The Dissectionality of Care in the U.S.: A Scoping Review in Healthcare of Implicit Bias, Perceived Discrimination, and Minority Stress Among Sexual and Gender Minorities.

Changes in gender-affirming care, reproductive rights, and healthcare within the USA result in greater inequities and disparities. This scoping review is the first to study the emerging literature of sexual and gender minorities (SGM) when navigating healthcare systems as it relates to the constructs of implicit bias, perceived discrimination, and minority stress. This review examines patient and provider interactions and how the above constructs impact healthcare access, the quality of care received, and clinical outcomes for patients within the framework of intersectionality and positionality. Database searches yielded 96 articles published between January 2015 and January 2025. Reviewed research included systematic literature reviews, mixed methods designs, and qualitative and quantitative designs studies which were conducted in the USA and based on various sexual groups and gender diverse populations who accessed medical or behavioral healthcare treatments. Research quality appraisal was conducted through the Crowe critical appraisal tool. Conceptual overlap between implicit bias, perceived discrimination, and minority stress was found. Medical decision-making and health outcomes during provider and patient interactions were further evaluated based on these concepts. Further research and interventions directed at more inclusive medical and behavioral healthcare for SGM populations are needed. We propose the term dissectionality of care, focusing attention on the gaps within healthcare settings in illustrating the multidirectional and multilayered intersections between patient and provider interactions. Barriers to care experienced by historically disadvantaged and under-resourced sexual and gender diverse patients and providers were found. We suggest ways to enhance professional curricula and direct further research.