School of Social Work, University of Washington, Seattle.
Now with School of Social Work and Criminal Justice, University of Washington, Tacoma.
JAMA Netw Open. 2024 Feb 5;7(2):e2356604. doi: 10.1001/jamanetworkopen.2023.56604.
Transgender (trans) patients report frequent discriminatory and harmful experiences in health care settings; gender-affirming, competent health care improves trans individuals' health and well-being.
To identify factors influencing trans patients' decision-making regarding sharing gender-related information with providers (clinicians, health care organizations, health care systems) and trans patient preferences for gender-related questions, as well as the subsequent impact on health care experiences.
DESIGN, SETTING, AND PARTICIPANTS: A qualitative, interpretivist phenomenological study was conducted via telephone or video (using Zoom) in English and Spanish from August 10 to September 11, 2020. Participants were recruited via trans-specific social media groups and email listservs. Interviews were transcribed verbatim and analyzed from October 2020 to January 2022 using thematic analysis by a majority trans research team.
Semistructured interviews explored patient health care experiences and preferences.
Participants included 27 trans and/or nonbinary adults (mean [SD] age, 30.9 [10.4] years; range, 21-69 years) from 13 US states. Four themes were identified: (1) impact of provider behaviors, (2) engaging in relational risk assessment, (3) receiving affirming vs medically competent care, and (4) "how are you going to fit [me] into your system?" The first theme reflected the impact of provider actions, including level of flexibility in care and interpersonal interactions, ability to explain medical relevance of gender-related questions, and preparedness to work with trans patients. Second, respondents weighed a variety of implicit or explicit safety cues when deciding whether and how to share information with providers. Third, participants spoke at length about affirming and medically competent care, noting that they have had to prioritize one over the other. Last, participants reported their needs often being at odds with health care system norms and standards of care.
In this qualitative study of trans patient preferences when discussing gender-related information with providers, it was found that equitable, gender-affirming, and competent health care requires flexibility and responsiveness to patient preferences. It requires provider humility and engagement, as well as institutional policies that support competent and gender-affirming spaces. Future research could identify additional roles that providers, administrators, and systems can play in ensuring competent care for trans patients.
跨性别（trans）患者在医疗保健环境中经常报告歧视和有害经历；提供性别认同、胜任的医疗保健可改善跨性别者的健康和幸福感。
确定影响跨性别患者决定与提供者（临床医生、医疗保健组织、医疗保健系统）分享与性别相关信息的因素，以及跨性别患者对与性别相关问题的偏好，以及随后对医疗保健体验的影响。
设计、环境和参与者：这是一项定性、解释主义现象学研究，于 2020 年 8 月 10 日至 9 月 11 日通过电话或视频（使用 Zoom）以英语和西班牙语进行。参与者通过特定于跨性别的社交媒体群组和电子邮件列表进行招募。访谈在 2020 年 10 月至 2022 年 1 月期间进行了逐字转录，并由一个主要由跨性别研究人员组成的团队进行了主题分析。
半结构化访谈探讨了患者的医疗保健体验和偏好。
参与者包括来自美国 13 个州的 27 名跨性别或非二元成年人（平均[SD]年龄，30.9[10.4]岁；范围，21-69 岁）。确定了四个主题：（1）提供者行为的影响，（2）进行关系风险评估，（3）接受认同或医学胜任的护理，以及（4）“你将如何将[我]融入你的系统？”第一个主题反映了提供者行为的影响，包括护理的灵活性和人际互动、解释与性别相关问题的医学相关性的能力，以及准备与跨性别患者合作。其次，受访者在决定是否以及如何与提供者分享信息时权衡了各种隐含或显式的安全线索。第三，参与者详细讨论了认同和医学胜任的护理，并指出他们必须将其中一项置于另一项之上。最后，参与者报告说，他们的需求经常与医疗保健系统规范和护理标准不一致。
在这项关于跨性别患者与提供者讨论与性别相关信息时的偏好的定性研究中，发现公平、性别认同和胜任的医疗保健需要灵活性和对患者偏好的响应。它需要提供者的谦逊和参与，以及支持胜任和性别认同空间的机构政策。未来的研究可以确定提供者、管理人员和系统可以在确保跨性别患者获得胜任的护理方面发挥的其他作用。
