| General Recommendations | Specific Recommendations |
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| The Joint Commission, 2014 |
Integrate unique LGBT patient needs into new policies or modify existing policies. Creating a welcoming environment that is inclusive of LGBT patients. Avoid assumptions about sexual orientation and gender identity. Facilitate disclosure of sexual orientation and gender identity but be aware that this disclosure or “coming out” is an individual process. Provide information and guidance for the specific health concerns facing lesbian and bisexual women, gay and bisexual men, and transgender people. Ensure equitable treatment and inclusion for LGBT employees. Demonstrate commitment to LGBT equity and inclusion in recruitment and hiring. Educate staff on LGBT employee concerns. Identify opportunities to collect LGBT-relevant data and information during the health care encounter. Collect feedback from LGBT patients and families and the surrounding LGBT communities. Ensure that communications and community outreach activities reflect a commitment to the LGBT community.
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Develop or adopt a nondiscrimination policy. Develop or adopt a policy ensuring equal visitation. Develop or adopt a policy identifying the patients' right to identify a support person of their choice. Integrate and incorporate a broad definition of family into new and existing policies. Demonstrate ongoing leadership commitment to inclusivity for LGBT patients. Develop clear mechanisms for reporting discrimination or disrespectful treatment. Develop disciplinary processes. Identify an individual directly accountable to leadership for overseeing organizational efforts. Appoint high level advisory group to assess climate for LGBT patients. Identify and support staff or physician champions who have special experience with LGBT issues. Prominently post the hospitals' nondiscrimination policy. Waiting rooms and other common areas should reflect and be inclusive of LGBT patients and families. Create or designate unisex or single stall restrooms. Ensure visitation policies are implemented in a fair and nondiscriminatory manner. Foster an environment that supports and nurtures all patients and families. Be aware of misconceptions, bias stereotypes, and other communications barriers. Recognize self-identification and behaviors that do not always align. Honor and respect the individual's decision and pacing in providing information. All forms should contain gender-neutral language. Become familiar with online and local resources for LGBT. Add LGBT inclusive language to job notices. Develop a plan to address the unique needs of transgender employees. Add information about sexual orientation and gender identity to patient surveys.
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| Hanssmann, 2008 |
General need for more training. Organizational or agency-wide change and support. Integrate patient satisfaction measures into practice.
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| Heck, 2006 |
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| Tillery, 2010 |
Health professional students and health professionals to need training about sexual orientation, gender identity and expression, and HIV status. Require all health care facilities and education programs that receive government funding to develop and implement goals, policies, and plans to ensure that LGBT people and people living with HIV are treated fairly and provide ongoing cultural competency training. Prohibit discriminatory practices by insurance providers that deny or limit coverage for needed care by LGBT people.
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Develop and implement goals and plans to ensure that LGBT people and people living with HIV are treated fairly. Establish nondiscrimination, fair visitation and other policies that prohibit bias and discrimination based on sexual orientation, gender identity and expression, and HIV status. Report discriminatory practices, sharing stories, and contacting Lambda Legal and other advocacy organizations and/or attorneys.
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| Reed 2010 | Clinicians knowledgeable and skilled in the followup of abnormal anal cytology results, including high resolution anoscopy and biopsy. |
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| Mimiaga et al., 2007 |
Training around the special needs and vulnerabilities of MSM. Clinical presentation of STDs among MSM, and to project a nonjudgmental manner when performing STD screening, providers also need to be trained to understand that STD and HIV risk-taking behavior among MSM is often occurring in the context of intertwined syndemics.
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Clinicians must demonstrate their comfort in addressing health issues tied to sexuality to draw people into testing and treatment. Medical histories and examinations can be conducted in ways that do not presume heterosexuality but are inclusive of various sexual identities, family/relationship arrangements, and sexual behaviors. Be especially attuned to patients who may be reticent to fully .disclose issues around sexuality, health risks, and exposures
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| Grant et al., 2010 |
Medical establishment must fully integrate transgender-sensitive care into its professional standards, and this must be part of a broader commitment to cultural competency around race, class, and age. Anti-transgender bias in the medical profession and U.S. health care system has catastrophic consequences for transgender and gender nonconforming people. Public and private insurance systems must cover transgender-related care; it is urgently needed and is essential to basic health care for transgender people.
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Doctors and other health care providers who harass, assault, or discriminate against transgender and gender nonconforming patients should be disciplined and held accountable according to the standards of their professions.
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| Gay & Lesbian Medical Association, 2006 |
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Filling out the intake form gives patients one of their first and most important impressions of your office. The experience sets the tone for how comfortable a patient feels being open about their sexual orientation or gender identity/expression. LGBT patients often ‘scan’ an office for clues to help them determine what information they feel comfortable sharing with their health care provider. When talking with transgender people, ask questions necessary to assess the issue, but avoid unrelated probing. Explaining why you need information can help avoid the perception of intrusion. Discuss safer sex techniques and be prepared to answer questions about STDs and HIV transmission risk for various sexualities relevant to LGBT people. When talking about sexual or relationship partners, use gender-neutral language such as ‘partner(s)’ or ‘significant other(s).’ Ask open-ended questions, and avoid making assumptions about the gender of a patient's partner(s) or about sexual behavior(s). Listen to your patients and how they describe their own sexual orientation, partner(s) and relationship(s), and reflect their choice of language. Universal gender-inclusive ‘Restroom’.
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| Dodge et al., 2012 |
Maintain privacy. Normalize bisexuality on a structural level, so that other individuals' potentially negative feelings about bisexual men do not interfere with decisions about health services. Improved education and access for bisexual men are a critical for increasing knowledge and improving uptake of services for rectal STI.
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The fear of inadvertent disclosure appeared throughout the narratives and across participants. Our data establish that the influence of others' perceptions of their sexuality have an impact on their likelihood of engaging in health services. Use broad terms like men's health, or list all three sexual orientation categories (bisexual, heterosexual, and homosexual) on health service materials, since this diminishes concerns related to other's perceptions of their sexuality. Providing information that is pertinent to men of all behavioral repertoires would allow men the option to read about issues facing men of all sexual orientations without fear of inadvertent disclosure. Set up systems that facilitate an individual being seen by the same provider over time, versus one of many providers at a clinic.
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| Kaestle et al., 2011 |
Sexual minorities may have particular difficulty communicating with their physicians, and physicians may be uncomfortable interacting with sexual minority patients. To facilitate a more accurate perception of risk among sexual minorities, health practitioners can work to promote the development and implementation of more effective curricula and to break down some of the stigma. and barriers in communication about sensitive sexual behaviors in public health services and physician offices
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| Politi et al., 2009 | |
Women who partner with women reported a strong preference for female providers because of perceived difficulties communicating about sexuality with male physicians. Male providers should be aware of both patients' and their own potential discomfort and should remain sensitive to discussions about sexual health. [Prior] to obtaining a sexual history, primary care providers should explain the reason for asking questions about sexual health. If written information is deemed necessary prior to a verbal history, questions should be phrased in ways that allow inclusion of all women regardless of partner gender or partner status.
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| Bradford et al., 2012 | |
Providers may not be comfortable asking these questions, or lack knowledge on how to elicit information…. this should not prevent providers from asking such questions and trying to gather such data. Providers should ask permission to include information about a patient's sexual orientation and gender identity in the medical record, remind the patient of its importance to quality health care, and assure him or her that the information will be kept confidential. When seeing a patient for the first time, providers should also ask questions about sexual orientation, behavior, and gender identity during the patient's visit. Questions both on registration forms and during patient exams will alert providers to screen patients for conditions disproportionately affecting LGBT people, and to provide preventative health education appropriate to LGBT people. Respondents are 1.5 to 1.6 times more likely to report same-sex behavior and attraction on an audio computer assisted self-interviewing survey than in response to questions asked by an interviewer.
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| Reisner et al., 2010 | |
Safer sex education materials are needed that are tailored to meet the needs of TMSM, including differentiating by partner genders (i.e., male, female, transmen, transwomen), type (i.e., casual, anonymous, monogamous, etc.), and sexual behaviors (i.e., frontal/vaginal or anal sex; oral sex; body contact with the exchange of body fluids; sex toys, etc.). Also needed is information about sexual health more broadly, including information about pregnancy and how to navigate pregnancy-related health care services as a transman. Integrating sexual health information ‘by and for’ transmen into other healthcare services, involving peer support, addressing mood triggers such as depression and anxiety, Internet-delivered information and services for transmen and their sexual partners, making safer sex materials ‘hot’ (i.e., erotic) and pleasure-focused.
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| Polek, et al., 2010 | |
Healthcare providers can help reduce barriers that women may encounter by assessing their offices for approachability, attitudes, accountability, and awareness.
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| Heck, et al., 2006 | |
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| National LGBT Health Education Center, 2013 | |
Health care organizations should have a system that allows patients to input their preferred name, gender, and pronouns into registration forms and other relevant documents. Avoid asking unnecessary questions: People are naturally curious about transgender people, which sometimes leads them to want to ask questions. However, like everyone else, transgender people want to keep their medical and personal lives private. Have procedures in place that hold staff accountable for making negative or discriminatory comments or actions against transgender people. Have single-occupancy bathrooms that are not designated as male or female. Avoid gender terms.
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| Martinez et al., 2005 | |
Extend the health guidance (or anticipatory guidance) time that clinicians spend with young women engaging in sexual activity. Have providers who can develop trusting relationships with them to have them openly disclose their sexual activities.
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| Marrazzo et al., 2005 | |
Because participants generally believed the risk of STD transmission between women to be low, interventions need to include an educational component explaining the evidence that exists to support such a possibility. If this is not adequately conveyed, women may have little motivation to practice protective behaviors…. interventions need to target a range of common sexual practices, including digital-vaginal penetration and use of vaginally insertive sex toys. Emphasize cleanliness, particularly as part of ‘natural health,’ and if they frame the preventative practice in terms of sexual enjoyment and healthy sexuality, rather than in terms of disease and emphasize respect for one's body and one's sexual choices.
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