Jackman Liam, Chan Cynthia, Garvilles Micon, Kamran Rakhshan
University of Toronto Institute of Health Policy Management and Evaluation, Toronto, Ontario, Canada.
Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada.
BMJ Open. 2025 Mar 12;15(3):e091135. doi: 10.1136/bmjopen-2024-091135.
Gender-affirming care (GAC) includes interventions aimed at supporting an individual's gender identity. Canada is experiencing an increase in referrals for GAC, higher than any other health service; therefore, there is a need for a systematic approach to health outcome measurement to effectively evaluate care. This review aims to analyse health outcome measurement in Canadian GAC, focusing on what is measured, how it is measured and associated barriers and enablers.
A comprehensive search was conducted in MEDLINE, Embase, PsycINFO, Scopus and CINAHL, up to 26 December 2023. Inclusion criteria were original articles involving transgender or gender-diverse (TGD) patients receiving gender-affirming care in Canada.
A total of 4649 articles were identified with 64 included, representing 6561 TGD patients. Most studies were conducted in Ontario (52%), British Columbia (19%) and Quebec (11%). The most common forms of GAC provided were hormonal (36%) and surgical (27%). Barriers to outcome measurement include that most studies (61%) did not use patient-reported outcome measures (PROMs). When PROMs were used, most did not capture gender-related constructs (eg, gender dysphoria). Barriers to accessing care included stigma, discrimination, lack of clinician knowledge, geographic, socioeconomic and institutional barriers.
This review reveals gaps in outcome measurement for GAC, particularly underutilisation of PROMs and inconsistent outcome measurement and reporting. There is a need to systematically implement PROMs, including those measuring gender-related constructs, to promote patient-centred care. This review provides evidence-based recommendations for improving health outcomes for TGD individuals in Canada.
性别肯定性医疗（GAC）包括旨在支持个体性别认同的干预措施。加拿大接受GAC转诊的人数正在增加，高于任何其他医疗服务；因此，需要一种系统的方法来衡量健康结果，以有效评估医疗服务。本综述旨在分析加拿大GAC中的健康结果测量，重点关注测量的内容、测量方法以及相关的障碍和促进因素。
截至2023年12月26日，在MEDLINE、Embase、PsycINFO、Scopus和CINAHL中进行了全面检索。纳入标准为涉及在加拿大接受性别肯定性医疗的跨性别或性别多样化（TGD）患者的原创文章。
共识别出4649篇文章，其中64篇被纳入，代表6561名TGD患者。大多数研究在安大略省（52%）、不列颠哥伦比亚省（19%）和魁北克省（11%）进行。提供的最常见的GAC形式是激素治疗（36%）和手术治疗（27%）。结果测量的障碍包括大多数研究（61%）未使用患者报告的结果测量指标（PROMs）。当使用PROMs时，大多数未涵盖与性别相关的构念（如性别焦虑）。获得医疗服务的障碍包括耻辱感、歧视、临床医生知识不足、地理、社会经济和机构障碍。
本综述揭示了GAC结果测量方面的差距，特别是PROMs的利用不足以及结果测量和报告的不一致。需要系统地实施PROMs，包括那些测量与性别相关构念的指标，以促进以患者为中心的医疗服务。本综述为改善加拿大TGD个体的健康结果提供了基于证据的建议。
