Department of Child and Adolescent Psychiatry, Leiden University Medical Center Curium, Leiden University Medical Center, Oegstgeest, the Netherlands.
Department of Child and Adolescent Psychiatry, Amsterdam University Medical Center, Location VUmc, VU University, Amsterdam, the Netherlands.
Pediatrics. 2021 Dec 1;148(6). doi: 10.1542/peds.2020-049643.
According to international transgender care guidelines, an important prerequisite for puberty suppression (PS) is transgender adolescents' competence to give informed consent (IC). In society, there is doubt whether transgender adolescents are capable of this, which in some countries has even led to limited access to this intervention. Therefore, this study examined transgender adolescents' medical decision-making competence (MDC) to give IC for starting PS in a structured, replicable way. Additionally, potential associated variables on MDC, such as age, intelligence, sex, psychological functioning, were investigated.
A cross-sectional semistructured interview study with 74 transgender adolescents (aged 10-18 years; 16 birth-assigned boys, 58 birth-assigned girls) within two Dutch specialized gender-identity clinics was performed. To assess MDC, judgements based on the reference standard (clinical assessment) and the MacArthur Competence Assessment Tool for Treatment (MacCAT-T), a validated semistructured interview, were used.
Of the transgender adolescents, 93.2% (reference standard judgements; 69 of 74) and 89.2% (MacCAT-T judgements; 66 of 74) were assessed competent to consent. Intermethod agreement was 87.8% (65 of 74). Interrater agreements of the reference standard and MacCAT-T-based judgements were 89.2% (198 of 222) and 86.5% (192 of 222), respectively. IQ and sex were both significantly related to MacCAT-T total score, whereas age, level of emotional and behavioral challenges, and diagnostic trajectories duration were not.
By using the MacCAT-T and clinicians' assessments, 93.2% and 89.2%, respectively, of the transgender adolescents in this study were assessed competent to consent for starting PS.
根据国际跨性别护理指南，进行青春期抑制（PS）的一个重要前提是跨性别青少年有能力做出知情同意（IC）。在社会上，人们怀疑跨性别青少年是否有能力做出这种决定，这在某些国家甚至导致他们获得这种干预的机会有限。因此，本研究以结构化、可复制的方式，检查了跨性别青少年在开始 PS 时做出 IC 的医疗决策能力（MDC）。此外，还研究了与 MDC 相关的潜在变量，如年龄、智力、性别、心理功能。
在荷兰两家专门的性别认同诊所中，对 74 名跨性别青少年（年龄 10-18 岁；16 名出生时为男孩，58 名出生时为女孩）进行了一项横断面半结构化访谈研究。为了评估 MDC，使用了基于参考标准（临床评估）和麦克阿瑟治疗能力评估工具（MacCAT-T）的判断，后者是一种经过验证的半结构化访谈。
在接受评估的跨性别青少年中，93.2%（参考标准判断；74 人中的 69 人）和 89.2%（MacCAT-T 判断；74 人中的 66 人）被评估为有能力做出同意决定。两种方法之间的一致性为 87.8%（74 人中的 65 人）。参考标准和基于 MacCAT-T 的判断的观察者间一致性分别为 89.2%（222 次中的 198 次）和 86.5%（222 次中的 192 次）。智商和性别均与 MacCAT-T 总分显著相关，而年龄、情绪和行为挑战水平以及诊断轨迹持续时间则没有。
使用 MacCAT-T 和临床医生的评估，本研究中的 93.2%和 89.2%的跨性别青少年被评估为有能力做出同意开始 PS 的决定。
