P3A048: Do Say Gay: Talking with Patients and Families About Sexual Orientation and Gender Identity

Background: Transgender and gender diverse (TGD) youth are more likely than their peers to experience poor physical health and are at higher risk of depression, anxiety, self-harm and suicide. Research shows LGBTQ youth value opportunities to discuss their gender and sexuality with their healthcare providers. In addition, addressing TGD youth by their chosen or preferred name is associated with decreased rates of depression and suicide. Initiating conversations about sexual orientation and gender identity is a vital first step in affirming patients’ identities and can be lifesaving.

Project Description: This advocacy project launched from a demonstrated need to improve healthcare outcomes of LGBTQ patients through creation of welcoming and inclusive care experiences while prioritizing patient confidentiality. An initial needs assessment demonstrated that there is: 1) a lack of primary evidence which describes how LGBTQ youth want to be asked about their sexual orientation and gender identity (SOGI) data, 2) inconsistency in internal workflows at our institution regarding the collection, storage, and use of SOGI data, 3) a need for advocacy to improve these workflows and data collection, and 4) there is no guidance for how a provider can act on SOGI data. An interdisciplinary team of clinicians, researchers, and students was assembled, and designed a four-part, ten-phase project (Fig 1). While the parts were meant to happen sequentially, they have been implemented simultaneously.

Discussion: Thus far, we have applied for and received a $20,000 grant to fund our research projects. We have worked with local, state, and national stakeholders to design and implement policy that provides explicit confidentiality protections for SOGI data in minors. Additionally, we have partnered with our primary care sites to process map SOGI data collection (Fig 2). The adolescent health questionnaire (AHQ) is a tablet-based survey given to adolescents at well visits to collect information, including SOGI data. There is ongoing work to implement best-practice for collection of SOGI data into the questionnaire with the primary care network. This practice gap highlights the need for a standardized, patient-centered approach to collecting, storing, and sharing SOGI data that could be utilized by providers to promote trust, ensure patient safety, and improve healthcare quality for LGBTQ youth.

Conclusion: Asking SOGI questions is a vital step in building patient-provider rapport and affirming a patient’s identity—interventions which can improve mental and physical health outcomes. SOGI data can be used to better understand social determinants of health and identify actionable issues in the broader environment of family and healthcare systems. Implementing practices which reflect patient-centered practices for collection, storage, and use of SOGI data will lead to improved healthcare outcomes by bolstering the provider-patient relationship and facilitating conversations with families around affirmation by leveraging the provider-parent-patient triad.