Provider Perspectives on the Application of Patient Sexual Orientation and Gender Identity in Clinical Care: A Qualitative Study
Provider Perspectives on the Application of Patient Sexual Orientation and Gender Identity in Clinical Care: A Qualitative Study
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DOI：
10.1007/s11606-018-4489-4
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发表时间：
2018-08-01
影响因子：
5.7
通讯作者：
Scheffey, Kathryn L.
中科院分区：
文献类型：
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作者：
Dichter, Melissa E.;Ogden, Shannon N.;Scheffey, Kathryn L.
联邦政府和其他组织建议医疗机构收集并记录患者的性取向和性别认同（SO/GI）信息，以增进对性少数和性别少数群体健康状况的了解，并消除现有的健康差异。然而，对于医疗服务提供者对患者SO/GI信息在临床相关性的认知，以及他们在个体护理中可能如何使用这些信息，人们知之甚少。为了探究医疗服务提供者对收集患者SO/GI信息的看法和经验，以及这些信息的了解如何影响临床护理。采用对医疗服务提供者进行深入个人访谈的定性研究。来自东海岸一个城市的单一医疗系统内家庭医学、内科、妇科和泌尿科的25名医疗服务提供者，包括医生、医师助理和执业护士。访谈进行了录音并逐字转录。使用扎根理论和主题分析的原则对转录文本进行编码和分析，以确定从数据中浮现的主题。医疗服务提供者认识到收集患者SO/GI信息对于理解人群层面的公共卫生问题和差异，以及理解和尊重患者生活背景的重要性。然而，医疗服务提供者也强调了解患者性行为和身体解剖结构对于解决健康风险和预防保健需求的重要性，并指出这些特征与患者SO/GI之间的区别。医疗服务提供者告诫说，基于对患者SO/GI了解的假设可能会无意中模糊患者行为和解剖结构的准确情况。除了常规收集患者SO/GI信息的潜在益处外，医疗服务提供者继续询问患者的行为和解剖结构以了解个体风险和需求评估也很重要。这项研究的结果可以为制定指南、培训和实践提供信息，以便将患者SO/GI信息与现有的评估实践相结合，以改善个体和人群的健康。
The federal government and other organizations have recommended that healthcare institutions collect and document patient sexual orientation and gender identity (SO/GI) information in order to advance the understanding of the health of sexual and gender minority populations and to combat existing health disparities. Little is known, however, about provider perception of the clinical relevance of, or how they might use, patient SO/GI information in individual care.To explore providers' perspectives on and experiences with collection of patient SO/GI information and how the knowledge of this information may impact clinical care.Qualitative study using in-depth individual interviews of healthcare providers.Twenty-five healthcare providers, including physicians, physician assistants, and nurse practitioners, from the fields of family medicine, internal medicine, gynecology, and urology within a single healthcare system in an east coast city.Interviews were recorded and transcribed verbatim. Transcripts were coded and analyzed using principles of grounded theory and thematic analysis to identify themes emerging from the data.Providers recognized the importance of collecting patient SO/GI information for understanding population-level public health concerns and disparities, as well as understanding and respecting the context of patients' lives. However, providers also emphasized the importance of knowing patients' sexual behaviors and physical anatomy for addressing health risk and preventive care needs-and noted the distinction between these characteristics and patient SO/GI. Providers cautioned that assumptions based on knowledge of patient SO/GI may unintentionally obscure accurate profiles of patient behavior and anatomy.Along with the potential benefits of routine collection of patient SO/GI, it is important that providers continue to inquire about patient behaviors and anatomy to inform individual risk and needs assessments. Findings from this study can inform the development of guidelines, trainings, and practices for incorporation of patient SO/GI along with existing assessment practices to improve individual and population health.