# Disclosure experiences in LGBTQ+ healthcare staff: a systematic review and meta-synthesis

## TL;DR

This study explores the challenges LGBTQ+ healthcare workers face when deciding to disclose their identity at work, highlighting the mental toll and need for supportive environments.

## Contribution

The study is the first to focus on LGBTQ+ healthcare professionals' disclosure experiences, filling a gap in existing literature.

## Key findings

- Five themes emerged: risk, decision-making, cost of non-disclosure, cost of disclosure, and benefits of disclosure.
- Five critical factors influencing disclosure include level, scope, time, elements, and method.
- A risk–benefit analysis showed a tension between authenticity and conformity due to heteronormativity.

## Abstract

Workplace disclosure of Lesbian, Gay, Bisexual, Transgender and Queer (LGBTQ+) identity by healthcare employees is an understudied area and existing reviews of LGBTQ+ disclosure in the healthcare sector focus on patient perspectives, overlooking the unique challenges that healthcare professionals encounter. The aim of this study was to conduct a systematic review and meta-synthesis of existing qualitative studies exploring disclosure experiences of LGBTQ+ healthcare employees.

The literature search integrated current research from 2011 to March 2023 and focused on qualitative studies exploring disclosure experiences of LGBTQ+ healthcare professionals. Ovid served as the primary platform for literature searches, supplemented by forward and backward citation tracking and additional searches in academic databases such as Google Scholar and Scopus. The studies underwent quality evaluation using the Critical Appraisal Skills Programme 2022 checklist and were synthesised using thematic analysis.

The findings revealed seven studies with five prominent themes: (1) risk associated with disclosure, (2) making the decision to disclose, (3) cost of non-disclosure, (4) cost of disclosure and (5) benefit of disclosure. Additionally, five critical factors of disclosure were identified: level, scope, time, elements and method. Finally, the risk–benefit analysis underscored the dilemma and balance between authenticity and conformity, largely influenced by pervasive heteronormativity, resulting in a significant mental toll.

The findings must be interpreted considering certain limitations, such as the lack of generalisability of studies. However, the findings emphasise the critical need for cultivating trusting and accepting healthcare work environments for LGBTQ+ staff.