Table 4.
Recommendations Collated From the Appraised Documents
| Recommendation | Document No.a |
|---|---|
| Principles | |
| Cultural competency/social model of health | |
| Person-centered, LGB as a cultural and lifestyle issue | 1, 2, 3, 4, 6, 7, 9, 10 |
| Equity and human rights | |
| Importance of antidiscrimination policy including sexual orientation | 1, 2, 3, 5, 6, 7, 8, 9, 10, 11 |
| Awareness of the LGB population | |
| Understanding the proportion of LGB patients and removing assumptions of heterosexuality | 1, 2, 3, 4, 6, 7, 8, 9, 10, 11 |
| Aware of multiple minority status: SES, disability, race | 2, 3, 4, 8, 9, 10 |
| Inclusive of LGB families | 1, 2, 4, 5, 6, 7, 8, 9, 10, 11 |
| Inclusive clinical environment | |
| Overt signs/displays | |
| Rainbow sticker, posters, brochures, information | 3, 4, 5, 7, 8, 9, 10, 11 |
| LGB magazines, newspapers | 3, 8, 9 |
| Receptionists and other staff | |
| Sensitive language and positive attitudes | 1, 4, 5, 8, 9 |
| Paperwork | |
| Intake forms inclusive and culturally appropriateb | 1, 2, 3, 5, 7, 8, 9, 10, 11 |
| Optional self-identification on forms | 1 |
| Policies and procedures | |
| Antidiscrimination, specifically include LGB | 1, 4, 10 |
| Have policy visible to clients | 1, 3, 4, 5, 7, 9, 10, 11 |
| Complaints procedures available | 1, 9 |
| Involve LGB people: feedback, service planning | 4, 5, 7, 8, 10 |
| Clinician-patient communication | |
| Attitudes | |
| Overtly nonjudgmental | 2, 3, 4, 7, 9, 10, 11 |
| Affirming | 7, 9, 11 |
| Conceal negative attitudes | 2 |
| Challenge negative attitudes in colleagues | 6, 10, 11 |
| Confidentiality assured | 1, 3, 4, 5, 6, 7, 8, 9, 10, 11 |
| Languagec | |
| Gender-neutral, culturally aware, inclusive | 2, 3, 4, 6, 8, 9, 10, 11 |
| Clarify and use patient’s terms | 2, 3, 6, 7, 9 |
| Interviewing skills | |
| Open questions | 2, 3, 4, 7, 9, 10, 11 |
| Inclusive of partner | 2, 3, 5, 10 |
| Inclusive of nonbiological parent | 5, 11 |
| Normalize sexual history: ask all patients | 9, 11 |
| Avoid assumptions (eg, about congruence, fluidity) | 2, 3, 4, 5, 7, 8, 9 |
| Disclosure | |
| Facilitation of disclosure, explain why asking | 2, 6, 8, 11 |
| Care with reactions to disclosure, respond positively | 2, 3, 11 |
| Direct inquiry about sexual behavior/identity | 2, 7, 9, 10, 11 |
| Respect nondisclosure | 2, 3, 7 |
| Documentation | |
| Medical notes | |
| Permission to document sexual orientation | 4, 6, 7 |
| Inform patient what is written | 3 |
| Referral letters | – |
| Decision makers/next of kin | |
| Ask and document emergency contact, who makes decisions | 6, 9 |
| Special knowledge for cultural awareness | |
| Impact of discrimination on health | |
| Experiences of violence and harassment | 2, 3, 4, 5, 8, 9, 10, 11 |
| Reduced level of support from family and community | 9 |
| Mental health | |
| Higher rates of depression, anxiety, suicidality | 2, 3, 4, 5, 7, 9, 10, 11 |
| Drugs, alcohol, smoking | |
| Higher rates of use over a longer period of time | 2, 3, 4, 5, 7, 9, 10, 11 |
| Fertility, pregnancy, parenting | 2, 4, 5, 9, 10 |
| Sexual health, safer sex | |
| Differing STI patterns and specific safer sex methods | 2, 3, 4, 5, 9, 10, 11 |
| Higher risks | 3, 4, 5, 9, 10, 11 |
| Men: higher rate of anal cancer, risk for heart disease | |
| Women: risks for breast and ovarian cancer, heart disease | |
| Coming out issues | 2, 3, 4, 5, 7, 9, 10 |
| Body image, weight, exercise, diet | 2, 3, 4, 5, 9 |
| Same-sex relationships including domestic violence | 4, 5, 7, 10 |
| Legal recognition of relationship and parenting | 4, 5, 9, 10 |
| Referral | |
| LGB support groups, information network | 3, 4, 5, 7, 11 |
| LGB-sensitive specialists and allied health | 1, 2, 4, 10 |
| LGB-specific health care professionals | 1, 6, 7 |
| Staff and training | |
| Receptionists: confidentiality, use of intake forms | 1, 3, 5 |
| All staff: antihomophobia, relevant LGB issues | 1, 5, 7, 8, 9, 10, 11 |
| Nondiscrimination policy including sexual orientation | 1, 8, 9 |
| Support visibility of LGB employees | 1, 5, 9 |
| Affirmative action to hire LGB staff | 7 |
| Population health | |
| Marketing service to LGB community | 7, 9, 10 |
| Health promotion targeted to LGB | 1, 5, 9 |
| Community outreach: relationship with LGB agencies | 1, 5, 8, 10 |
| Advocacy | 1, 2, 9 |
LGB = lesbian, gay, and bisexual; SES = socioeconomic status; STI = sexually transmitted infection.
a See Table 2▶ for details on each document.
b Sample intake forms: documents 2, 3, 7, 9.
c Patient interview suggestions: documents 2, 4, 9, 10, 11.