In a recent study, Duke School of Nursing’s Amie Koch, DNP, FNP-C, RN, ACHPN, sought to understand the experiences of LGBTQ+ individuals, and their experience coming out within social settings, religious settings, and health care settings. She studied the act of disclosing individuals’ sexual orientation to health care providers (HCPs). The study sheds light on the challenges faced by LGBTQ+ individuals and offers insights into how HCPs can create a more supportive and inclusive environment.

The study reveals that LGBTQ+ individuals often grapple with the decision to disclose their sexual orientation to family, friends, religious communities, and HCPs due to fears of abandonment, judgment, discrimination, and potential negative repercussions. This hesitancy is rooted in safety concerns and the anticipation of biased treatment, which can lead to significant stress and anxiety for individuals seeking care.

“Participants in our study reported feelings of grief and fear associated with loss which affected numerous aspects of their lives, including their physical and mental health,” Koch explained. “Given the findings, it is important that HCPs be aware of the negative physical and psychological challenges experienced by LGBTQ+ individuals, including increased rates of depression, anxiety, substance use, discrimination, fear of abandonment, and loss of family and friends when coming out/ disclosing sexual orientation.”

Despite these challenges, the study identifies key practices that can foster a supportive atmosphere in the health care setting. These include the use of nonjudgmental language, the implementation of inclusive paperwork processes, the display of visible signs of allyship, and the possession of specific knowledge about LGBTQ+ health issues. Such measures can significantly enhance the patient-provider relationship and encourage open communication.

The findings also highlight the broader issue of health disparities within the LGBTQ+ community. The study underscores the discrimination and inequities that LGBTQ+ individuals face in health care settings, pointing to a pressing need for culturally competent care that addresses these gaps.

In response to these findings, the study offers a set of recommendations for HCPs. To improve the health care experience for LGBTQ+ patients, providers are encouraged to actively educate themselves on LGBTQ+ health matters, challenge their own assumptions, and strive to create an environment that signals welcome and acceptance to all patients, regardless of sexual orientation.

“Our findings indicate that maintaining a welcoming office/institution, using visible rainbow signage or flags, wearing inclusivity pins, using inclusive intake forms, having written statements supporting LGBTQ+ individuals, using nonheteronormative intake forms and documentation, and maintaining gender-neutral bathrooms were all easy ways to indicate support for LGBTQ+ individuals,” said Koch.

This study is a call to action for the health care industry to prioritize inclusivity and cultural competence. By doing so, HCPs can not only enhance the quality of care for LGBTQ+ patients but also contribute to a more equitable health care system for all.

Koch reports, “We are now working to examine the impact of religion on mental health for LGBTQ+ individuals during the coming out/disclosure process, so stay tuned.”

Rabins, M., Brennan-Cook, J., Jackson, G., & Koch, A. (2024). LGBTQ+ disclosure: challenges and possibilities. Culture, health & sexuality, 1–15. Advance online publication. https://doi.org/10.1080/13691058.2024.2360989

Koch, A., Rabins, M., Messina, J., & Brennan-Cook, J. (2023). Exploring the challenges of sexual orientation disclosure among lesbian, gay, bisexual, transgender, queer individuals. The Journal for Nurse Practitioners, 19(10), 104765. https://doi.org/10.1016/j.nurpra.2023.104765