Abstract: Transgender Identity Disclosure Strategies in Patient-Provider Interactions

◆ L. Brooke Friley, Texas A&M University-Corpus Christi
◆ Maria K. Venetis, Purdue University

The HealthyPeople 2020 mandate listed transgender individuals as a population of concern due to increasing health inequities(1) related to poor quality of care, lack of qualified providers, and higher rates of physical and mental health issues compared to the general population(2,3). Unfortunately, the 2020 goal may be unfulfilled as transgender patients continue reporting experiences of discrimination in medical settings(4). These experiences complicate trans-patients’ decisions to disclose this identity to medical providers. However, quality health outcomes are intrinsically tied to productive patient-provider relationships, and transgender patients often must disclose this identity to receive proper care. Many transgender individuals attempt to “pass” as their affirmed gender(5), and the state of being transgender cannot be readily confirmed through casual interaction alone(6). This naturally leads to situations, such as medical interactions, where the sharing of transgender identity becomes central to the conversation.
One variable across disclosure theories that influences if and how one discloses is disclosure efficacy(7,8), or one’s confidence in their ability to share information and achieve desired outcomes. Efficacy is influenced by risk perceptions of sharing the information and anticipated recipient response. In situations of high risk and anticipated negative responses, individuals may be willing to disclose in specific conditions such as medical interactions when the provider needs to know the information. Increased efficacy predicts increased disclosure and use of strategies perceived as effective for sharing information. Reduced efficacy predicts disclosure strategies that are evaluated as less effective in achieving desired outcomes(7,9). The purpose of this study was to explore transgender patients’ disclosure strategies used in sharing this with medical providers.
The following research question was posed:
RQ1: What are the strategies transgender patients report using when disclosing their transgender identity to medical providers?
Interviews were conducted with 26 transgender individuals. Participants discussed their strategies for telling providers about their transgender identity. Interviews were coded using an inductive analytic approach to identify major themes(10); coding was refined according to the constant comparative method(11).
Three overarching themes with sub-themes were identified. Theme one includes disclosure planning, or participants’ preparations when deciding how to disclose to providers. Sub-themes include selecting interactional versus non-interactional disclosure options; tailoring disclosure messages using basic terminology that is clear, concise, and avoids bias. Theme two describes how participants determine timing of the disclosure by finding a point of entry within the conversation. Theme three describes participants’ disclosure preparation of rehearsing or seeking advice. This includes intrapersonal strategizing and preparing mental or written scripts; strategizing with trans friends and close others to plan disclosures; and strategizing with support groups to plan disclosure based on shared experiences through the lens of best practices. These themes align with several revelation strategies outlined across disclosure literature, and present new ways of conceptualizing disclosure, especially within unique relationship contexts such as the patient-provider.
Study implications include highlighting the experiences of a minority population within healthcare settings; exploring intersections of health, gender, and sexuality; and extending current disclosure research into a unique context.