Provider beliefs and practices about assessing sexual orientation in two veterans Health Affairs Hospitals

Purpose: Despite known health disparities for lesbian, gay, and bisexual (LGB) individuals, research in the civilian sector has documented low rates of patient disclosure and provider assessment of this domain. Very little is known about Veterans Health Affairs (VHA) providers' care of LGB veterans, a population that has been relatively invisible until recently because of the vestiges of the Department of Defense policy of “Don't Ask, Don't Tell.” This study examined the attitudes, beliefs, and clinical practices of VHA healthcare providers regarding sexual minority veterans. Methods: Physical and mental health VHA healthcare providers (n=202) from two southern VHA hospitals completed an anonymous self-report questionnaire. Measures included comfort in providing care to LGB veterans, factors affecting decisions about assessing sexual orientation with veterans, and attitudes toward sexual minority individuals. Results: Although approximately half of VHA providers thought that sexual orientation should be routinely discussed, the providers rarely assessed this issue with their patients. Over half of providers believed that veterans would disclose their sexual orientation if it was important to them, and almost half of providers believed sexual orientation is not relevant to healthcare. Conclusion: Many VHA providers may be unaware of the unique health disparities experienced by LGB individuals. Culturally appropriate care cannot be provided to LGB veterans unless providers explicitly assess sexual orientation in healthcare visits. Central to this assessment is providing patients with a clear rationale for the purpose of the assessment and related documentation. Staff training is needed to address providers' beliefs and reservations about discussing sexual orientation that emerged in this investigation.