%, p< 0.02). Seventy percent of AYA were comfortable being asked about their SOGI, and no single method was preferred over another. Over 96% of GD youth wanted their chosen name and pronouns displayed in EHRs.

Conclusion: Most AYA are comfortable being asked for their SOGI data in a healthcare setting. GD and LGB youth expressed higher rates of comfort than their cisgender and heterosexual peers for SOGI questions respectively. AYA did not have a preference on the SOGI collection method. Clinics should focus on integrating SOGI collection into their practice to provide more comprehensive care to AYA.