Yale Cancer Center, Yale School of Medicine, New Haven, Connecticut (A.B.A.);
Center for Gerontology and Healthcare Research, Department of Health Services, Policy & Practice, Brown University School of Public Health, Providence, Rhode Island (A.B.A., E.B.).
Ann Fam Med. 2023 Sep-Oct;21(5):408-415. doi: 10.1370/afm.3010.
Investigating transgender people's experiences sharing health information in clinical encounters may yield insights for family medicine clinicians.
This was a qualitative study using a community-based participatory research approach and interpretive description methodology. Seven qualitative focus groups were conducted with 30 transgender adults living in North America. We used purposive sampling to ensure diversity. The focus groups were transcribed verbatim, and 2 investigators independently reviewed and coded each transcript, then they mutually reviewed the transcripts, reconciled their coding, and summarized the codes into themes. Themes were reviewed with community members, participants, and uninvolved clinically oriented investigators for member checking and peer debriefing.
Four themes were noted: (1) transgender people often perceive clinicians' questions as voyeuristic, stigmatizing, or self-protective; (2) patients describe being pathologized, denied or given substandard care, or harmed when clinicians learned they are transgender; (3) transgender people frequently choose between risking stigma when sharing information and risking ineffective clinical problem solving if clinicians do not have all the information about their medical histories; (4) improving the safety of transgender people is difficult in the context of contemporary medical systems.
Transgender people often must choose between stigma and potentially suboptimal care. Improvements in medical culture, policies, procedures, and data collection tools are necessary to improve the quality and safety of clinical care for transgender people. Institutional and systems changes may be required to safely and effectively implement sexual orientation and gender identity (SOGI) data collection in clinical settings.
研究跨性别者在临床接触中分享健康信息的体验，可能为家庭医学临床医生提供一些见解。
这是一项使用基于社区的参与式研究方法和解释性描述方法的定性研究。我们与居住在北美的 30 名跨性别成年人进行了 7 次定性焦点小组。我们采用目的性抽样来确保多样性。将焦点小组的转录逐字记录下来，然后由 2 名调查员独立审查和编码每个转录本，然后他们相互审查转录本，协调他们的编码，并将代码总结为主题。主题与社区成员、参与者和未参与临床导向研究的调查员进行了审查，以进行成员检查和同行汇报。
注意到了四个主题：（1）跨性别者通常认为临床医生的问题是窥探性的、污名化的、自我保护的；（2）患者描述了自己被病理化、拒绝或提供标准以下的护理，或者当临床医生了解到他们是跨性别者时受到伤害；（3）跨性别者经常在分享信息时面临污名化的风险，或者如果临床医生没有他们所有的医疗史信息，就会面临临床问题解决无效的风险；（4）在当代医疗体系中，提高跨性别者的安全性是困难的。
跨性别者经常不得不在污名化和潜在的护理不佳之间做出选择。为了提高跨性别者临床护理的质量和安全性，需要改善医疗文化、政策、程序和数据收集工具。可能需要机构和系统的改变，以安全有效地在临床环境中实施性取向和性别认同（SOGI）数据收集。
