Comparing Ways to Ask Patients about Sexual Orientation and Gender Identity in the Emergency Room—The EQUALITY Study

Abstract

Results Summary Download Summary Español (pdf) Audio Recording (mp3) Results Summary What was the research about? Hospitals do not usually collect information about people’s sexual orientation and gender identity, or SO/GI. People who are lesbian, gay, bisexual, transgender, or queer—sometimes called sexual and gender minorities, or SGM—have said it is important for doctors to know their identities to provide good care. The research team wanted to find the best way to ask all patients for this information. In this study, the research team compared two ways to ask patients about their SO/GI in the emergency room, or ER. In one method, a nurse asked the patient. In the other method, the patient filled out a form. The team then gave a survey to a smaller group of patients about their comfort in sharing SO/GI information during their ER visits. What were the results? Patients who identified as SGM were more comfortable filling out a form than giving answers to a nurse. Patients who did not identify as SGM were equally comfortable with either way. Who was in the study? During the study, 198,137 patients went to one of four ERs in the Northeastern United States. Of these, 19,742 patients gave verbal information about SO/GI, and 3,630 patients filled out a form. The research team then gave a survey to 180 patients who were SGM and to 180 patients who did not identify as SGM about how comfortable they felt in the ER. The team also asked another 180 patients who did not answer questions about SO/GI about their comfort in the ER. What did the research team do? For a six-month period, ER nurses asked patients about their SO/GI. Then, for the next six months, ER staff gave patients hospital intake forms with SO/GI questions. After each six-month period, the team asked a smaller group of patients about their comfort with sharing SO/GI information with hospital staff. What were the limits of the study? The hospitals in the study were in the Northeastern United States. Results may differ in other locations. The study didn’t include patients who chose “other” for SO/GI. Also, the study didn’t include patients who didn’t speak English or who had a mental health condition. Not including these patients could have changed the results. Nurses may have talked only to patients they thought would answer the questions. Asking only some patients may also have changed the results. Future research could look at how hospitals and their staff decide how to ask about SO/GI with all patients. Future studies could also include patients who don’t use common SO/GI labels and patients with mental health conditions. How can people use the results? Hospital staff can use these results to design a process to ask patients about SO/GI. Regularly asking all patients about SO/GI may make patients feel more comfortable sharing this information. Professional AbstractProfessional AbstractObjective To compare the effectiveness of two patient-centered methods for collecting sexual orientation and gender identity (SO/GI) information in the emergency department (ED) Study Design Design Elements Description Design Quasi-experimental study Population 540 patients who were asked about comfort outcome during ED visit Interventions/ Comparators SO/GI information collected verbally by a nurse SO/GI information collected nonverbally by a registrar Patient did not respond to questions about SO/GI (control) Outcomes Patient comfort during the ED visit Timeframe Same-visit follow-up for study outcome This multisite, matched intervention trial compared two methods for collecting patient SO/GI information at four hospital EDs in the Northeastern United States, to address a lack of data on SO/GI that poses a major challenge to addressing health disparities for sexual and gender minorities (SGM). For the first six months of the study, nurses collected this information verbally; during the second six months, registrars collected this information nonverbally, using a form they distributed to patients. All English-speaking adult patients who entered one of four EDs during the trial period were eligible to participate in the study unless they had a mental health condition, were under the influence of substances that might interfere with cognition, had an Emergency Severity Index score <2, or had a hand or arm injury. Researchers then surveyed patients who identified as SGM—gay, lesbian, bisexual, transgender, or queer—about their ED experiences. Researchers also asked about ED experiences with patients who did not identify as SGM and with a matched group of ED patients who did not answer questions about SO/GI. During the verbal collection period, 19,742 patients (18% of 109,994 patients who entered the EDs) provided SO/GI information. During collection using forms, 3,620 patients (4% of 88,143 patients who went to the EDs) reported SO/GI. In total, 673 patients identified as SGM. Researchers collected follow-up survey data about patient comfort with ED communications from 180 patients who identified as SGM, 180 matched patients who did not identify as SGM, and 180 matched patients who did not answer questions about SO/GI. The researchers used survey data for all analyses. Results Patients who identified as SGM had significantly higher comfort scores during nonverbal collection compared with verbal collection (p=0.0274). Patients who were not SGM were equally comfortable with either collection method. Patients who identified as SGM were 2.57 times more likely to prefer nonverbal collection over verbal collection after controlling for age, race, and illness severity (95% confidence interval: 1.13, 5.82, p=0.02). Comfort scores for ED visits overall did not differ between patients who answered or did not answer questions about SO/GI. Limitations The study took place in the Northeastern United States. Results may differ in other parts of the country. The outcome surveys did not include patients who identified as “other” for their SO/GI or patients who did not speak English or who had a psychiatric diagnosis. These patients may have had different experiences in the ED. The relatively low percentage of patients who provided SO/GI information may be due to selection bias. Nurses and registrars may have asked for SO/GI information only from patients they thought would answer the questions. Conclusions and Relevance Patients who identified as SGM reported higher comfort using the nonverbal collection method compared with the verbal disclosure method. Future Research Needs Future studies could focus on how community, hospital, or staff factors affect SO/GI data collection and on how to implement SO/GI collection for all patients. Researchers could also include patients with psychiatric diagnoses and patients who use nonconventional terms for SO/GI.