Clark Beth A, Virani Alice, Marshall Sheila K, Saewyc Elizabeth M
School of Nursing, The University of British Columbia, T222-2211 Wesbrook Mall, Vancouver, BC V6T 2B5, Canada.
Ethics Service, Provincial Health Services Authority, Department of Medical Genetics, 4480 Oak Street, Vancouver, BC V6H 3N1, Canada.
Health Promot Int. 2021 Apr 15;36(2):570-580. doi: 10.1093/heapro/daaa043.
Information is lacking on the role shared decision making plays in the care of transgender (trans) youth. This qualitative, descriptive study explored how trans youth, parents and health care providers engaged or did not engage in shared decision-making practices around hormone therapy initiation and what conditions supported shared decision-making approaches in clinical practice. Semi-structured interviews were conducted with 47 participants in British Columbia, Canada, and analyzed using a constructivist grounded theory approach. While formal shared decision-making models were not used in practice, many participants described elements of such approaches when asked about their health care decision-making processes. Others described health care interactions that were not conducive to a shared decision-making approach. The key finding that emerged through this analysis was a set of five conditions for supporting shared decision making when making decisions surrounding initiation of hormone therapy with trans youth. Both supportive relationships and open communication were necessary among participants to support shared decision making. All parties needed to agree regarding what decisions were to be made and what role each person would play in the process. Finally, adequate time was needed for decision-making processes to unfold. When stakeholders meet these five conditions, a gender-affirming and culturally safer shared decision-making approach may be used to support decision making about gender-affirming care. Implications for clinical practice and future research are discussed.
关于共同决策在跨性别青少年护理中所起的作用，目前信息匮乏。这项定性描述性研究探讨了跨性别青少年、家长和医疗服务提供者如何参与或未参与围绕激素治疗开始的共同决策实践，以及在临床实践中哪些条件支持共同决策方法。对加拿大不列颠哥伦比亚省的47名参与者进行了半结构化访谈，并采用建构主义扎根理论方法进行分析。虽然在实践中未使用正式的共同决策模型，但许多参与者在被问及他们的医疗保健决策过程时描述了此类方法的要素。其他人则描述了不利于共同决策方法的医疗保健互动。通过该分析得出的关键发现是，在与跨性别青少年围绕激素治疗开始做出决策时，支持共同决策的一组五个条件。参与者之间需要支持性的关系和开放的沟通来支持共同决策。所有各方需要就做出哪些决策以及每个人在该过程中将扮演什么角色达成一致。最后，决策过程需要足够的时间来展开。当利益相关者满足这五个条件时，可以采用肯定性别的、文化上更安全的共同决策方法来支持关于性别肯定性护理的决策。讨论了对临床实践和未来研究的启示。
