University of Texas Southwestern Medical School, Dallas, Texas, USA.
Children's Health System of Texas, Dallas, Texas, USA.
LGBT Health. 2021 May-Jun;8(4):281-289. doi: 10.1089/lgbt.2020.0487. Epub 2021 Apr 8.
No information exists on the needs of transgender youth transitioning their gender-affirming health care from pediatric to adult settings. We obtained perspectives of transgender youth, their parents, and providers, and aimed to identify barriers and unmet needs during the transition of care. Five online focus groups were conducted between February and March 2019 with separate groups for transgender youth 13-17 and 18-21 years old; parents of transgender youth 13-17 and 18-21 years old; and gender-affirming health care providers. Thematic analysis of transcripts was conducted by two researchers. Pooled Cohen's was 0.83, indicating excellent inter-rater reliability. Sixty-six participants (29 youth, 27 parents, and 10 providers) identified 10 themes. Themes related to barriers to transition included access and insurance challenges, patient readiness and hesitancy to transfer care, and multidisciplinary-system inefficiencies. Themes related to improving transition focused on prioritizing referrals from trusted sources, establishing gradual patient independence, aligning gender transition goals, and setting impetus for transferring care. Successful health care transition for transgender youth must consider the intricacies of a complex medical system and challenges that they pose to adolescents' perceived abilities to independently manage health care and willingness to prepare transfer of care. Given that patients, parents, and providers assume important roles during the process, each can uniquely contribute toward ensuring a smooth transition. Efforts to improve this process should focus on enhancing collaboration between clinics and families through crowdsourcing resources, continued verification of health goals, supporting greater patient autonomy, and delineating an explicit timeline for transition.
目前尚无信息可查，了解 transgender youth 将其性别肯定的医疗保健从儿科转移到成人环境中的需求。我们获得了 transgender youth、他们的父母和提供者的观点，并旨在确定护理过渡期间的障碍和未满足的需求。2019 年 2 月至 3 月期间，我们进行了五组在线焦点小组，分别为 13-17 岁和 18-21 岁的 transgender youth；13-17 岁和 18-21 岁的 transgender youth 的父母；以及性别肯定的医疗保健提供者。两位研究人员对转录本进行了主题分析。合并的 Cohen's 为 0.83，表明评分者间可靠性极好。66 名参与者（29 名青年、27 名父母和 10 名提供者）确定了 10 个主题。与过渡障碍相关的主题包括获取和保险挑战、患者准备情况以及对转移护理的犹豫、多学科系统效率低下。与改善过渡相关的主题侧重于优先考虑从可信赖的来源转介、建立逐渐的患者独立性、调整性别过渡目标以及为转移护理设定动力。成功的 transgender youth 医疗保健过渡必须考虑到复杂医疗系统的复杂性以及他们对青少年独立管理医疗保健能力和准备转移护理意愿的挑战。鉴于患者、父母和提供者在这个过程中都扮演着重要的角色，每个人都可以独特地为确保顺利过渡做出贡献。改善这一过程的努力应侧重于通过众包资源、持续验证健康目标、支持更大的患者自主权以及明确过渡时间表，加强诊所和家庭之间的合作。
