The Impact of Physician Self-disclosure of Sexual Identity on Patient Trust

Background: Annual polls suggest that upwards of 30% of Americans would feel somewhat or very uncomfortable to find out that their physician is part of the LGBTQ+ community. There has been little to no randomized research into the impact of physician self-disclosure of their sexual
identity.

Methods: This randomized trial utilized an experimental, vignette-based study design. Participants were recruited to take an anonymous online survey through social media platforms, using both organic shares and paid advertisements. The survey included three sections. The first was common to all participants, using a previously validated survey tool to measure baseline trust in medical professionals. The second section involved a set of two experimental vignettes followed by a series of questions to gauge the participant’s trust in the physician in the vignette. These questions were coded and scored with a higher total indicating more trust. The manipulated variable between the vignettes was the disclosure of the sexuality of the physician within the context of sharing the experience of the physician’s spouse to reassure and relate to the patient. Participants were randomized to 4 different groups: male-heterosexual physician, female-heterosexual physician, male-homosexual physician, and female-homosexual physician. The primary endpoint was comparing the difference in trust scores between vignettes 1 and 2 between randomization groups.

Results: A total of 191 individuals took the Physicians Actions Changing Trust (PACT) Survey with 181 randomized after meeting eligibility criteria. Significant demographics included a skew toward suburban respondents (58.6%) and college educated respondents (70.2%). The mean difference between Vignette 1 and Vignette 2 across the 4 randomization groups was 0.517. The only randomization group to trend towards a significant difference was the male-homosexual physician group with a Difference in Means=1.51 with p=0.111.

Conclusion: On first look, these results suggest that disclosure of sexual identity does not significantly impact patient trust in a physician. The PACT survey is limited by a small and non-representative sample size. A larger and more diverse sample population may reveal significant differences in trust of physicians that disclose a non-heterosexual relationship.