June is National Pride Month, a time to honor the impact LGBTQ people have had on the world — and to recognize and try to alleviate the health disparities that still affect this community every day.
Health Risks for LGBTQ People
About 3.8 percent of Americans, from a variety of races, ethnicities and socioeconomic backgrounds, identify as LGBT. Meanwhile, 29 percent of lesbian, gay, and bisexual people and 30 of transgender people delay or avoid seeking healthcare services (compared to 17 percent of heterosexuals). LGBT people are also twice as likely to be uninsured as their heterosexual peers. What’s more, LGBT people have higher rates of tobacco, alcohol and drug use, and a greater risk of contracting STIs, attempting suicide and homelessness. These are all barriers to this community receiving the optimal healthcare they deserve.
Previous research also indicates that biases, often subconscious or unintentional, from healthcare providers are still prevalent, despite increased acceptance of the LGBT community in recent years. For example, a 2015 study found heterosexual nurses held strong implicit preferences for heterosexual people over gay and lesbian people. In addition, a national survey found the average nursing school spends only 2.12 hours on LGBTQ health issues.
And of course there are inevitable mental and physical health issues that come with being a member of a stigmatized minority group. One study found LGB respondents in states without protective policies were five times more likely than those in other states to have two or more mental disorders. Another found that LGB people living in communities with lots of antigay prejudice die 12 years earlier than their peers in other locations.
What Clinicians Should Know about Treating LGBTQ People
It’s natural to think that treating all patients with the same respect will minimize the discrimination LGBTQ people face in healthcare settings, but that’s not the case. A recent report from Nursing2019 offers some specific strategies for improving this community’s quality of care.
Educate yourself about intersectionality. Factors beyond sexual orientation and gender identity influence a patient’s experience in the world, especially in healthcare settings. Understand that race, age and class can create different sets of concerns from one patient to another. Some aspects of a patient’s identity may be hidden. Above all else, help your patients feel safe presenting their whole identity before treatment.
Encourage SOGI disclosure. Intake forms rarely ask about sexual orientation and gender identity, and when they do, they usually have limited options for relationship status and gender. Research shows that without being asked about SOGI, LGBTQ people might wonder if they can safely disclose their identity without it resulting in substandard care. That’s why nurses should ask about SOGI during the assessment. Plus, this knowledge can help screen and prevent conditions more common in LGBTQ people and help get a better understanding of a patient’s support system.
Worried your patient won’t want to share their SOGI? A recent study found that’s the case with only 10 percent of LGB patients, and another suggested LGBTQ patients believe disclosing improves communication and made them more comfortable. Use open-ended questions and always ask if the patient is okay with the information becoming part of their medical record.
Seek out training. Three nationally respected organizations offer training in LGBTQ cultural competence for healthcare professionals, both for individuals and staff. They are:
- GLMA: Health Professionals Advancing LGBT Equality
- National LGBT Cancer Network
- National LGBT Health Education Center
Lead your workplace in better LGBT cultural competency. The amount of time nurses spend with patients positions them to be the best advocates for improve LGBT care throughout their facilities. Consider creating a committee that involves a variety of healthcare professionals and local LGBTQ community members.
Empower LGBTQ patients to make decisions about their own care. Think about working with your patients instead of on them, one study explains. The goal is to increase your patient’s interest in shared decision-making and eventually their trust.
Dimensions of inclusive care, The Journal of Excellence in Nursing Leadership.
A National Survey of Faculty Knowledge, Experience, and Readiness for Teaching Lesbian, Gay, Bisexual and Transgender Health in Baccalaureate Nursing Programs, Nursing Education Perspectives.
Increasing cultural competence with LGBTQ patients, Nursing2019.
Last updated on 10/3/19.