Otto-Moudry Reade, Kinney Linda M, Butcher Rebecca L, Blasdel Gaines, Brown Lee K, Elwyn Glyn, Myers Jeremy B, Turco John H, Nigriny John F, Moses Rachel A
From the Geisel School of Medicine at Dartmouth, Hanover, N.H.
The Center for Program Design and Evaluation (CPDE), The Dartmouth Institute, Hanover, N.H.
Plast Reconstr Surg Glob Open. 2024 May 30;12(5):e5840. doi: 10.1097/GOX.0000000000005840. eCollection 2024 May.
Metoidioplasty and phalloplasty gender-affirming surgery (MaPGAS) is increasingly performed and requires patients to make complex decisions that may lead to decisional uncertainty. This study aimed to evaluate decisional conflict in individuals considering MaPGAS.
We administered a cross-sectional survey to adult participants assigned female sex at birth and considering MaPGAS, recruited via social media platforms and community health centers. We collected data on demographics, medical and surgical history, MaPGAS type considered, and the Decisional Conflict Scale (DCS). DCS scores range from 0 to 100 (>37.5 indicates greater decisional conflict). Demographic characteristics and DCS scores were compared between subgroups, using descriptive and chi-square statistics. Participants commented on MaPGAS uncertainty, and their comments were evaluated and thematically analyzed.
Responses from 264 participants were analyzed: mean age 29 years; 64% (n = 168) trans men, 80% (n = 210) White, 78% (n = 206) nonrural, 45% (n = 120) privately insured, 56% (n = 148) had 4 or more years of college, 23% (n = 84) considering metoidioplasty, 24% (n = 87) considering phalloplasty, and 26% (n = 93) considering metoidioplasty and phalloplasty. DCS total scores were significantly higher (39.8; < 0.001) among those considering both MaPGAS options, as were mean ratings on the Uncertainty subscale [64.1 (SD 25.5; < 0.001)]. Concerns surrounding complications were the top factor contributing to uncertainty and decisional conflict.
In a cross-sectional national sample of individuals seeking MaPGAS, decisional uncertainty was the highest for those considering both MaPGAS options compared with metoidioplasty or phalloplasty alone. This suggests this cohort would benefit from focused decision support.
阴茎成形术和阴茎再造术等性别确认手术（MaPGAS）的实施越来越多，患者需要做出复杂的决策，这可能导致决策上的不确定性。本研究旨在评估考虑接受MaPGAS的个体的决策冲突情况。
我们对出生时被指定为女性且考虑接受MaPGAS的成年参与者进行了一项横断面调查，这些参与者通过社交媒体平台和社区健康中心招募。我们收集了有关人口统计学、医疗和手术史、考虑的MaPGAS类型以及决策冲突量表（DCS）的数据。DCS分数范围为0至100（>37.5表示决策冲突更大）。使用描述性统计和卡方统计比较亚组之间的人口统计学特征和DCS分数。参与者对MaPGAS的不确定性发表了评论，并对他们的评论进行了评估和主题分析。
分析了264名参与者的回复：平均年龄29岁；64%（n = 168）为跨性别男性，80%（n = 210）为白人，78%（n = 206）来自非农村地区，45%（n = 120）有私人保险，56%（n = 148）拥有4年或以上大学学历，23%（n = 84）考虑阴茎成形术，24%（n = 87）考虑阴茎再造术，26%（n = 93）考虑阴茎成形术和阴茎再造术。在考虑两种MaPGAS手术方式的参与者中，DCS总分显著更高（39.8；<0.001），不确定性子量表的平均评分也是如此[64.1（标准差25.5；<0.001）]。对并发症的担忧是导致不确定性和决策冲突的首要因素。
在一个寻求MaPGAS的全国性横断面样本中，与仅考虑阴茎成形术或阴茎再造术的人相比，考虑两种MaPGAS手术方式的人的决策不确定性最高。这表明这一群体将从有针对性的决策支持中受益。
