From silence to sensitivity: a new Identity Disclosure model to facilitate disclosure for same-sex attracted women in general practice consultations.

Women's same-sex attraction is rarely raised within general practice consultations, despite a common desire for its inclusion. Same-sex attracted women are significantly more likely than heterosexual women to suffer a range of health inequalities, making disclosure of sexual orientation often clinically relevant. This research explored the influences on disclosure from the perspectives of GPs and their regular same-sex attracted female patients. We conducted in-depth semi-structured interviews between mid 2005 and late 2006 with 33 same-sex attracted Australian women, 27 GPs and 1 psychiatrist, including 24 patient-GP pairs. Analysis revealed three disclosure patterns by same-sex attracted women with their preferred GPs, which we labelled open (telling), passive (waiting to be asked) and private (not telling). The three main influences on disclosure patterns were women's sexual identity experience, the risk of disclosure perceived by women and GPs, and the quality of the patient-doctor relationship. We developed the Identity Disclosure model to explain the interactions between these three influences. The more important a woman's sexual identity, the more likely she was to prefer an open disclosure approach, while a lower level of identity importance led to a passive or private approach. Risk and relationship then counterbalanced the disclosure decision. A high level of perceived risk for women or GPs would reduce women's openness, or GPs' willingness to facilitate disclosure. Reciprocal knowing within the relationship would attenuate risk and increase openness. Reciprocity had the capacity to increase GPs' shared responsibility for disclosure, which was desired by many women. We suggest that the Identity Disclosure model will facilitate GPs' understanding of the complex influences on disclosure, and ultimately transform their consultations with same-sex attracted women beyond the habitual silence to a new level of sensitivity.