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Patient Attitude and Satisfaction Questions by Experimental Group

Patient Attitude and Satisfaction Questions by Experimental Group

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Objectives: To (1) test whether patient attitudes toward intake forms at three Midwestern outpatient clinics are significantly more negative among those who are asked to complete SOGI questions versus those who are not; and (2) gain an in-depth understanding of patient concerns about SOGI questions. Study setting: Data were collected between 6/2...

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... were no significant differences in patient attitudes between the experimental and control groups in the proportions who answered agree, neither agree nor disagree, or disagree for any of the questions about the survey ( Table 2). The proportion of respondents indicating they agreed with the question, "Was filling out this questionnaire tiring?" was higher in the experimental group (22.6 percent, vs. 15.4 percent of the control group; p = .03) ...

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... The same group (Ruben et al., 2021) replicated these findings in a subsequent analysis, finding veterans as comfortable as non-veterans in disclosing information related to their gender identity and sexual orientation both during surveys and healthcare referrals/visits. Similarly, Rullo et al. (2018) found an acceptability rate of 97%. Alexander et al. (2020) interviewed 225 oncology patients who reported favourable perceptions regarding gender, sex-at-birth, pronoun, and sexual orientation questions. ...
... Previous research has shown that including SOGI questions in healthcare intake forms is acceptable, relevant, and important to patients and providers, especially since sexual and gender minorities experience significant health disparities and require care and services tailored to their unique needs (Cahill et al., 2014;Thompson, 2016;Dichter et al., 2018;Haider et al., 2018;Rullo et al., 2018;Pinto et al., 2019;Puckett et al., 2020;Lau et al., 2021). Importantly, these findings suggest that most individuals are not offended by SOGI questions. ...
... The experiment showed that employee biographies which explicitly identified the employee's gender pronouns resulted in more positive attitudes toward that workplace, and greater organizational attraction, commitment, and trust, relative to the biographies with pronouns absent. Another experimental study assessed participant attitudes toward gender pronouns and other SOGI questions when given a healthcare survey (Rullo et al., 2018). In that study, 491 patients from a large academic medical center were randomly assigned to complete either intake forms with SOGI questions (experimental) or intake forms without SOGI questions (control). ...
... It is also possible that being a cisgender individual, regardless of sexual orientation, does not drastically change the perception of typical demographic questions since there is no misalignment between biological sex and social gender identity. This finding supports the results found by Rullo et al. (2018), where no difference in participant attitudes were found between SOGI survey conditions in a predominantly heterosexual and cisgender sample. ...
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This research examines whether the mere presence of asking about gender pronouns (e.g., she/her, he/him, they/them, and ze/zir) in a survey enhances participants’ attitudes and satisfaction of answering the questions. A large sample ( N = 1,511) of heterosexual, cisgender, and LGBTQIA+ participants across the United States (US) were surveyed an online “personality test” (as a deception), with the real purpose of examining whether asking a pronoun question enhanced their perceptions of the survey. Three demographic groups were included: (i) heterosexual–cisgender ( n = 503), (ii) gay–cisgender ( n = 509), and (iii) genderqueer (trans, non-conforming, other, n = 499). Half of each group were randomly given either a survey that included a gender pronoun question (test) or not (control), and then all rated their perceptions of the survey questions. For participants who identified as heterosexual or gay, no major differences were found between survey conditions. However, participants who identified as genderqueer experienced significant increases of satisfaction, comfort level, and perceived relevance of the questions when given a survey that asked their gender pronouns versus the survey that did not. These findings have implications for any surveys that ask about personal demographics, and suggest that any form of written communication should include clarity about gender pronouns.
... Instead, the collection of SOGIE data as part of routine clinical practice has shown acceptable to most patients, including those who are heterosexual, cisgender, and older than 50 years of age. 21 Furthermore, failure to collect SOGIE data can result in negative repercussions, including the invisibility of sexual and gender diverse patients to policymakers and researchers 22 ; difficulties in tracking the preventative health needs of LGBTQ people 3 ; and reduced patient satisfaction due to failure to use LGBTQ-affirming communication skills. 23 To systematize SOGIE screening, primary care stakeholders can partner with electronic health record (EHR) vendors to develop systems for the administration of SOGIE questions and private storage of data within the EHR. ...
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Behavioral health concerns related to sexual and gender minority stress impair functioning and limit quality of life. With greater interest in implementing LGBTQ-affirmative health care practices, primary care providers likely will see larger numbers of LGBTQ individuals presenting with behavioral health concerns. Behavioral health and medical providers may not feel prepared to address the biological, psychological, social, and cultural minority stress factors that have an impact on LGBTQ patients. LGBTQ-affirmative behavioral health providers in primary care can offer a unique service by conducting tailored evaluations and individualized interventions targeting multifactorial influences that cause and perpetuate psychological distress in LGBTQ patients.
... This can be done on an intake form or as a prompt in an electronic medical record system [40]. Patients find the routine collection of gender identity information acceptable in healthcare settings [41]. Intake paperwork can be adjusted in order to include this information, and staff must be trained to answer questions about these items in a culturally responsive way. ...
Chapter
With growing visibility of diverse gender identities and communities, it is necessary for clinicians involved in eating disorder prevention, screening, and treatment to create affirming spaces for transgender and gender non-binary (T/GNB) patients and clients. Further underscoring this need, there is mounting evidence that T/GNB populations are at 2–4 times greater risk of experiencing eating disorder symptoms compared to their cisgender (i.e., non-transgender) counterparts. Although research on the risk and protective factors underlying these health inequities is growing, more epidemiologic and clinical research is urgently needed. This chapter synthesizes the current state of the science and provides recommendations for clinicians at all levels of familiarity with T/GNB populations, including clinicians who are just beginning to think about gender diversity in their practice as well as those who have expertise in this area and wish to identify next steps for their clinical care, research, and/or advocacy in the field.
... With regard to collecting information about patient sexual orientation and gender identity (SOGI), earlier studies indicate that 80% physicians were concerned that asking SOGI questions would offend patients; however, 97% of SGM patients were not offended by such questions and felt them to be a relevant part of their health care visit. 28 This demonstrates the need for further education to help health care providers feel comfortable and competent providing care to SGM patients. For bariatric practices to begin identifying SGM patients, the following items should be included in all intake forms: sexual orientation, gender identity, preferred pronoun, and preferred name. ...
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Background: This article has two aims: review current literature addressing sexual and gender minority (SGM) bariatric patients and describe a pilot study identifying sexual minority (SM) bariatric patients at an academic medical center. Methods: The literature review was conducted using keywords: lesbian, gay, bisexual, transgender, and bariatric. Our bariatric program's database from January 1, 2005 to September 10, 2015 was reviewed retrospectively. Chart review of partnered patients identified individuals with same-sex partners. Descriptive demographics and weight loss outcomes were obtained. Results: The literature review identified two articles about transgender bariatric patients and zero articles about SM bariatric patients. The database review yielded 5576 patients; 145 patients self-identified as partnered, including 16 (0.29%) with same-sex partners (11 women, 5 men). Mean age and preoperative weight were 40 years and 305 lbs (body mass index, BMI 48.5). Bariatric operations included 12 gastric bypass, 2 duodenal switch, 1 sleeve gastrectomy, and 1 gastric band. Twelve-month mean weight was 200 lbs (BMI 30, 50% excess weight loss) with 5 (31%) patients lost to follow-up. Conclusions: The published literature discussing SGM bariatric patients is limited. Within our case series, the SM bariatric patient population identified was 0.29%. Documentation of sexual orientation and gender identity within the bariatric screening process could better identify this population.
... With regard to collecting information about patient sexual identity, as well as gender identity, further education is needed to help healthcare providers feel comfortable and competent providing care to SGM patients. A prior study indicated that 80% of physicians were concerned that asking such questions would offend patients; however, 97% of SGM patients were not offended and felt them to be a relevant part of their healthcare visit [37]. Another study found that SGM patients were more comfortable reporting their sexual and gender identities via a nonverbal method (i.e., as part of a demographic form) rather than via in-person communication with a medical provider [38]. ...
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Background Disparities in obesity care and bariatric surgery persist among patients of diverse identities. However, little is known about sexual minority (SM) bariatric patients. Objectives This study sought to describe, in a preliminary fashion, sexual orientation variables of outness, self-esteem, and perceived discrimination among a sample of SM patients pursuing bariatric surgery. The study also sought to compare SM and heterosexual bariatric candidates on measures of eating behaviors, anxiety, and depression. Setting Academic medical center in the United States. Methods Data were collected as part of a standard psychological evaluation for surgical clearance between May 1st, 2018 and December 31st, 2019. Data included demographics, sexual orientation variables, eating behaviors, anxiety, and depression. Descriptive statistics were included to present findings among SM patients. One-way analyses of covariance (ANCOVAs) were conducted to assess differences between SM and heterosexual patients. Results A total of 633 patients were evaluated (38 SM and 595 heterosexual). SM patients had high outness scores with high self-esteem and minimal perceived discrimination. SM patients endorsed lower cognitive restraint, higher disinhibition and increased hunger compared to heterosexual patients (p < 0.05). SM patients also reported significantly more symptoms of anxiety and depression compared to heterosexual patients (p < 0.05). Conclusions Findings provide preliminary evidence toward the importance of assessing for sexual orientation among bariatric patients. Future research is warranted to assess the unique role of sexual orientation, as well as explore causal links between sexual orientation, eating behaviors, and mental health among bariatric patients pre- and post-surgery.
... Despite these extensive arguments for data collection and the successive rollout of several SOGI data initiatives, however, there is relatively little work that examines big data in action within the health systems expected to transform. Existing studies focus on the technical details of item responses, reporting relatively high levels of patient acceptability in support of data collection (Cahill et al., 2014;Rullo et al., 2018). But as promising as they may appear, these studies typically employ survey methods that miss crucial elements affecting health care delivery in everyday practice. ...
Article
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Large-scale data systems are increasingly envisioned as tools for justice, with big data analytics offering a key opportunity to advance health equity. Health systems face growing public pressure to collect data on patient “social factors,” and advocates and public officials seek to leverage such data sources as a means of system transformation. Despite the promise of this “data-driven” strategy, there is little empirical work that examines big data in action directly within the sites of care expected to transform. In this article, I present a case study on one such initiative, focusing on a large public safety-net health system’s initiation of sexual orientation and gender identity (SOGI) data collection within the clinical setting. Drawing from ethnographic fieldwork and in-depth interviews with providers, staff, and administrators, I highlight three main challenges that elude big data’s grasp on inequality: (1) provider and staff’s limited understanding of the social significance of data collection; (2) patient perception of the cultural insensitivity of data items; and (3) clinic need to balance data requests with competing priorities within a constrained time window. These issues reflect structural challenges within safety-net care that big data alone are unable to address in advancing social justice. I discuss these findings by considering the present data-driven strategy alongside two complementary courses of action: diversifying the health professions workforce and clinical education reform. To truly advance justice, we need more than “just data”: we need to confront the fundamental conditions of social inequality.
... Moreover, the use of electronic health record (EHR) prompts has been shown to significantly increase provider documentation of gender identity in the medical record [13]. When trialed in adult patients, questions on sexual orientation and gender identity were not distressing to 97% of heterosexual, cisgender patients [14]. The inclusion of gender questions on clinic forms in pediatric settings has not been studied, although interviews with transgender and genderqueer adolescents found this concept to be desirable [15]. ...
Article
Purpose Transgender youth experience significant barriers to health care. Asking patients about gender identity on clinic intake forms is recommended to improve care in adult populations. Little is known about how to implement these recommendations in adolescent populations. This study aimed to evaluate the addition of gender-related questions in an adolescent primary care setting and to determine if adding these questions to clinic forms could improve documentation of gender identity in the electronic health record (EHR). Methods We conducted cognitive interviews with 21 adolescents (n = 11 transgender, n = 10 cisgender) to examine gender-related questions (name, pronoun, gender identity, assigned sex at birth). These questions were added to a clinic intake form. We conducted a retrospective chart review of patients who came to the clinic for a physical examination visit three months before (n = 615) and after (n = 827) the form change and used chi-square tests to examine the differences in EHR documentation of gender identity. Results In interviews, the new questions were acceptable and interpretable to adolescents of diverse gender identities. Participants described the questions as beneficial to all patients and perceived them as an indicator of a welcoming clinic environment. The retrospective chart review found that provider documentation of gender identity in the EHR significantly increased after the form change from 51.3% to 66.3% (p < .0001). Conclusions This intervention was acceptable to adolescents and associated with a significant increase in EHR documentation. Future studies should investigate how the form change may have facilitated discussion about gender and health and implications for provider training and support.
... These questions have been found to be understood and acceptable to transgender individuals as well as to the majority of heterosexual, cisgender patients. 13 Sexual and gender minority patients may prefer to disclose their gender identity in writing, for example by completing registration forms. 14 Knowledge of a person's sex assignment at birth is important for health care providers to deliver appropriate medical care, in particular for sexual and reproductive health and cancer screenings. ...
Article
There are approximately 1 million transgender and gender-diverse adults in the United States. Despite increased awareness and acceptance, they frequently encounter medical settings that are not welcoming and/or health care providers who are not knowledgeable about their health needs. Use of correct terminology, following best practices for name and pronoun use, and knowledge of gender-affirming interventions can create office environments that are welcoming to transgender clients. Health disparities faced by transgender patients that impact access to care include higher rates of mental health issues, substance use disorders, violence, and poverty. Transgender women are at greater risk for HIV acquisition and are less likely to achieve viral suppression compared with cisgender (nontransgender) individuals. Medical providers can facilitate HIV prevention efforts by offering pre- and postexposure prophylaxis to transgender patients at risk for HIV infection. Improving health outcomes requires attention to cultural competency and an understanding of lived experiences and priorities of transgender people.
... Outside of counseling, scholars have demonstrated that providing space for more inclusive information (gender identity, pronouns) on intake forms is generally preferred by clients/ patients (Cahill et al., 2014;Maragh-Bass et al., 2017). Some providers believe that asking for information on intake forms related to sexual orientation and gender identity could be offensive to patients or clients (Haider et al., 2017), but in a recent study, researchers indicated that 97% of participants were not distressed, upset, or offended answering such questions on an intake form (Rullo et al., 2018). In fact, in our experience, clients report feeling affirmed when they are given the opportunity to share and discuss their identities. ...
Article
Therapists may encounter many opportunities and dilemmas when working with transgender and non-binary clients. Transgender and non-binary clients may use pronouns that are new or unfamiliar to their therapists, but little is known about the unique impact that pronoun use may have in therapy. The pronouns and preferred names that transgender and non-binary clients use may also shift during the course of the therapeutic relationship. Best practices for affirmative therapy include recognizing and validating a client’s gender identity, use of gender pronouns that are congruent with a client’s gender identity, and using the client’s preferred or chosen name, not their birth name. These clients may present to therapy for a variety of reasons; therefore, it is important to trust the client’s self-perception of their own gender identity and to not engage in harmful gatekeeping practices. Scholars have highlighted the negative emotions that individuals may experience when they are misgendered, deadnamed, invalidated, or otherwise denied access to medically appropriate care. Therapists may experience anxiety about providing care that is transgender-affirmative, which may affect the therapist-client alliance. The authors draw on their own experiences as therapists working with transgender and non-binary clients and provide recommendations and guidance for therapists.