Interdisciplinary clinicians’ attitudes, challenges, and success strategies in providing care to transgender people: a qualitative descriptive study (original) (raw)
Related papers
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.
BMC Health Services Research, 2012
Background: Members of the transgender community have identified healthcare access barriers, yet a corresponding inquiry into healthcare provider perspectives has lagged. Our aim was to examine physician perceptions of barriers to healthcare provision for transgender patients. Methods: This was a qualitative study with physician participants from Ontario, Canada. Semi-structured interviews were used to capture a progression of ideas related to barriers faced by physicians when caring for trans patients. Qualitative data were then transcribed verbatim and analysed with an emergent grounded theory approach. Results: A total of thirteen (13) physician participants were interviewed. Analysis revealed healthcare barriers that grouped into five themes: Accessing resources, medical knowledge deficits, ethics of transition-related medical care, diagnosing vs. pathologising trans patients, and health system determinants. A centralising theme of "not knowing where to go or who to talk to" was also identified. Conclusions: The findings of this study show that physicians perceive barriers to the care of trans patients, and that these barriers are multifactorial. Access barriers impede physicians when referring patients to specialists or searching for reliable treatment information. Clinical management of trans patients is complicated by a lack of knowledge, and by ethical considerations regarding treatments-which can be unfamiliar or challenging to physicians. The disciplinary division of responsibilities within medicine further complicates care; few practitioners identify trans healthcare as an interest area, and there is a tendency to overemphasise trans status in mental health evaluations. Failure to recognise and accommodate trans patients within sex-segregated healthcare systems leads to deficient health policy. The findings of this study suggest potential solutions to trans healthcare barriers at the informational level-with increased awareness of clinical guidelines and by including trans health issues in medical education-and at the institutional level, with support for both trans-focused and trans-friendly primary care models.
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.
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...
Improving Health Care Encounters and Communication With Transgender Patients.
J Comm Healthcare: Strategies, Media and Engagement in Global Health 2014;7:25-40.
Transgender persons represent a generally ill-served or underserved population. This marginalized group continues to experience considerable difficulty in obtaining culturally competent health care despite recommendations by professional organizations and introduction of antidiscrimination legislation. This review examines communication and procedural barriers to transgender health care and suggests practical steps to help ameliorate disparities and unequal treatment. Methods: Publications addressing health disparities and communication and procedural barriers to health care of transgender persons were identified by a structured search of electronic databases. The most pertinent articles are reviewed and consolidated with the authors' collective experiences. Results: To improve their interactions and communication with transgender persons, health care providers can take a variety of practical steps in several key areas: office environment, registration forms, initial interview and assessment, confidentiality, personnel training, awareness of and compliance with applicable antidiscrimination legislation, health insurance-related issues, and outreach and transgender health promotion. Conclusions: Enhancing patient satisfaction through culturally competent health care, quality assurance, and patient feedback is critical to creating open lines of communication between practitioner and patient and fostering a favorable context for transgender patient care.
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...
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.
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...
Primary Care Clinicians’ Willingness to Care for Transgender Patients
The Annals of Family Medicine
Transgender patients report negative experiences in health care settings, but little is known about clinicians' willingness to see transgender patients. We surveyed 308 primary care clinicians in an integrated Midwest health system and 53% responded. Most respondents were willing to provide routine care to transgender patients (85.7%) and Papanicolaou (Pap) tests (78.6%) to transgender men. Willingness to provide routine care decreased with age; willingness to provide Pap tests was higher among family physicians, those who had met a transgender person, and those with lower transphobia. Medical education should address professional and personal factors related to caring for the transgender population to increase access.
International Journal of Environmental Research and Public Health
Transgender and gender diverse individuals face a variety of barriers when attempting to access healthcare, from discrimination to lack of access to lack of knowledgeable providers. Using data from the 2015 United States Trans Survey (N = 27,715), this study looks at the differences within the TGD population regarding having seen a doctor in the past year, having a primary care provider, and having a primary care provider who is knowledgeable about trans health. Logistic regressions indicate that even within an all transgender and gender diverse sample, a variety of identities and experiences are related to increased or decreased likelihood of each of these outcomes, with significant differences across gender, race/ethnicity, age, sexual orientation, disability status, educational attainment, annual income, disability status, religiosity, military status, overall health, housing status, and insurance coverage. Not only should there be an effort to support transgender and gender dive...