Frohard-Dourlent Hélène, MacAulay Margaret, Shannon Monica
School of Nursing, The University of British Columbia, Vancouver, British Columbia, Canada.
Int J Transgend Health. 2020 Apr 2;21(2):147-162. doi: 10.1080/26895269.2020.1742842. eCollection 2020.
A surgical readiness assessment is a major step in the medical journey of trans people seeking gender-affirming surgery. Much of the peer-reviewed literature surrounding surgical readiness assessments emphasizes the perspectives of academics and clinicians, leaving the voices of trans and gender diverse patients largely unheard. This paper foregrounds patient experiences with surgery readiness assessments to discuss the tensions, challenges and opportunities they generate. We conducted a thematic analysis of 35 in-depth interviews with trans people who accessed or were seeking to access gender-affirming surgery in British Columbia. We developed three main themes to capture participants' narratives of their surgical assessment experiences. The first, assessments as gatekeeping, explores the stories of people who described their assessments as outdated and even discriminatory processes. The second, assessments as a barrier to care, discusses the informational missteps, bureaucratic regulations, economic issues, and geographic concerns that made assessments difficult to access. The third, assessments as useful, includes positive stories about assessments that often involved feeling supported by an assessor and feeling prepared for the next steps. These narratives demonstrate how much variation exists among people's experiences of readiness assessments for gender-affirming surgery. No matter how their actual assessment turned out, many participants approached their appointments with a great deal of anxiety and trepidation. We attributed this stress was to challenges ranging from lengthy wait times, arbitrary medical gatekeeping, a lack of access to knowledgeable and supportive providers, unclear or changing administrative processes, and insufficient communication. To address these challenges, it is crucial for the medical system to create more accessible pathways with centralized, up-to-date information for people trying to access assessments. Patients are best served by multi-disciplinary gender-affirming teams that provide individualized care.
手术准备情况评估是寻求性别肯定手术的跨性别者医疗过程中的重要一步。围绕手术准备情况评估的许多同行评议文献都强调了学者和临床医生的观点，跨性别及性别多样化患者的声音在很大程度上未被听到。本文突出了患者在手术准备情况评估方面的经历，以探讨评估所产生的紧张关系、挑战和机遇。我们对35名在不列颠哥伦比亚省接受或寻求接受性别肯定手术的跨性别者进行了深入访谈，并进行了主题分析。我们提出了三个主要主题来概括参与者对手术评估经历的叙述。第一个主题是“评估作为把关”，探讨了那些将评估描述为过时甚至歧视性过程的人的故事。第二个主题是“评估作为获得护理的障碍”，讨论了导致评估难以获得的信息失误、官僚规定、经济问题和地理因素。第三个主题是“评估是有用的”，包括关于评估的积极故事，这些故事通常涉及感受到评估者的支持以及为下一步做好准备。这些叙述表明，人们在性别肯定手术准备情况评估方面的经历存在很大差异。无论实际评估结果如何，许多参与者在预约时都充满了焦虑和恐惧。我们将这种压力归因于各种挑战，包括漫长的等待时间、随意的医疗把关、缺乏获得知识渊博且支持性的医疗服务提供者的机会、行政程序不明确或不断变化以及沟通不足。为应对这些挑战，医疗系统为试图进行评估的人创建更易获取的途径并提供集中、最新的信息至关重要。由多学科性别肯定团队提供个性化护理能为患者提供最佳服务。
