title: Exploring lesbian, gay, bisexual, and queer (LGBQ) people's experiences with disclosure of sexual identity to primary care physicians: a qualitative study.
abstract: BACKGROUND
  It has been demonstrated that health disparities between lesbian, gay, bisexual and queer (LGBQ) populations and the general population can be improved by disclosure of sexual identity to a health care provider (HCP). However, heteronormative assumptions (that is, assumptions based on a heterosexual identity and experience) may negatively affect communication between patients and HCPs more than has been recognized. The aim of this study was to understand LGBQ patients' perceptions of their experiences related to disclosure of sexual identity to their primary care provider (PCP).
  
  
  METHODS
  One-on-one semi-structured telephone interviews were conducted, audio-recorded, and transcribed. Participants were self-identified LGBQ adults with experiences of health care by PCPs within the previous five years recruited in Toronto, Canada. A qualitative descriptive analysis was performed using iterative coding and comparing and grouping data into themes.
  
  
  RESULTS
  Findings revealed that disclosure of sexual identity to PCPs was related to three main themes: 1) disclosure of sexual identity by LGBQ patients to a PCP was seen to be as challenging as coming out to others; 2) a solid therapeutic relationship can mitigate the difficulty in disclosure of sexual identity; and, 3) purposeful recognition by PCPs of their personal heteronormative value system is key to establishing a strong therapeutic relationship.
  
  
  CONCLUSIONS
  Improving physicians' recognition of their own heteronormative value system and addressing structural heterosexual hegemony will help to make health care settings more inclusive. This will allow LGBQ patients to feel better understood, willing to disclose, subsequently improving their care and health outcomes.
authors.affiliation: Faculty of Medicine, University of Toronto, Medical Sciences Building, 1 King's College Circle, Room 3157, Toronto, ON, M5S 1A8, Canada. marcus.law@utoronto.ca.|Department of Family & Community Medicine, University of Toronto, 500 University Avenue, 5th Floor, Toronto, ON, M5G 1V7, Canada. marcus.law@utoronto.ca.
authors.forename: Marcus
authors.initials: M
authors.lastname: Law
authors.affiliation: Department of Family & Community Medicine, University of Toronto, 500 University Avenue, 5th Floor, Toronto, ON, M5G 1V7, Canada. anila.mathai@utoronto.ca.
authors.forename: Anila
authors.initials: A
authors.lastname: Mathai
authors.forename: Paula
authors.initials: P
authors.lastname: Veinot
authors.affiliation: Department of Family & Community Medicine, University of Toronto, 500 University Avenue, 5th Floor, Toronto, ON, M5G 1V7, Canada. Fiona.Webster@utoronto.ca.
authors.forename: Fiona
authors.initials: F
authors.lastname: Webster
authors.affiliation: Faculty of Medicine, University of Toronto, Medical Sciences Building, 1 King's College Circle, Room 3157, Toronto, ON, M5S 1A8, Canada. maria.mylopoulos@utoronto.ca.|The Wilson Centre, 200 Elizabeth Street, 1ES-565, Toronto, ON, M5G 2C4, Canada. maria.mylopoulos@utoronto.ca.
authors.forename: Maria
authors.initials: M
authors.lastname: Mylopoulos
mesh_terms: D000328:Adult; D001291:Attitude of Health Personnel; D001727:Bisexuality / Q000523:psychology*; D005260:Female; D018452:Homosexuality, Female / Q000523:psychology*; D018451:Homosexuality, Male / Q000523:psychology*; D006801:Humans; D008297:Male; D058007:Physicians, Primary Care / Q000523:psychology*; D011320:Primary Health Care / Q000941:ethics*; D011785:Quality Assurance, Health Care / Q000379:methods*; D012650:Self Disclosure