Kaur Manraj N, Morrison Shane D, Kennedy Shelby L, van de Grift Tim C, Højgaard Astrid, Jacobsen Amalie Lind, Johnson Natasha, Mullender Margriet G, Poulsen Lotte, Satterwhite Thomas, Santucci Richard, Semple John, Tople Tannon, Edd Kinusan Savard, Sørensen Jens Ahm, Hu Sophia, Pusic Andrea L, Klassen Anne F
Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
Division of Plastic Surgery, Department of Surgery, University of Washington, Seattle, WA, USA; Department of Urology, University of Washington, Seattle, WA, USA.
J Plast Reconstr Aesthet Surg. 2025 Apr;103:384-388. doi: 10.1016/j.bjps.2024.10.014. Epub 2024 Oct 11.
Transgender and gender-diverse (TGD) individuals face significant barriers to healthcare access, including healthcare providers' (HCPs) lack of knowledge on TGD-specific healthcare issues, discrimination, and mistreatment. The World Professional Association for Transgender Health recommends integrating TGD health competencies into training. However, specific guidance on what these competencies should be, particularly from a patient-centered lens, is lacking. Hence, the purpose of this study was to establish core competencies for HCPs and clinics providing gender-affirming care using patient perspectives.
Patients who were 16 years or older and seeking gender-affirming care at tertiary care centers or communities in Canada, Denmark, the Netherlands or the United States 2018-2020 were included. Concept elicitation interviews were conducted, and the interviews were analyzed using content analysis approach.
84 participants were included. Participant-elicited core competencies were described at the level of HCP and the clinic. Competencies pertaining to HCPs were categorized into 4 domains: generic traits (professionalism, nonjudgmental attitude, openness), cultural competency (awareness of TGD-specific health issues, trauma-informed care), patient-centered care (incorporating patient preferences, knowledge, and goals into treatment plans), and care organization and delivery (multi-disciplinary care). Competencies pertaining to clinics were categorized into 2 domains: generic traits (timeliness, efficiency, responsiveness) and gender-affirming care-specific cultural competency (culturally competent support staff, discrete check-in processes, non-assumptive forms).
Patient-centered core competencies should be integrated into HCP trainings and clinic workflows and have the capability to improve the quality of care that TGD patients receive.
跨性别者和性别多样化（TGD）个体在获得医疗保健方面面临重大障碍，包括医疗保健提供者（HCP）对TGD特定医疗问题缺乏了解、歧视和虐待。世界跨性别健康专业协会建议将TGD健康能力纳入培训。然而，对于这些能力应该是什么，尤其是从以患者为中心的角度，缺乏具体指导。因此，本研究的目的是从患者角度确定为提供性别肯定护理的HCP和诊所建立核心能力。
纳入2018年至2020年期间在加拿大、丹麦、荷兰或美国的三级护理中心或社区寻求性别肯定护理的16岁及以上患者。进行了概念激发访谈，并使用内容分析方法对访谈进行了分析。
纳入了84名参与者。参与者提出的核心能力在HCP和诊所层面进行了描述。与HCP相关的能力分为4个领域：一般特征（专业精神、无评判态度、开放）、文化能力（对TGD特定健康问题的认识、创伤知情护理）、以患者为中心的护理（将患者偏好、知识和目标纳入治疗计划）以及护理组织与提供（多学科护理）。与诊所相关的能力分为2个领域：一般特征（及时性、效率、响应性）和性别肯定护理特定文化能力（具有文化能力的支持人员、离散的登记流程、无假设表格）。
应以患者为中心的核心能力应纳入HCP培训和诊所工作流程，并能够提高TGD患者接受的护理质量。
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