Improving Health Care Encounters and Communication With Transgender Patients. (original) (raw)
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Journal of Health Care for the Poor and Underserved, 2018
Research demonstrates health disparities between gender-minority individuals and cisgender individuals. These disparities arise from multiple sources, including negative health care experiences. This study examines interactions between transgender and gender non-binary (TGGNB) individuals and their health care providers. We analyzed 119 participants' descriptions of positive and negative health care experiences, and what they wish providers knew about caring for TGGNB patients. Health care experiences went well when providers and staff used inclusive language, demonstrated their experience and education, and treated identity disclosure as routine. Negative interactions were characterized by misgendering, unfamiliarity with TGGNB people and health issues, and transphobic practices. Participants wished providers understood their health concerns, did not expect their patients to educate them, and created a welcoming clinical environment. Medical educators, administrators, and providers share responsibility for improving TGGNB patient experiences. Through a framework of cultural safety, we recommend several changes to ensure more equitable treatment in health care.
Addressing Needs of Transgender Patients: The Role of Family Physicians
The Journal of the American Board of Family Medicine, 2020
There are approximately 1 million transgender and gender-diverse adults in the United States. Despite increased awareness and acceptance, they frequently encounter medical settings that are not welcoming and/or health care providers who are not knowledgeable about their health needs. Use of correct terminology, following best practices for name and pronoun use, and knowledge of gender-affirming interventions can create office environments that are welcoming to transgender clients. Health disparities faced by transgender patients that impact access to care include higher rates of mental health issues, substance use disorders, violence, and poverty. Transgender women are at greater risk for HIV acquisition and are less likely to achieve viral suppression compared with cisgender (nontransgender) individuals. Medical providers can facilitate HIV prevention efforts by offering pre-and postexposure prophylaxis to transgender patients at risk for HIV infection. Improving health outcomes requires attention to cultural competency and an understanding of lived experiences and priorities of transgender people.
Providing culturally sensitive care for transgender patients
Cognitive and Behavioral Practice, 2005
Culturally senszttve znformation is cruc*al for provzdzng approprzate care to any m,nonty populatzon Th2s art, cle provides an overview of *mportant issues to conszder when working w, th transgender patients, including clar~ficatzon of transgender termznology, dzagnoszs zssues, zdentity development, and approprzate pronoun use We also revzew common chnzcal zssues for transgender ind*vzduals seeking mental health care, how these can be addressed within a CBT framework, and the process of sett,ng up a CBT support group wzthin a VA hosp*tal system. CBT group outcome data and demonstratwe examples from male to female transsexuals are also presented.
Transgender Health - Eliminating Inequalities and Strengthening Clinician-Patient Relationships
This article considers healthcare experiences of transgender patients on their transition journeys. One case illuminates ways in which binary-dominance—the prevailing assumption that a person must be either male or female to be normal—is a species of cultural imperialism that can influence the quality of clinical encounters. We focus specifically on clinicians’ affective orientation toward a transgender patient and how it can influence the patient’s general and mental healthcare experience. When expressed in healthcare contexts, binary dominance exacerbates the vulnerabilities of transgender patients and reinforces trends of underservice to members of this community. Generally, clinicians tend to lack knowledge about the medical and mental health needs of transgender patients, and clinicians and office staff tend to lack cultural humility regarding the multi-dimensional challenges of being transgender in a binary-dominant society. We suggest a five-point model of foundational clinical and ethical competencies related to different patients’ transition experiences, which can help clinicians and organizations identify and eliminate binary dominance expressions from their practices and policies.
BMC Health Services Research
Background Access to clinicians competent in transgender health remains a significant barrier and contributor toward health inequity for transgender people. Studies on access and barriers to care have predominantly evaluated transgender patients’ perceptions, but scant research has included the perspectives of clinicians. Aims We conducted a qualitative study to explore how clinicians (meaning physicians and advanced practice providers, in this paper) in the United States: (1) attain and utilize information, (2) perceive barriers and facilitators, and (3) understood gaps in their professional training, in regard to practicing transgender health care. Methods A Qualitative Descriptive approach guided our conventional content analysis of field notes and interviews with clinicians within a parent study that explored health care access among transgender adults. Transcripts were coded into meaning units that were iteratively abstracted into themes. Standard measures were performed to pro...
2016
The purpose of this project was to improve knowledge and identify personal bias and beliefs in the acute and primary healthcare needs of transgender persons, through the implementation of a clinical education program with healthcare providers and staff working within the urgent care and emergency department settings. The need for such a program exists due to the lack of suitable and accessible healthcare that may lead to misdiagnosis, delay of treatment and poor health outcomes. Including clinical education in the acute and primary healthcare needs of transgender persons that can be integrated into healthcare organizations may aid in the improvement of overall healthcare and healthcare experiences of transgender persons. Goals of the educational program included: increased healthcare provider and staff knowledge in the acute and primary care of transgender persons; identification of personal bias and beliefs in the healthcare of transgender persons; and the identification of factors...
Transgender health care: improving medical students' and residents' training and awareness
Advances in medical education and practice, 2018
A growing body of research continues to elucidate health inequities experienced by transgender individuals and further underscores the need for medical providers to be appropriately trained to deliver care to this population. Medical education in transgender health can empower physicians to identify and change the systemic barriers to care that cause transgender health inequities as well as improve knowledge about transgender-specific care. We conducted structured searches of five databases to identify literature related to medical education and transgender health. Of the 1272 papers reviewed, 119 papers were deemed relevant to predefined criteria, medical education, and transgender health topics. Citation tracking was conducted on the 119 papers using Scopus to identify an additional 12 relevant citations (a total of 131 papers). Searches were completed on October 15, 2017 and updated on December 11, 2017. Transgender health has yet to gain widespread curricular exposure, but effor...
Barriers to healthcare for transgender individuals
Current opinion in endocrinology, diabetes, and obesity, 2016
Transgender persons suffer significant health disparities and may require medical intervention as part of their care. The purpose of this manuscript is to briefly review the literature characterizing barriers to healthcare for transgender individuals and to propose research priorities to understand mechanisms of those barriers and interventions to overcome them. Current research emphasizes sexual minorities' self-report of barriers, rather than using direct methods. The biggest barrier to healthcare reported by transgender individuals is lack of access because of lack of providers who are sufficiently knowledgeable on the topic. Other barriers include: financial barriers, discrimination, lack of cultural competence by providers, health systems barriers, and socioeconomic barriers. National research priorities should include rigorous determination of the capacity of the US healthcare system to provide adequate care for transgender individuals. Studies should determine knowledge a...
Journal of health care for the poor and underserved, 2017
Transgender people face numerous barriers when utilizing health care in the United States. The current study sought to highlight transgender consumer perspectives in order to present theoretically informed, concrete recommendations for increasing transgender health care utilization. The search yielded several prominent themes associated with barriers to health care for transgender people: 1) provider lack of knowledge concerning transgender identity issues and transgender health issues, 2) transgender patients' previous negative experiences with the health care system or anticipation of these experiences, 3) transgender patients' inability to pay for health care services, and 4) health care provider refusal to provide health care services to transgender people. We present a modified version of Adapted Behavioral Model of health care utilization for transgender people focused on transgender individuals as a guiding theoretical framework that informs our recommendations for in...