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Healthcare workers may be biased regarding the sexual orientation of their patients, according to results of the first study to examine the issue.

University of Washington researchers compared the attitudes of more than 200,00 physicians, nurses and other providers of heterosexual versus lesbian and gay patients over six years. Heterosexual nurses had the strongest implicit preference for heterosexual men over gay men, according to results published in the American Journal of Public Health on July 16.

The results reflect how clinical care of the LGBT population isn’t addressed in most nursing, medicine or healthcare areas, according to Janice Sabin, Ph.D., lead investigator and research associate professor. Nursing homes have struggled with the issue, facing criticism for a lack of acceptance and training when treating gay or lesbian seniors. The American Geriatrics Society called for new policies in February to treat the population more fairly.

In the study, providers took a test asking them to indicate their preference on statements such as “I strongly prefer straight people to gay people.” The university described it as the first to look at healthcare provider attitudes when treating gay or lesbian adults.

“For healthcare organizations that aim to serve these populations, these data suggest an opportunity to examine methods likely to mitigate implicit biases, such as eliminating discretion from decision-making, use of clinical guidelines, awareness of personal bias as self-caution, organizational policies that promote objective decision-making, and inclusion of counter-stereotypical experiences in educational programs,” the authors wrote.

Future research will look at whether the implicit or explicit attitude impacts care delivery to the LGBT population, researchers said.