- The PCORI Strategic Plan
- Our Programs
- Our Vision & Mission
- Financial Statements and Reports
- The PCORI Strategic Plan
- Board of Governors
- Methodology Committee
- Authorizing Law
- Evaluating Our Work
- PCORI's Advisory Panels
- Procurement Opportunities
Past Opportunities to Provide Input
- Patient-Centered Economic Outcomes Landscape (2023-2024)
- Systematic Review of Audio Care for the Management of Mental Health and Chronic Conditions (2023) -- Draft Key Questions
- Proposed New Methodology Standards for Usual Care as a Comparator (2023)
- Stakeholder Views on Components of 'Patient-Centered Value' in Health and Health Care (2023)
- PCORI's Proposed Research Agenda (2021-2022)
- Proposed National Priorities for Health (2021)
- Proposed Principles for the Consideration of the Full Range of Outcomes Data in PCORI-Funded Research (2020)
- Proposed New PCORI Methodology Standards (2018)
- Data Access and Data Sharing Policy: Public Comment (2017)
- Proposed New PCORI Methodology Standards (2017)
Comment on the Proposed New and Revised PCORI Methodology Standards (2016)
- 1. Standards for Formulating Research Questions
- 10: Standards for Studies of Diagnostic Tests
- 12. Standards on Research Designs Using Clusters
- 13: General Comments on the Proposed Revisions to the PCORI Methodology Standards
- 2: Standards Associated with Patient-Centeredness
- 3: Standards for Data Integrity and Rigorous Analysis
- 4: Standards for Preventing and Handling Missing Data
- 5: Standards for Heterogeneity of Treatment Effects
- 6: Standards for Data Registries
- 7: Standards for Data Networks as Research-Facilitating Structures
- 8. Standards for Causal Inference Methods
- 9. Standards for Adaptive Trial Designs
- Peer-Review Process Comments (2014)
- Draft Methodology Report Public Comment Period (2012)
- Past Opportunities to Provide Input
The lesbian, gay, bisexual, and transgender (LGBT) population faces unique mental and physical health challenges. Perceived stigma and a lack of cultural competence from healthcare providers can be additional challenges among transgender individuals, a group that has been largely overlooked in health research. Transgender is a term for individuals whose gender identity differs from the sex they were assigned at birth.
The LGBT population faces physical health challenges that can relate to anything from gender dysphoria to stroke. Compared with heterosexual people, some members of the LGBT population are also at higher risk for HIV, cancer, and other diseases. LGBT individuals are also more likely to smoke, use illicit drugs, and drink alcohol excessively than heterosexuals.
PCORI’s mandate includes funding research that addresses healthcare disparities in underserved populations, a categorization that includes LGBT individuals. To date, PCORI has funded eight clinical comparative effectiveness research studies related to LGBT health, an investment of $26 million. (See box, PCORI's LGBT Health Focus.) While the studies address very different health concerns, they share goals of reducing disparities and improving health outcomes for the LGBT community.
Unique Health Concerns
In response to some of the critical health disparities transgender people experience, a PCORI-funded project led by Michael Goodman, MD, MPH, at Emory University examined the risks and benefits of gender reassignment therapies, such as estrogen treatment for transgender women. Researchers found that transgender women who receive estrogen treatments face a higher risk for stroke and dangerous blood clots than postmenopausal women do.
The mental health challenges facing the LGBT community—and particularly the transgender community—are also a reason to do research to improve health outcomes.
Crowdsourcing LGBT Health Data to Improve Research
In addition to the LGBT-related clinical comparative effectiveness research studies PCORI has funded, PCORI also funds the Population in Identity and Disparities for Equality Patient-Powered Research Network, or PRIDEnet. PRIDEnet is one of the research networks that make up PCORnet, the National Patient-Centered Clinical Research Network.
PRIDEnet consists of more than 40 partner organizations, including health groups, community centers, and organizations that support the LGBT community. It has enrolled more than 10,000 people, who answer questions about their health history. It is working to engage the LGBT community as partners and participants in research to understand how sexual orientation and gender identity affect health and how to improve health outcomes for LGBT individuals.
A national survey found that 41 percent of transgender individuals attempt suicide at some point, as do some 10 to 20 percent of lesbian, gay, and bisexual adults. These figures are more than double, and up to 10 times as high as, the average percentage of the national population who report attempting suicide.
Goodman’s study adds young people to these concerning statistics. The team reported in Pediatrics that children or adolescents describing themselves as transgender to a healthcare provider need evaluation for possible life-threatening depression or other mental health concerns.
Another PCORI-funded study, based at Fenway Community Health Center in Massachusetts, compared two methods of testing for human papillomavirus, or HPV. The virus is the most common sexually transmitted infection in the country and is responsible for almost all cervical cancer cases. The study focused on 131 transmasculine people—individuals assigned female sex at birth who identify as male—and compared HPV swab tests conducted by clinicians with swab tests that patients performed themselves.
More than 90 percent of patients preferred the self-testing method, the research team reported in PLOS ONE, and the results from this method were nearly as accurate as the tests performed by clinicians. Self-testing could be effective for people who aren’t comfortable undergoing an exam by a healthcare provider, the researchers conclude.
Collecting Data in Hopes of Improving Care
Another PCORI-funded study, led by Adil Haider, MD, MPH, of Brigham and Women’s Hospital in Massachusetts, is testing ways to collect information about sexual orientation and gender identity in the emergency department. Collecting this information hasn’t been standard practice, but it could help clinicians become more aware of patients’ needs.
To assess the feasibility of collecting this information, researchers surveyed clinicians and patients in the emergency room. While nearly 80 percent of clinicians surveyed said patients would be unwilling to provide sexual orientation and gender identity information, only 10 percent of patients said they would be uncomfortable providing it, the researchers reported in JAMA Internal Medicine.
Next, researchers worked with patients and other stakeholders to develop two approaches—one verbal and one written—to asking about sexual orientation and gender identity in the emergency department. The research team implemented those approaches at two teaching hospitals and two community hospitals.
The study’s full results are forthcoming, but its preliminary message is encouraging: Most patients are willing to share information about their sexual orientation and gender identity, despite clinicians’ preexisting beliefs to the contrary. Asking these questions or adding them to intake forms—just as race and ethnicity questions were added a few decades ago—could get doctors information they need to treat patients.
More Results to Come
PCORI’s LGBT research portfolio also includes projects related to HIV and sexual health screening, depression, opioid use, and training community health center workers to work better with LGBT patients.
At PCORI, we’re committed to supporting patient-centered research that will produce reliable evidence that LGBT people and other underserved populations can use to make better-informed decisions about health and healthcare issues that affect them and their families. You can find more information about the work we’re funding in the Research and Results section of our website.
PCORI’s LGBT Health Focus
PCORI has funded eight comparative clinical effectiveness research studies related to the health of LGBT people, an investment of $26 million. They are the following:
- CASA: Care and Support Access Study for Implementation of a Palliative Approach with HIV Treatment
Carla S. Alexander, MD | University of Maryland Baltimore
- Resilience Against Depression Disparities (RADD)
Bowen Chung, MD, MS | Regents of the University of California, Los Angeles
- A Simple Large Trial of Patient-Centered Care for Opioid Use Disorders in Federally Qualified Healthcare Centers and Specialty Care Settings
David R. Gastfriend, MD | Public Health Management Corporation
- Examining Health Outcomes for People Who Are Transgender
Michael Goodman, MD, MPH | Emory University
- Patient-Centered Approaches to Collect Sexual Orientation/Gender Identity Information in the Emergency Department
Adil Haider, MD, MPH | Brigham and Women’s Hospital
- Comparative Effectiveness Research to Improve the Health of Sexual and Gender Minority Patients through Cultural Competence and Skill Training of Community Health Center Providers and Nonclinical Staff
Kenneth Mayer, MD | Fenway Community Health Center
- Comparing Clinician-Collected and Self-Collected Tests for Detecting High-Risk HPV Infection among Female-to-Male Transgender Adults
Sari Reisner, ScD | Fenway Community Health Center
- Transgender Cohort Study of Gender Affirmation and HIV-Related Health
Sari Reisner, ScD | Boston Children's Hospital
April 15, 2020, 6:15 PM
Comment by PCORI Blog,
Thanks for reading!
April 14, 2020, 9:40 AM
Comment by Mark John,
I like your posts and I like a post you are most information and This is really great work.
June 1, 2018, 9:07 PM
Comment by PCORI,
Hello. Thank you so much for your comment. We appreciate it.
May 15, 2018, 4:21 PM
Comment by Carolyn Hunt,
Great article! Thank you.
May 14, 2018, 11:22 PM
Comment by TR,
I'm grateful there is research into Patient-centered approaches to collecting information about sexual orientation and gender identity in the emergency department. As with any information gathering such as this, it's so important to educate the emergency department staff so they do not immediately jump to conclusions when getting responses to these questions, but see this as simply more pieces to the puzzle of any individual's health.
Our daughter's physical complaints were brushed aside in the ED after she honestly answered these questions. It was suddenly assumed her complaints came from anxiety and that she was overly dramatic. She has since expressed that she is unsure whether she should have responded honestly. Her physical symptoms being brushed aside could have been fatal. She had advanced Crohn's disease.