Rutherford Leo L, Castle Elijah R, Adams Noah, Berrian Logan, Jennings Linden, Scheim Ayden, Devor Aaron, Lachowsky Nathan J
School of Public Health and Social Policy, Faculty of Human and Social Development, University of Victoria, Victoria, BC, Canada.
Hunter Alliance for Research and Translation (HART), Hunter College of the City University of New York, New York, NY, USA.
BMC Med Ethics. 2024 Dec 31;25(1):155. doi: 10.1186/s12910-024-01148-3.
Some transgender and nonbinary people undergo phalloplasty and/or metoidioplasty as part of their medical transition process. Across surgical disciplines, a variety of resources are used to assist patients who are preparing for surgeries, including educational materials, workshops, peer support, and lifestyle changes. For gender-affirming surgeries, patients undergoing assessments to discern whether they are ready to undergo the surgery, and to assist them in achieving preparedness when needed. Little research investigates what resources are useful in helping patients to feel prepared to undergo phalloplasty or metoidioplasty, and how assessments and resources can promote patient autonomy in the process. Respect for patient autonomy is one of the central tenets of ethical healthcare, yet historically, scholarship related to pre-surgical assessments for gender-affirming surgery has focused determining the ideal surgical candidate rather than respecting patient autonomy and ascertaining individual patient needs.
This study sought to fill this gap by utilizing data from PROGRESS (Patient-Reported Outcomes of Genital Reconstruction and Experiences of Surgical Satisfaction), a cross-sectional, community-based survey of trans and nonbinary adults from the United States of America and Canada who had undergone one or more of these surgeries.
Results revealed most participants (86%, n = 186) felt prepared to undergo surgery, though the majority of our sample (53%, n = 105) did not find referral letter assessments to be helpful. Peer support such as online resources/blogs were rated as highly useful, along with surgical consults. In a multivariable logistic regression, higher perceived preparedness was associated with identifying as queer (inclusive of gay, bi and pansexual compared to being straight), and feeling that one's assessment process was useful (as opposed to not useful). Type of assessment was not significantly associated with preparedness; therefore, what is most useful when preparing for surgery may vary across individuals.
Healthcare professionals who interact with preparing patients should develop new or utilize existing resources to assist patients in identifying their preparation needs and achieving preparedness. Our data supports assessments that center surgical care planning rather than assessing level of gender dysphoria. Future longitudinal research could further refine which assessment processes are most effective in helping patients who are preparing for these surgeries. Assessments should ensure that patients are appropriately prepared to undergo and recover from surgery through a robust process of informed consent.
一些跨性别者和非二元性别者在其医疗过渡过程中会接受阴茎成形术和/或阴囊成形术。在各个外科领域，会使用各种资源来帮助准备手术的患者，包括教育材料、研讨会、同伴支持以及生活方式的改变。对于性别肯定手术，患者需要接受评估，以确定他们是否准备好接受手术，并在需要时帮助他们做好准备。很少有研究调查哪些资源有助于患者为接受阴茎成形术或阴囊成形术做好准备，以及评估和资源如何在这个过程中促进患者的自主性。尊重患者的自主性是道德医疗的核心原则之一，但从历史上看，与性别肯定手术的术前评估相关的学术研究一直侧重于确定理想的手术候选人，而不是尊重患者的自主性和确定个体患者的需求。
本研究试图通过利用来自PROGRESS（生殖器重建患者报告结果和手术满意度体验）的数据来填补这一空白，这是一项基于社区的横断面调查，对象是来自美国和加拿大的接受过一次或多次此类手术的跨性别和非二元性别成年人。
结果显示，大多数参与者（86%，n = 186）觉得自己已为手术做好准备，不过我们样本中的大多数（53%，n = 105）认为转诊信评估并无帮助。在线资源/博客等同伴支持以及手术咨询被评为非常有用。在多变量逻辑回归中，更高的感知准备度与认同为酷儿（包括同性恋、双性恋和泛性恋，与异性恋相比）以及感觉自己的评估过程有用（与无用相反）相关。评估类型与准备度没有显著关联；因此，手术准备时最有用的东西可能因人而异。
与准备手术的患者互动的医疗专业人员应开发新的资源或利用现有资源，以帮助患者确定他们的准备需求并做好准备。我们的数据支持以手术护理计划为中心的评估，而不是评估性别焦虑程度。未来的纵向研究可以进一步完善哪些评估过程在帮助准备这些手术的患者方面最有效。评估应通过完善的知情同意程序，确保患者为接受手术及术后恢复做好适当准备。
