Fear Is Not a Strategy Neira, Paula M.; Saletnik, Laurie
AORN journal,
November 2022, 2022-11-00, 20221101, Letnik:
116, Številka:
5
Journal Article
Recenzirano
Odprti dostop
Finding a way to address these divisions has great implications for those who will have the power at the federal level to drive policies that will either reduce or perpetuate the health inequities ...faced by many marginalized communities. ...of this writing, health care professionals at the Boston Children's Hospital who provide medically necessary, gender-affirming care to transgender youth are being subjected to online harassment and death threats.3 In 2022, more than 300 anti-LGBTQ bills have been introduced into legislation in multiple states, with many targeting transgender youth specifically.4 In Texas, the attorney general "declared gender-affirming surgical procedures in children and prescribing drugs that affect puberty to be considered 'child abuse,'" and both the governor and attorney general called on the Texas Department of Family and Protective Services to investigate such instances in which the supportive parents of transgender children provide their children with gender-affirming health care, which is evidence-based, medically necessary care.5 In Alabama, the state has enacted a law that criminalized the provision of gender-affirming care to transgender youth.6 The actions in Texas and Alabama have been temporarily halted while litigation goes forth.7 In Florida, after passing a law limiting the ability to discuss sexual orientation or gender identity in schools,8 the state government has begun the process to enact a rule that will categorically exclude gender-affirming care under the Florida Medicaid program.9 It is not irrational to be afraid.
One in six gay and bisexual men will be diagnosed with prostate cancer in their lifetime. Lesbian, gay, bisexual, and transgender (LGBT) populations are under-represented in cancer research, and ...guidelines on prostate-specific antigen (PSA) screening are limited. We performed a cross-sectional study to assess patterns of PSA screening and decision-making in this cohort. The Behavioral Risk Factor Surveillance System database was queried for LGBT adults for 2014–2016 and 2018, when PSA questions were asked in the annual survey. Multivariable logistic regression was performed to evaluate the association of LGBT status with PSA screening and informed and shared decision-making. A total of 164 370 participants were eligible for PSA screening, representing a weighted estimate of 1.2 million LGBT individuals. Compared to cisgender (CG) straight individuals, CG gay/bisexual cohorts were more likely to participate in PSA screening (CG gay: odds ratio OR 1.07; p < 0.001; CG bisexual: OR 1.06; p < 0.001). CG gay participants were more likely to make informed decisions (OR 1.10; p < 0.001) and engage in shared decision-making (OR 2.55; p < 0.001). Select gay populations were more likely to undergo PSA screening recommended by their clinicians and participate in informed and shared decision-making.
This large study of sexual and gender minorities in the USA suggests that gay and bisexual individuals were more likely to undergo prostate cancer screening and that select gay individuals were more likely to make informed and shared decisions. However, transgender individuals were less likely to have prostate cancer screening and make informed decisions.
Select gay populations are more likely to undergo prostate cancer screening and make informed and shared decisions. However, transgender populations are less likely to have prostate cancer screening and make informed decisions.
ABSTRACT
Ignorance, stigma, and discrimination have contributed to persistent and well‐documented disparities and inequities in the United States health care system with regards to meeting the needs ...of transgender and gender‐diverse (TGD) people. Only recently has the collective understanding of this marginalized community increased, along with actions to address its health concerns. Nurses want to provide high‐quality care for all patients. However, many nurses may feel anxious or uncertain about interacting with TGD people because of a lack of education and training. Perioperative nurses may encounter TGD patients and family members in their clinical settings for many reasons and should know how to provide appropriate care, including gender‐affirming care. This article presents foundational cultural competency information about TGD people and the health concerns they face. Additionally, it provides actionable communication approaches that perioperative nurses can employ, as well as organization‐level strategies that can be implemented to provide a welcoming, supportive, and affirming environment.
...many transgender patients seek gender-affirming interventions to achieve concordance between physical appearance and function and their gender identity. Even though transgender individuals are ...estimated to be overrepresented in the military compared with the general population,3 one estimate in the New England Journal of Medicine suggested that medically necessary transgender-related health care would cost the military about $5 million a year,4 less than a quarter ofthe $23 million the military spends on acne medications each year5 and about 0.0001 of the $49.3 billion the Department ofDefense spends on health care each year.1 Furthermore, the provision of gender-affirming care, even in the general population, has been shown to be highly costeffective.6 The evidence is unambiguous: giving patients support and allowing them to embrace their identity consistently improve their quality oflife. UNCONSTITUTIONAL AND IMMORAL Furthermore, the threats to unit performance and morale by suddenly forcing out loyal personnel-who were serving their country without any issues-are likely more real than any imagined disruption from working alongside transgender individuals. Because the issue of transgender military service was fully vetted by our military leadership, and transgender personnel have served openly for the past year, the ostensible rationale for this ban put forth by the president is not rational.
The population of individuals who identify as transgender (TG) is increasing in the United States, yet disparities in cancer screening services are widening. It is imperative that interpersonal and ...systemic barriers to cancer care are identified and removed for this vulnerable population. Our study sought to examine the difference in self-reported breast and cervical cancer screening rates between TG and cisgender (CG) people.
Cross-sectional data from the 2014 to 2016 and 2018 Behavioral Risk Factor Surveillance System (BRFSS) was obtained on individuals who identified as CG or TG (male-to-female MTF and female-to-male FTM), including their responses to questions regarding breast and cervical screening history and their primary care access and associated barriers.
Compared with the CG population, TG participants were less likely to adhere to or have undergone breast (FTM: odds ratio OR 0.47 and 0.32; MTF: OR 0.04 and 0.02, respectively; all P<0.001) and cervical cancer (FTM: OR 0.42 and 0.26, respectively; all P<0.001) screening. They were also less likely to have a primary care physician (FTM: OR 0.79; MTF: OR 0.58; all P<0.001) and less likely to seek primary care within a year owing to medical costs (FTM: OR 1.44; MTF: OR 1.36; all P<0.001).
Disparities exist in the uptake of routine cancer screening in the TG population despite their increased risk for breast and cervical cancer. Interventions are urgently needed to mitigate delays to cancer screening, close gaps in provider and patient knowledge about cancer screening, and improve health care experiences of gender minorities in the United States.
Gender affirmation is standard medical care, and community input is an essential component of patient-centered care. This study shares how our organization assessed patients' perceptions of health ...care organizations that provide gender-affirming care. Building on qualitative interview data, we distributed an online survey via a lesbian-gaybisexual-transgender-queer research firm. The survey was completed by 314 transgender individuals residing in 37 U.S. states and territories. Most respondents (69%) reported negative experiences seeking health care. Patients would travel long distances for competent providers and were more willing to seek care from an institution actively working to change a formerly negative reputation. Patients described high-quality organizations as prioritizing staff training (95.5%), having inclusive policies (93.3%), and hiring expert staff (86.0%). Programs should ensure cultural competency training for all staff. They should recruit and retain providers skilled in transgender medicine, especially trans-identified providers. Patient experience and reputation in the community influence where patients seek care.
BACKGROUNDGender-affirming care, including surgery, has gained more attention recently as third-party payers increasingly recognize that care to address gender dysphoria is medically necessary. As ...more patients are covered by insurance, they become able to access care, and transgender cultural competence is becoming recognized as a consideration for health care providers. A growing number of academic medical institutions are beginning to offer focused gender-affirming medical and surgical care. In 2017, Johns Hopkins Medicine launched its new Center for Transgender Health. In this context, history and its lessons are important to consider. We sought to evaluate the operation of the first multidisciplinary Gender Identity Clinic in the United States at the Johns Hopkins Hospital, which helped pioneer what was then called “sex reassignment surgery.”
METHODSWe evaluated the records of the medical archives of the Johns Hopkins University.
RESULTSWe report data on the beginning, aim, process, outcomes of the clinic, and the reasons behind its closure. This work reveals the function of, and the successes and challenges faced by, this pioneering clinic based on the official records of the hospital and mail correspondence among the founders of the clinic.
CONCLUSIONThis is the first study that highlights the role of the Gender Identity Clinic in establishing gender affirmation surgery and reveals the reasons of its closure.
Gender-affirming care for transgender and gender diverse (TGD) individuals is a multidisciplinary endeavor that requires organized efforts of many specialized practitioners. TGD individuals ...experience many health care barriers, including the scarcity of multidisciplinary teams formed to coordinate and deliver complex care in an efficient and affirming way. The Johns Hopkins Center for Transgender Health was founded in 2017 with the mission of decreasing health disparities and improving the health of the TGD community. The authors present their experience building the center around a service line model in which patients have 1 point of contact, they are tracked throughout the care process, and the multidepartmental practitioners involved in their care are aligned. This model allowed for a patient-centered experience in which all involved disciplines were seamlessly integrated and the patient could navigate easily among them. With the structure and mission in place, the next challenge was to develop an infrastructure for culturally competent care. Through competency training and adjustment of systems-based logistics, measures were put in place to prevent traumatic experiences, such as misgendering, use of culturally inappropriate vocabulary, and use of incorrect names. Partnerships among colleagues in the fields of plastic surgery, urology, gynecology, otolaryngology, anesthesia, psychiatry/mental health, internal medicine, endocrinology, fertility, nursing, social work, speech therapy, and pediatrics/adolescent care were necessary to provide the appropriate breadth of services to care for TGD patients. Since its inception, the center has seen steady and continual growth, with more than 2,800 patients in its first 5 years. By sharing their experience in creating and developing a center of excellence, the authors hope to provide a blueprint for others to expand health care quality and access for TGD individuals.
PDF
