PC3100: Knowledge, Attitudes, and Practices in the Orthopaedic Care of Sexual and Gender Minority Youth: A Survey of Two Pediatric Academic Hospitals

Background: While the care of sexual and gender minority (LGBTQ) patients has been well-studied in other medical specialties, little work has been conducted within the field of orthopaedic surgery — the least diverse, slowest to progress medical and surgical specialty.

Methods: We conducted a two-institution survey of pediatric orthopaedic healthcare professionals’ attitudes towards and knowledge about caring for sexual and gender minority youth using a 34-question, internet-based, anonymous questionnaire. We also investigated existing initiatives to improve orthopaedic care for LGBTQ patients that clinicians were aware of at their home institutions. Of the eligible participants, 66% (81 of 123) completed the survey. To assess potential nonresponse bias, we compared early responders (within two weeks) with late responders (after two weeks) and found no differences in responder demographics or in questionnaire responses (all p > 0.05). To answer our research questions regarding clinician attitudes, knowledge, and awareness of institutional initiatives, we compared participant responses using chi-squared tests, Student’s t-test, and McNemar’s tests.

Results: A total of 99% (80 of 81) and 95% (76 of 81) of the respondents reported comfort in treating sexual minority (e.g., lesbian, gay, bisexual) and gender minority (e.g., transgender) youth, respectively, but fewer were confident in their knowledge of sexual minority (63%; 51 of 81; p < 0.001) and gender minority (45%; 37 of 81; p < 0.001) youth’s health needs. There was substantial interest in receiving more education regarding health concerns of LGBTQ people (82%; 66 of 81) and being listed as an LGBTQ-friendly clinician (90%; 73 of 81). The only factor associated with select attitude or knowledge items was duration of licensure; gender identity, political leaning, institutional affiliation, educational degree, or having LGBTQ friends and family were not associated. Many respondents were aware of the use of clinic intake forms and the electronic medical record to collect and provide patient gender identity and sexual orientation data at their practices, as well as signage and symbols (for example, rainbow posters) to cultivate LGBTQ-welcoming clinic spaces.

Conclusion: The study findings support the further investment in clinician training opportunities by healthcare administrators and orthopaedic associations related to the care of sexual and gender minority patients, as well as in the expansion of medical documentation to record and report important patient information such as pronouns and gender identity. Simultaneously, based on these discoveries, clinicians should engage with the increasing number of educational opportunities, explore their personal biases, and implement changes into their own practices, with the ultimate goal of providing equitable and informed orthopaedic care. Given the gaps in knowledge, it is important for future studies to assess a broader sample of orthopaedic healthcare professionals, as well as to investigate disparities in the care received by LGBTQ patients.