Department of Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA.
Department of Emergency Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
Emerg Med J. 2019 Mar;36(3):136-141. doi: 10.1136/emermed-2018-207669. Epub 2019 Jan 10.
In the USA, The Joint Commission and Institute of Medicine have called for collection of patient sexual orientation (SO) and gender identity (GI) information in healthcare. In a recent study, we reported that ED clinicians believe patients will refuse to provide this information; however, very few patients say they would refuse to provide SO/GI. As part of this study, we interviewed patients and providers regarding the importance of collecting this information. While these interviews were briefly summarised in our prior report, the qualitative data warranted a more thorough analysis and exposition to explore provider and patient views as well as risks and benefits of collecting SO/GI.
A purposive sample of 79 participants was recruited for semi-structured interviews between August 2014 and January 2015. Participants included community members who had a previous ED encounter and ED providers from 3 community and 2 academic centres in a major US metropolitan area. Interviews were conducted one-on-one in person, audio-recorded and transcribed verbatim. Data were analysed using the constant comparative method.
Fifty-three patients and 26 ED providers participated. Patients perceived collection of SO/GI to be important in most clinical circumstances because SO/GI is relevant to their identity and allows providers to treat the whole person. However, many providers felt SO/GI was not relevant in most clinical circumstances because similar care is provided to all patients regardless of SO/GI. Patients and providers agreed there are risks associated with collecting SO/GI in the ED.
ED clinicians do not perceive routine collection of SO/GI to be medically relevant in most circumstances. However, patients feel routine SO/GI collection allows for recognition of individual identity and improved therapeutic relationships in the ED. These discordant perspectives may be hindering patient-centred care, especially for sexual and gender minority patients.
在美国，联合委员会和医学研究所呼吁在医疗保健中收集患者的性取向（SO）和性别认同（GI）信息。在最近的一项研究中，我们报告称 ED 临床医生认为患者会拒绝提供此信息；然而，很少有患者表示他们会拒绝提供 SO/GI。作为这项研究的一部分，我们采访了患者和提供者，了解他们对收集这些信息的重要性的看法。虽然这些采访在我们之前的报告中进行了简要总结，但这些定性数据需要更深入的分析和阐述，以探讨提供者和患者的观点以及收集 SO/GI 的风险和益处。
2014 年 8 月至 2015 年 1 月期间，我们从美国一个主要大都市地区的 3 家社区和 2 家学术中心招募了 79 名参与者进行半结构式访谈。参与者包括有之前 ED 就诊经历的社区成员和 ED 提供者。访谈在现场进行一对一的个人访谈、录音和逐字记录。使用恒定性比较方法分析数据。
53 名患者和 26 名 ED 提供者参与了研究。患者认为在大多数临床情况下收集 SO/GI 很重要，因为 SO/GI 与他们的身份相关，并允许提供者治疗整个人。然而，许多提供者认为在大多数临床情况下 SO/GI 并不相关，因为无论 SO/GI 如何，他们都会为所有患者提供相似的护理。患者和提供者都认为在 ED 收集 SO/GI 存在风险。
ED 临床医生认为在大多数情况下，常规收集 SO/GI 在医学上并不相关。然而，患者认为常规 SO/GI 收集允许在 ED 中识别个人身份并改善治疗关系。这些不一致的观点可能会阻碍以患者为中心的护理，特别是对性和性别少数群体患者。
