Background 

Lesbian, gay, bisexual, transgender, and queer (LGBTQ) children and adolescents continue to experience unmet healthcare needs, partly because of clinician biases, discrimination, and inadequate education. Although clinician attitudes and knowledge related to sexual and gender minority health have been well studied in other medical specialties, these have been scarcely studied in orthopaedics.

Questions/purposes 

(1) What are pediatric orthopaedic healthcare professionals’ attitudes (perceived importance, openness, comfort, and confidence) toward caring for sexual and gender minority youth? (2) What do pediatric orthopaedic healthcare professionals know about caring for this patient population? (3) What factors are associated with clinician attitude and/or knowledge? (4) What existing initiatives to improve orthopaedic care for this population are clinicians aware of at their home institutions?

Methods 

All 123 orthopaedic healthcare professionals at two pediatric academic hospitals in the Midwestern and Northeastern United States were sent a 34-question, internet-based, anonymous survey. The survey queried respondent demographics, attitudes, knowledge, and practice behaviors at their home institutions related to the care of sexual and gender minority youth. Respondent attitudes were queried using the Attitudes Summary Measure, which is a survey instrument that was previously validated to assess clinicians’ attitudes regarding sexual and gender minority patients. Items used to assess knowledge and practice behaviors were developed by content experts in LGBTQ health and/or survey design, as well as orthopaedic surgeons to improve face validity and to mitigate push-polling. Attitude and knowledge items used a 5-point Likert scale. Sixty-six percent (81 of 123) of clinicians completed the survey. Of those, 47% (38 of 81) were physicians, 73% (59 of 81) were licensed for fewer than 20 years, 63% (51 of 81) were women, and 53% (43 of 81) described themselves as liberal-leaning. The response proportions were 73% (38 of 52) among eligible physicians specifically and 61% (43 of 71) among other clinicians (nurse practitioners, physician assistants, and registered nurses). To assess potential nonresponse bias, we compared early responders (within 2 weeks) with late responders (after 2 weeks) and found no differences in responder demographics or in questionnaire responses (all p > 0.05). The main outcome measures included responses to the attitude and knowledge questionnaire, as well as the existing practices questionnaire. To answer our research questions regarding clinician attitudes knowledge and awareness of institutional initiatives, we compared participant responses using chi-square tests, the Student t-test, and the McNemar tests, as appropriate. To answer our research question on factors associated with questionnaire responses, we reported data for each question, stratified by hospital, years since licensure, and political leaning. Comparisons were conducted across strata using chi-square tests for Likert response items and ANOVA for continuous response items. All p values less than 0.05 were considered significant.

Results 

Of the respondents who reported feeling comfortable treating lesbian, gay, and bisexual (sexual minority) youth, a small proportion reported feeling confident in their knowledge about these patients’ health needs (99% [80 of 81] versus 63% [51 of 80], 36% reduction [95% confidence interval 23% to 47%]; p < 0.001). Similarly, of those who reported feeling comfortable treating transgender (gender minority) youth, a smaller proportion reported feeling confident in their knowledge of their health needs (94% [76 of 81] versus 49% [37 of 76], 45% reduction [95% CI 31% to 59%]; p < 0.001). There was substantial interest in receiving more education regarding the health concerns of LGBTQ people (81% [66 of 81]) and being listed as an LGBTQ-friendly clinician (90% [73 of 81]). Factors that were associated with select attitude and knowledge items were duration of licensure and political leaning; gender identity, 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 practice, as well as signage and symbols (for example, rainbow posters) to cultivate LGBTQ-welcoming clinic spaces.

Conclusion 

There were varying degrees of confidence and knowledge regarding the health needs of sexual and gender minority youth among pediatric orthopaedic healthcare professionals. There was considerable interest in more focused training and better use of medical technologies to improve care for this population.

Clinical Relevance 

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 findings, 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.

中文翻译：

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性和性别少数青少年骨科护理的知识、态度和实践：对两家儿科学术医院的调查

背景 

女同性恋、男同性恋、双性恋、跨性别者和酷儿 (LGBTQ) 儿童和青少年的医疗保健需求仍然得不到满足，部分原因是临床医生的偏见、歧视和教育不足。尽管其他医学专业对临床医生与性和性别少数健康相关的态度和知识进行了深入研究，但在骨科中却很少进行研究。

问题/目的 

(1) 儿科骨科医疗保健专业人员对照顾性少数和性别少数青少年的态度（感知重要性、开放性、舒适性和信心）是什么？(2) 儿科骨科医疗保健专业人员对护理该患者群体了解多少？(3) 哪些因素与临床医生的态度和/或知识相关？(4) 临床医生在其所在机构了解哪些现有的旨在改善该人群骨科护理的举措？

方法 

美国中西部和东北部两家儿科学术医院的所有 123 名骨科医疗保健专业人员都收到了一份包含 34 个问题的基于互联网的匿名调查。该调查询问了受访者在其所在机构中与照顾性少数和性别少数青少年相关的人口统计数据、态度、知识和实践行为。使用态度总结测量来询问受访者的态度，该测量是一种调查工具，之前经过验证，可用于评估临床医生对性少数和性别少数患者的态度。用于评估知识和实践行为的项目由 LGBTQ 健康和/或调查设计方面的内容专家以及整形外科医生开发，以提高表面有效性并减少推式民意调查。态度和知识项目使用 5 点李克特量表。66%（123 名临床医生中的 81 名）完成了调查。其中，47%（81 人中的 38 人）是医生，73%（81 人中的 59 人）获得执照的时间少于 20 年，63%（81 人中的 51 人）是女性，53%（81 人中的 43 人）称自己是自由主义者-倾斜。特别是符合资格的医生中的回复比例为 73%（52 名中的 38 名），其他临床医生（执业护士、医师助理和注册护士）中的回复比例为 61%（71 名中的 43 名）。为了评估潜在的不答复偏差，我们将早期答复者（2 周内）与晚期答复者（2 周后）进行了比较，发现答复者人口统计数据或问卷答复没有差异（全部 p > 0.05）。主要结果指标包括对态度和知识调查问卷以及现有实践调查问卷的答复。为了回答有关临床医生态度知识和机构举措意识的研究问题，我们酌情使用卡方检验、学生 t 检验和麦克尼马尔检验来比较参与者的反应。为了回答我们关于与问卷答复相关的因素的研究问题，我们报告了每个问题的数据，按医院、获得许可后的年数和政治倾向进行分层。使用李克特响应项目的卡方检验和连续响应项目的方差分析进行跨层比较。所有小于 0.05 的 p 值均被认为是显着的。

结果 

在表示愿意治疗女同性恋、男同性恋和双性恋（性少数）青年的受访者中，一小部分人表示对自己了解这些患者的健康需求充满信心（99% [81 人中的 80 人] vs 63% [80 人中的 51 人]） ]，降低 36% [95% 置信区间 23% 至 47%]；p < 0.001）。同样，在那些表示对治疗跨性别（性别少数）青年感到放心的人中，较小比例的人表示对自己的健康需求了解充满信心（94% [81 人中的 76 人] 对比 49% [76 人中的 37 人]，减少了 45% [ 95% CI 31% 至 59%]；p < 0.001）。人们非常有兴趣接受更多有关 LGBTQ 人群健康问题的教育（81% [81 人中的 66 人]）并被列为 LGBTQ 友好型临床医生（90% [81 人中的 73 人]）。与选择态度和知识项目相关的因素是执照期限和政治倾向；性别认同、所属机构、教育程度或是否有 LGBTQ 朋友和家人均不相关。许多受访者意识到在诊所使用诊所登记表和电子病历来收集和提供患者性别认同和性取向数据，以及使用标牌和符号（例如彩虹海报）来培养欢迎 LGBTQ 的诊所空间。

结论 

儿科骨科医疗保健专业人员对性少数和性别少数青少年的健康需求有不同程度的信心和了解。人们对更有针对性的培训和更好地利用医疗技术来改善对这一人群的护理表现出极大的兴趣。

临床相关性 

研究结果支持医疗保健管理人员和骨科协会进一步投资与性少数和性别少数患者护理相关的临床医生培训机会，以及扩大医疗文件记录和报告重要患者信息（例如代词和性别认同） 。同时，基于这些发现，临床医生应该利用越来越多的教育机会，探索他们的个人偏见，并在自己的实践中实施改变，最终目标是提供公平和知情的骨科护理。