Providing Culturally Competent Care for LGBTQ+ Patients

Laura M. Cascella, MA, CPHRM

Diversity is a cornerstone of American culture that is reflected throughout our society, including our healthcare system. Healthcare workers interact on a daily basis with people of varying backgrounds and experiences. Although patient populations might differ based on the type of healthcare facility or other factors, the need for culturally competent care never diminishes.

One facet of our diverse society is the LGBTQ+ community. People who identify as lesbian, gay, bisexual, transgender, queer (or questioning), or another orientation other than heterosexual make up 7.6 percent of U.S. adults.¹ Although each group within this community is unique, the term “LGBTQ+” often is used as an umbrella term to discuss overarching issues — such as access and barriers to healthcare — that affect various individuals and groups within this community.

The National Academies of Sciences, Engineering, and Medicine explains that LGBTQ+ individuals face numerous health disparities, and “The physical and mental health of SGD [sexual and gender diverse] populations is substantially affected by external influences that include discrimination, stigma, prejudice, and other social, political, and economic determinants of health.”² Additionally, a KFF Polling survey found that LGBTQ+ adults are more likely than others to report negative experiences with healthcare providers (e.g., insults, disrespect, unfair treatment, refusal of care, and disregard) as well as adverse outcomes related to these experiences.³

In an attempt to overcome these numerous issues and align with the ideals of health equity and patient-centeredness, the healthcare community has made strides in recent years to address cultural competence for LGBTQ+ patients. Although more work remains “to ensure that healthcare settings are truly welcoming and understanding of diverse orientations and identities,”⁴ various strategies have emerged to help guide healthcare organizations. Below are recommendations for healthcare leaders, providers, and staff to consider in the areas of organizational policies/practices, patient care, and education/training.⁵

• Organizational policies/practices:
  • Assess your organization to identify potential gaps in policies and services related to LGBTQ+-inclusive care. Make sure policies comply with federal and state regulations as well as any applicable accreditation standards.
  • Depending on the size of your organization, designate a point person, office, or advisory group to oversee LGBTQ+-related issues as part of your organization’s overall health equity strategy.
  • Include language on your website and marketing materials that describes the organization’s commitment to high-quality, culturally competent, patient-centered care. Make sure that marketing, advertising, and informational materials reflect diverse populations.
  • Consider creating a webpage or portal for information and resources related to LGBTQ+ care. As part of this information, offer an easily accessible directory of providers within the organization who are knowledgeable about, experienced with, and sensitive to LGBTQ+ issues.
  • Review codes of conduct and ethics policies to ensure they include expectations for respectful, courteous communication with all patients, visitors, and staff members. Organizational policies also should specify consequences for code/policy violations.
  • Make patients, workers, and visitors aware of your organization’s nondiscrimination, antiharassment, and confidentiality policies. Post these policies in visible physical and electronic locations.
  • Evaluate environmental factors that might present issues for LGBTQ+ patients, such as bathroom designations and rooming policies. Discuss ways to adopt approaches that will create the greatest level of comfort for all patients.
  • Review your patient forms to ensure they are inclusive and include elements such as a space to provide preferred name and pronouns in addition to legal name, a blank space where patients can voluntarily document sexual orientation and gender identity (separate from sex assigned at birth), a spouse/partnership option under relationships, and general wording such as “parents/guardians” rather than “mother” and “father” to accommodate same-sex parents.
  • Evaluate your documentation systems and policies to determine any issues related to documenting care for LGBTQ+ patients. Devise strategies and solutions (including working with your electronic health record vendor) to ensure accurate and thorough documentation of patient information and care.
  • Review visitation policies (for inpatient facilities) to ensure that they empower patients to decide who can visit them and act on their behalf.
• Patient care:
  • When providing care, do not make assumptions about patients’ sexual orientations, gender identities, beliefs, or concerns based on physical characteristics, such as clothing, tone of voice, perceived femininity/masculinity, etc.
  • Politely ask for clarification if it is unclear what name a patient prefers or how the patient would like for you to address them. Apologize if you mistakenly refer to a patient using the wrong name or pronouns.
  • Do not ask patients questions about sexual orientation or gender identity that are not material to their care or treatment. When questions about sexual orientation, gender identity, and sexual history are necessary, ask them in a respectful way and assure the patient about the confidentiality of such information.
  • Do not disclose patients’ sexual orientations or gender identities to individuals who do not explicitly need the information as part of the patients’ care.
  • Implement strategies to promote patient dignity throughout the course of patient care and treatment.
  • Stay current on health issues affecting the LGBTQ+ community, and be aware that the various groups within this community may have different and unique healthcare needs.
  • Be prepared to provide appropriate referrals for LGBTQ+ patients, and consider participating in referral programs through LGBTQ+ organizations.
• Education/training:
  • Build awareness within your organization about the LGBTQ+ community and considerations for care. For example, review appropriate terminology with healthcare providers and staff members and discuss the difference between sexual orientation and gender identity. Some people might find these concepts confusing but hesitate to ask for clarification.
  • Help providers and staff members understand that sexual orientation and gender identity are just two factors that contribute to an individual’s overall identity. Other factors — such as race, ethnicity, religion, socioeconomic status, education level, income, and more — also contribute to a person’s overall experience, perceptions of healthcare, and potential barriers to care.
  • Provide training to healthcare providers and staff members on culturally competent care and organizational policies related to conduct, ethics, privacy, and communication. Training should occur at orientation and periodically thereafter to reinforce expectations and standards.
  • Train providers and staff members to use patients’ preferred names and pronouns, and make sure this information is clearly indicated in patients’ health records.
  • Provide education on health issues of particular importance to the LGBTQ+ community, such as hormone therapy, HIV/AIDS prevention, substance abuse and mental health, and intimate partner violence.
  • Educate providers and staff members about the principles of trauma-informed care and how this approach can support patient engagement and help patients build resilience and cope with adversity.
  • Train providers and staff members on inclusive communication principles and language that promotes health equity.
  • Make sure all education and training opportunities are based on reliable and reputable resources. Consider developing a list of credible resources that providers and staff members can access to further their knowledge.

In Summary

Providing high-quality and culturally competent care to patients in the LGBTQ+ community requires ongoing learning and recognition of factors affecting this diverse population. Healthcare organizations should identify opportunities to improve processes, raise awareness, and educate the workforce on LGBTQ+-related issues. Even healthcare organizations that have taken steps to improve cultural competence can find new ways to address barriers to care and engage staff in improvement initiatives.

To learn more, see MedPro’s Risk Resources: LGBTQ+-Inclusive Care for links to a variety of informative publications and materials.

Endnotes

¹ Jones, J. M. (2024, March 13). LGBTQ+ identification in U.S. now at 7.6%. GALLUP News. Retrieved from https://news.gallup.com/poll/611864/lgbtq-identification.aspx

² National Academies of Sciences, Engineering, and Medicine. (2020). Understanding the well-being of LGBTQI+ populations. Washington, DC: The National Academies Press. doi: https://doi.org/10.17226/25877

³ Montero, A., Hamel, L., Artiga, S., & Dawson, L. (2024, April 2). LGBT adults’ experiences with discrimination and health care disparities: Findings from the KFF survey of racism, discrimination, and health. KFF Polling. Retrieved from www.kff.org/report-section/lgbt-adults-experiences-with-discrimination-and-health-care-disparities-findings/

⁴ ECRI. (2024, June 7). Delivering LGBTQ-inclusive healthcare. Retrieved from https://home.ecri.org/

⁵ Ibid; AHIMA. (2017, March). Improved patient engagement for LGBT populations: Addressing factors related to sexual orientation/gender identity for effective health information management. Journal of AHIMA, 88(3): extended online version. Retrieved from https://bok.ahima.org/; Deutsch, M. B., ed. (2016, June). Guidelines for the primary and gender-affirming care of transgender and gender nonbinary people (2nd edition). Center of Excellence for Transgender Health, Department of Family and Community Medicine. University of California San Francisco. Retrieved from https://transcare.ucsf.edu/guidelines; The Joint Commission. (2011). Advancing effective communication, cultural competence, and patient- and family-centered care for the lesbian, gay, bisexual, and transgender (LGBT) community: A field guide. Retrieved from https://lgbtagingcenter.org/library/item/advancing-effective-communication-cultural-competence-and-patient-and-family-centered-care-for-the-lesbian-gay-bisexual-and-transgender-lgbt-community/; University of Iowa Healthcare. (2017). Quick tips for medical providers of transgender patients. Retrieved from https://uihc.org/health-topics/quick-tips-medical-providers-transgender-patients; Vermeir, E., Jackson, L. A., & Marshall, E. G. (2018). Improving healthcare providers’ interactions with trans patients: Recommendations to promote cultural competence. Healthcare Policy, 14(1), 11–18. doi: https://doi.org/10.12927/hcpol.2018.25552

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