Nonbinary Patients Research Articles

Provider cultural competence and humility in healthcare interactions with transgender and nonbinary young adults.

Transgender and nonbinary (TGNB) patients experience many barriers when seeking quality healthcare services, including ineffective communication and negative relationships with their providers as well as a lack of provider competence (including knowledge, training, and experience) and humility (engagement in the process of self-reflection and self-critique) in treating TGNB individuals. The purpose of this qualitative study was to identify factors associated with cultural competence and humility that facilitate and impede effective relationships between TGNB young adults and their healthcare providers. Data came from individual interviews with 60 young adults aged 18 to 24 from Florida who self-identified as transgender or nonbinary. We analyzed the data using inductive thematic approaches, and a feminist perspective, to identify themes associated with patient-provider relationships. We identified 4 themes related to patient-provider relationships: (1) Participants indicated effective patient-provider communication and relationships are facilitated by providers requesting and utilizing TGNB patients' correct names and personal pronouns. (2) Participant narratives conveyed their preferences that providers "follow their lead" in terms of how they described their own anatomy, reinforcing the utility of cultural humility as an approach for interactions with TGNB patients (3) Participants discussed the detrimental effects of TGNB patients having to educate their own providers about their identities and needs, suggesting clinicians' competence regarding gender diversity is paramount to fostering and maintaining patient comfort. (4) Finally, participants' responses indicated concerns regarding the confidentiality and privacy of the information they provided to their providers, suggesting a lack of trust detrimental to the process of building rapport between patients and their providers. Our findings indicate balancing the use of cultural humility and cultural competence during clinical encounters with TGNB young adults can enhance patients' experiences seeking healthcare. Nursing education is often devoid of focus on caring for transgender and nonbinary persons. Additional provider training and education on approaching clinical encounters with TGNB patients with cultural humility and competence should improve patient-provider communication and relationships, leading to a higher quality of patient care.

Uterine and Ovarian Histopathology in Transmasculine and Nonbinary Patients on Testosterone Compared to Cisgender Control Patients [ID: 1381367

INTRODUCTION: Hormonal treatment is a critical aspect of health care for transgender and nonbinary patients, but scientific literature describing ovarian and uterine histopathology in the setting of testosterone therapy remains limited and conflicted. METHODS: After IRB approval and patient consent, uterine and ovarian histopathology was prospectively evaluated in 22 gender-diverse patients on testosterone compared with 21 premenopausal cisgender controls not on hormones undergoing hysterectomy. RESULTS: Average duration of testosterone administration was 54.9 months. Average age was 30 years in the testosterone group and 40.6 years in the control group. Average body mass index was 28 kg/m2 in the testosterone group and 31 kg/m2 in the control group. 18 (82%) patients in the testosterone group had inactive/atrophic endometria, compared with 2 (10%) in the control group. 4 (18%) patients in the testosterone group had proliferative endometria, compared to 10 (48%) in the control group. No patients on testosterone had secretory endometrium, compared to 6 (29%) in the control group. Leiomyoma were noted for 5 (23%) in the testosterone group and 4 (19%) in the control group. Adenomyosis was present in 1 (5%) in the testosterone group, compared to 5 (24%) in the control group. Low rates of preoperative cervical dysplasia were reported in both groups. All cervical and fallopian tube specimens in both groups were benign. CONCLUSION: Compared to a cisgender control group, patients on long-term testosterone therapy were more likely to have inactive/atrophic endometrium. Increasing our knowledge of the effects of testosterone has implications for preoperative surgical assessment and surveillance for patients not undergoing surgery.

Sex Categories in Healthcare Contexts―A Consequentialist Analysis1

We offer a consequentialist-based rejection of a recent argument claiming that patients should no longer be required to specify a sex category (i.e., mark “male” or “female”) on healthcare forms. The targeted argument—based on claims that non-binary and transgender patients experience negative consequences when asked to choose a sex category—fails because (1) no data are provided to support this claim; (2) the broader consequences of removing this information have not been considered; and (3) eliminating the sex category question is unlikely to solve the problems identified.

Feminizing Rhinoplasty: A Systematic and Institutional Review of Operative Techniques and Clinical Outcomes

Background: Facial gender-affirming surgery encompasses a myriad of procedures ranging from skeletal to soft tissue maneuvers depending on the manifestation of dysphoria in individual patients. In this work, we reviewed techniques for feminizing rhinoplasty in a single center and performed a systematic review of the literature. Methods: A systematic literature review was performed in order to survey articles that discussed techniques and clinical considerations when performing rhinoplasty among transgender females and non-binary patients. In addition, a retrospective review of such patients undergoing rhinoplasty by the senior author. Variables collected included demographic factors, operative details, and post-operative events. Results: Initial review yielded 56 articles. Standardized application of inclusion and exclusion criteria resulted in a total of 12 studies. Priorities of feminizing rhinoplasty entail reduction of dorsal hump, as well as tip refinement and deprojection. Sixty-five patients were included for analysis. The majority of patients underwent rhinoplasty through an open approach (83%). For the dorsum, 89% received dorsal reduction and 80% underwent percutaneous osteotomies. For tip work, 37 (56.9%) received a septal caudal extension graft, while a minority of patients required columellar strut (25%) or tip graft (8%). For functional restoration, septoplasty (71%) and spreader flaps/grafts (58%) were utilized to correct internal valve collapse, while alar rim (8%) and alar crural strut (3%) grafts were performed to address external valve collapse. Complications included septal deviation, hypertrophic scar, and contour irregularity. Two patients required revision (3%). Conclusion: The core tenets of the operation lie in the reduction of the nose, tip deprojection and rotation, as well as the creation of harmony with other facial structures. Our multi-pronged analysis presents an updated review of these principles, as well as a longitudinal outlook on outcomes associated with feminizing rhinoplasty.

Transgender and Nonbinary Patients and Perioperative Scoring Systems

This Viewpoint advocates for inclusion of nonbinary and transgender reporting in medical research and practice.

Implementation of Patient-Reported Outcome Measures for Gender-Affirming Care Worldwide

Gender-affirming care is a key clinical area that can benefit from implementation of patient-reported outcome measures (PROMs). Identifying barriers to and enablers of PROM implementation is needed to develop an evidence-based implementation strategy. To identify (1) PROMs previously implemented for gender-affirming care and constructs measured, (2) how patients completed PROMs and how results were reported and used, and (3) barriers to and enablers of PROM implementation. In this systematic review, PubMed, Embase, MEDLINE, PsycINFO, CINAHL, and Web of Science were searched from inception to October 25, 2021, and updated on December 16, 2022. Gray literature was searched through gray literature database, online search engine, and targeted website searching. Inclusion criteria were (1) original articles of (2) a formally developed PROM or ad hoc instrument administered for gender-affirming care to (3) patients accessing gender-affirming care. The Critical Appraisal Skills Programme tool was used to evaluate quality of included studies. This review was registered on PROSPERO (CRD42021233080). In total, 286 studies were included, representing 85 395 transgender and nonbinary patients from more than 30 countries. A total of 205 different PROMs were used in gender-affirming care. No studies described using an implementation science theory, model, or framework to support PROM deployment. Key barriers to PROM implementation included issues with evidence strength and quality of the PROM, engaging participants, and PROM complexity. Key enablers of PROM implementation included using PROMs validated for gender-affirming care, implementing PROMs able to be deployed online or in person, implementing PROMs that are shorter and reduce patient burden, engaging key stakeholders and participants as part of developing an implementation plan, and organizational climate. In this systematic review of barriers to and enablers of PROM implementation in gender-affirming care, PROM implementation was inconsistent and did not follow evidence-based approaches in implementation science. There was also a lack of patient input in creating implementation strategies, suggesting a need for patient-centered approaches to PROM implementation. Frameworks created from these results can be used to develop evidence-based PROM implementation initiatives for gender-affirming care and have potential generalizability for other clinical areas interested in implementing PROMs.

MP57-19 THE INCLUSION OF TRANSGENDER PATIENT CARE IN UROLOGY:A REVIEW OF UROLOGY RESIDENCY WEBSITES

You have accessJournal of UrologyCME1 Apr 2023MP57-19 THE INCLUSION OF TRANSGENDER PATIENT CARE IN UROLOGY:A REVIEW OF UROLOGY RESIDENCY WEBSITES Macie Darden, Valencia Henry, Philipp Dahm, and Nissrine Nakib Macie DardenMacie Darden More articles by this author , Valencia HenryValencia Henry More articles by this author , Philipp DahmPhilipp Dahm More articles by this author , and Nissrine NakibNissrine Nakib More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003310.19AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: With the steady increase in the transgender population, it is vital to ensure their inclusivity in medicine. Previous studies have shown these individuals suffer from extreme inequalities and bias in healthcare provision. In today's digital age, patients frequently turn to hospital websites for information. Subsequently, transgender patients' first exposure to a provider or hospital system may be through the respective websites. The lack of transgender health-related information, gendered language, and imagery may further alienate them from the healthcare system. This study investigates the websites of Urology programs for incluse language that conveys the institution is one where they will be respected and can receive transgender-specific care. METHODS: To evaluate the trans friendliness of programs, markers adapted from the Healthcare Equality Index were used. This is an annual project by the Human Rights Campaign (HRC) created to measure policies and practices for inclusive and equitable care of LGBTQ patients. The markers were applied to websites of urology departments with established residency programs. Two reviewers independently reviewed each department’s website, and the two sets of data were combined in order to obtain an understanding of perceived inclusivity. RESULTS: A total of 156 Urology program websites were reviewed and 99% had websites demonstrating availability of reconstructive urology services, 19% included LGBTQ inclusive language or symbols, such as the pride flag, and 13% included direct links to additional gender care or LGBTQ specific healthcare resources. None of the programs explicitly included the gender pronouns of their staff physicians. CONCLUSIONS: Most academic urology departments acknowledge the availability of reconstructive services on their websites, but only a small portion meet criteria set by the HRC. This is an opportunity to improve patient facing content to better meet the urological needs specific to transgender and non-binary patients. Source of Funding: This research received no external funding. © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e792 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Macie Darden More articles by this author Valencia Henry More articles by this author Philipp Dahm More articles by this author Nissrine Nakib More articles by this author Expand All Advertisement PDF downloadLoading ...

155 An Assessment of Gender-Affirming Language within Patient Encounter Notes

OBJECTIVES/GOALS: Transgender, non-binary, and gender expansive (TGE) patients experience significant barriers to high-quality care including limited provider expertise and pathologization within health documentation. This study aimed to evaluate the use of gender-affirming language within free text medical notes of TGE patients. METHODS/STUDY POPULATION: We conducted a qualitative analysis of free text medical notes in adult (> age 18 years) TGE patients seen in inpatient and outpatient medicine and general surgery clinics between January 2019 and January 2022 at three independent health systems in San Francisco. TGE patients were identified based on self-identified gender identity, sex assignment at birth, and legal sex. We conducted a thematic analysis to assess use of gender-affirming language, including self-identified pronouns, chosen names, gendered and gender-neutral descriptors, sex-related traits, and pathologizing language. RESULTS/ANTICIPATED RESULTS: Within pilot data, we found inconsistent use of gender-affirming language within notes, with pronounced variability within the history of present illness, the clinical one liner, and the problem list. Within one liners, many did not include patient-identified pronouns (81%), omitted chosen names (53%), and utilized gendered language that was misaligned with patient self-identified gender identity (27%) - frequently including the use of outdated terms i.e. female-to-male and transsexual. Many problem lists included gender-related care, with some describing hormonal and surgical interventions and others utilizing language to pathologize trangender status. DISCUSSION/SIGNIFICANCE: Our study identifies gaps in the use of gender-affirming language in medical notes. Of particular significance in the era of open notes wherein patients can view their medical records, our study offers a framework for assessing and increasing gender-affirming language use within free text medical notes that can be applied across health systems.

Feminizing Genioplasty: A Review of Operative Techniques and Clinical Outcomes

Background: Facial feminization procedures can be performed to alleviate gender dysphoria among transfeminine or non-binary patients. Moreover, the chin may play an important role in immediate identification and recognition of the face as cis-masculine or cisfeminine, and thus, can be addressed via feminizing genioplasty in the transfeminine population. The purpose of this study was multi-fold: 1) perform a systematic literature review to investigate the current methods utilized to feminize the chin, and 2) study clinical outcomes within an institutional cohort undergoing feminizing genioplasty. Methods: A systematic literature review was conducted in order to survey articles that discussed techniques and clinical considerations when performing genioplasty among transgender females and nonbinary patients. In addition, a retrospective review of such patients undergoing genioplasty by the senior author was conducted. Variables collected included demographic factors, operative details, and postoperative outcomes. Results: Query of the PubMed database resulted in forty articles after removal of duplicates. Eleven studies that discussed surgical technique about genioplasty in facial feminization surgery were selected for analysis and discussion. Commonly discussed techniques were surgical incision, horizontal and vertical reduction, and material used for fixation. Eighty-seven patients were included in our institutional cohort. Approximately half of the patients underwent 2-piece reduction genioplasty, while 8 patients had 1-piece reduction. Horizontal osteotomies and vertical osteotomies were performed in the majority of patients. About one-third of patients received osseous augmentation via centralized osteotomy segments and cranial bone grafts. Conclusions: The core tenets of feminization of the chin lie in the reduction in both horizontal and vertical planes, as well as the creation of harmony with other facial structures. Our analysis presents an updated review of these principles, as well as an in-depth analysis of the senior author’s technique in feminization of the chin in transgender women.

Spirometry for Transgender and Nonbinary Patients.

"Spirometry for Transgender and Non-binary Patients." Annals of the American Thoracic Society, 0(ja), pp. –

Transgender and nonbinary patients’ psychotherapy goals: A secondary analysis from a randomized controlled trial

ObjectiveGoal setting is an important factor that contributes to positive outcomes in psychotherapy, yet research has not focused on this particular aspect of process and outcome of psychotherapy for transgender and nonbinary (TNB) patients. MethodsThe present study used secondary data analysis from a pilot randomized controlled trial focused on trans-affirmative therapy for TNB patients (N = 19). The aims of the present study were twofold: 1) gain an in-depth understanding of goals prior to the course of psychotherapy for TNB patients and 2) determine the outcome of goal setting after a 12-session course of psychotherapy with TNB patients. Content analysis and descriptive statistics were used to analyze the data. ResultsResults indicated that the majority (70%) of goals were met at termination. The results also indicated that the majority of goals (73%) were not related to gender. The content analysis revealed that there were five overarching themes regarding the types of goals described by TNB patients: 1) managing mental health symptoms, stress, and distress; 2) developing skills to improve well-being; 3) working on relationships; 4) exploring and understanding of trans identity (gender identity); and 5) orienting towards positive growth and development. Patients’ mean scores indicated that goals focused on developing skills to improve well-being were rated the highest regarding change over the course of 12 sessions of psychotherapy. ConclusionsThis study illuminates the importance of assessing TNB patients’ goals and understanding which goals resulted in the highest amount of self-reported change over 12 sessions of psychotherapy.

Selecting a chest masculinization plastic surgeon: a survey of transgender patients.

Chest masculinization is a commonly performed gender-affirming procedure in transmasculine and non-binary patients and has increased in prevalence in recent years despite continued barriers to surgical care. With the expansion of insurance coverage and trained surgeons, patients at times have the opportunity to be selective in choosing their gender-affirming surgeon. This study aimed to investigate factors that transmasculine individuals consider important when selecting their chest masculinization plastic surgeon. All patients who underwent chest masculinization with a single surgeon between January 2018 and December 2021 were surveyed via an online questionnaire to rate 21 factors associated with surgeon selection. Multiple-choice questions and free text space were included to further clarify patient preferences. Results were analyzed to rate factors in order of importance. One hundred three individuals completed the survey, generating a response rate of 49.5%. Average patient age at time of surgery was 27.0years, and 2.0% of patients had prior gender affirmation surgery (GAS). The top five most important factors were surgeon specialization in GAS, insurance coverage, board certification, number of times surgeon has performed procedure, and availability of Before and After photographs. The five least important factors were age of surgeon, medical publications, availability of YouTube videos, location of training, and surgeon presence on social media. Transmasculine patients employ distinct criteria when selecting a chest masculinization gender-affirming plastic surgeon. An improved understanding of these factors informs providers of ways to enhance patient access to information and gender-affirming care.Level of evidence: Not gradable.

Gender Affirming Surgery in Nonbinary Patients: A Single Institutional Experience

Background An increasing number of nonbinary patients are receiving gender-affirming procedures due to improved access to care. However, the preferred treatments for nonbinary patients are underdescribed. The purpose of this study was to investigate the goals and treatments of nonbinary patients. Methods A retrospective study of patients who self-identified as nonbinary from our institutional Gender Health Program was conducted. Patient demographics, clinical characteristics, surgical goals, and operative variables were analyzed. Results Of the 375 patients with gender dysphoria, 67 (18%) were nonbinary. Over half of the nonbinary patients were assigned male at birth ( n = 57, 85%) and nearly half preferred the gender pronoun they/them/theirs ( n = 33, 49%). A total of 44 patients (66%) received hormone therapy for an average of 2.5 ± 3.6 years, primarily estrogen ( n = 39). Most patients ( n = 46, 69%) received or are interested in gender-affirming surgery, of which, almost half were previously on hormone therapy ( n = 32, 48%). The most common surgeries completed or desired were facial feminization surgery ( n = 15, 22%), vaginoplasty ( n = 15, 22%), mastectomy ( n = 11, 16%), and orchiectomy ( n = 9, 13%). Nonbinary patients who were assigned male at birth (NB-AMAB) were more often treated with hormones compared to nonbinary patients assigned female at birth (NB-AFAB) (72% vs. 30%, p = 0.010). Conversely, patients who were AFAB were more likely to complete or desire surgical intervention than those who were AMAB (100% vs. 63.0%, p < 0.021). Conclusion Majority of nonbinary patients were assigned male at birth. NB-AFAB patients all underwent surgical treatment, whereas NB-AMAB patients were predominantly treated with hormone therapy.

Assessing Medical Students' Attitudes and Knowledge Regarding LGBTQ Health Needs Across the United States.

The lesbian, gay, bisexual, transgender, and queer/questioning (LGBTQ) community experiences health disparities. It is thus imperative that medical trainees receive training in the care of LGBTQ community. The objective of this study was to identify gaps in knowledge and comfort among medical school students in providing care for the LGBTQ community. An online survey was administered to medical students at 3 institutions in the United States from December 2020 to March 2021. Using a Likert scale, the survey assessed attitudes, comfort, and knowledge in providing care for the LGBTQ community. The survey included questions for each specific LGBTQ population. Results were quantified using descriptive and stratified analyses, and an exploratory factor analysis was used to calculate attitude summary measure (ASM) scores. A total knowledge score was calculated, with higher values indicating greater knowledge. Among the 300 medical students who completed the survey, the majority were female (55.7%), White (54.7%), and heterosexual (64.3%). The majority of medical students felt comfortable (strongly agree/agree) participating in the care of lesbian (94.3%), gay (96.0%), and bisexual (96.3%) patients; this percentage dropped to 82.3% for non-binary and 71.3% for transgender patients. Only 27.0% of medical students reported confidence in their knowledge of health needs of transgender patients. LGBTQ self-identification, percent of core rotations completed in school, region of country, and friends and/or family who are part of the LGBTQ community were significantly associated with various ASM scores. Knowledge questions yielded high percentages of "neutral" responses, and medical students who identified as LGBTQ had significantly higher total knowledge scores. Overall, the surveyed medical students feel comfortable and willing to provide care for LGBTQ persons. But, there is limited knowledge about specific LGBTQ health needs. More education and training in the needs of transgender and non-binary patients, in particular, is indicated.

Gender Identity, Race, and Ethnicity-based Discrimination in Access to Mental Health Care: Evidence from an Audit Correspondence Field Experiment.

Racial, ethnic, and gender minorities face mental health disparities. While mental health care can help, minoritized groups could face discriminatory barriers in accessing it. Discrimination may be particularly pronounced in mental health care because providers have more discretion over accepting patients. Research documents discrimination broadly, including in access to health care, but there is limited empirical research on discrimination in access to mental health care. We provide the first experimental evidence, from a correspondence audit field experiment (“simulated patients” study), of the extent to which transgender and non-binary people, African Americans, and Hispanics face discrimination in access to mental health care appointments. We find significant discrimination against transgender or non-binary African Americans and Hispanics. We do not find evidence of discrimination against White transgender and non-binary prospective patients. We are mostly inconclusive as to if cisgender African Americans or Hispanics face discrimination, except we find evidence of discrimination against cisgender African American women.

Reducing Adult Transgender Barriers to Care in the Emergency Department: Strategies to Improve Policies and Practices.

The Research to Practice column is intended to improve the research critique skills of the advanced practice registered nurse (APRN) and the emergency department (ED) registered nurse (RN) and to assist with translating research into practice. In this column, we review a recent qualitative research study by M. Allison, S. Marshall, G. Stewart, M. Joiner, C. Nash, and M. Stewart (2021) titled "Experiences of Transgender and Gender Nonbinary Patients in the Emergency Department and Recommendations for Health Care Policy, Education, and Practice" with discussion of how their findings can be applied to inform providers how to deliver appropriate care of transgender patients within the ED.

Factors Related to Treatment Attendance for Patients Seeking Gender-Affirming Voice Therapy.

The purpose of this study was to investigate factors related to treatment attendance for patients seeking gender-affirming voice therapy (GAVT). We completed retrospective chart reviews of 50 patients (43 transgender women, three transgender men, four nonbinary patients; aged 18-67 years, M = 34.92 years, SD = 12.32 years) referred for GAVT at a Midwest outpatient center from 2016 to 2021. Data extraction included patient demographics, therapy visit specifics (e.g., number of sessions attended, treatment completion status, and in-person vs. virtual visits) and treatment timing (in relation to the onset of the COVID-19 pandemic), and psychosocial and socioeconomic information. There was no impact of treatment-timing relative to the onset of the pandemic on any attendance measure; however, patients were 1.9 times more likely to complete therapy with each virtual telehealth session attended. Individual factors of outside social support and hormone replacement therapy were positively related to the number of therapy sessions attended, whereas insurance provider and employment status were related to therapy completion. Telehealth attendance during the COVID-19 pandemic was positively associated with GAVT completion. Future research should investigate psychosocial and socioeconomic factors to understand how to identify patients at risk for poor treatment adherence and facilitate access to clinical care.

Perioperative Hormone Management in Gender-Affirming Mastectomy: Is Stopping Testosterone before Top Surgery Really Necessary?

Gender-affirming mastectomy, or "top surgery," has become one of the most frequently performed procedures for transgender and nonbinary patients. However, management of perioperative testosterone therapy remains controversial. Despite a lack of supporting evidence, many surgeons require cessation of testosterone before top surgery. This is the first study to compare complication rates in patients undergoing gender-affirming mastectomy with and without discontinuation of perioperative testosterone. This retrospective review included patients undergoing top surgery by the senior author between 2017 and 2020. Reflecting a change in the senior author's practice, before May of 2019, all patients were required to discontinue testosterone before surgery; all patients treated after this point continued their testosterone regimens throughout the perioperative period. Patients were stratified according to testosterone regimen and perioperative hormone management, with demographic characteristics and postoperative outcomes compared among groups. A total of 490 patients undergoing gender-affirming mastectomy during the study period were included. Testosterone was held perioperatively in 175 patients and continued in 211 patients; 104 patients never received testosterone therapy. Demographic characteristics were similar among groups and there was no difference in rates of hematoma (2.9% versus 2.8% versus 2.9%, respectively; P = 0.99), seroma (1.1% versus 0% versus 1%, respectively; P = 0.31), venous thromboembolism (0% versus 0.5% versus 0%, respectively; P = 0.99), or overall complications (6.9% versus 4.3% versus 5.8%, respectively; P = 0.54). Our results demonstrate no difference in postoperative complication rates among groups. Whereas further investigation is warranted, our data suggest that routine cessation of testosterone in the perioperative period is not necessary for patients undergoing gender-affirming mastectomy. Therapeutic, III.

Using a Social Justice Lens in Nursing: Intersectionalizing Person-Centered Care With Transgender and Non-Binary Patients.

Transgender and non-binary patients are greatly impacted by political initiatives intended to diminish their rights, including the right to access to gender-affirming medical care. Nurses who provide Person-centered Care (PCC) are uniquely positioned to honor their patients' rights and humanity. PCC is an important component of building trust with transgender and non-binary patients, but honoring their humanity fully and comprehensively requires an intersectional approach. To build trust, the authors suggest that a paradigm that interweaves PCC with intersectionality promotes social justice for transgender and non-binary patients.

OR05-6 Designing a Gender Affirming Hospital: Patient Perspectives on Gender Inclusive Care

Abstract Background Studies have shown transgender and non-binary individuals encounter discrimination and harassment in medical settings leading to delays in seeking care and worse physical and mental health outcomes. Organizations, including the American Academy of Pediatrics, published recommendations for medical centers to foster respectful and inclusive care through systems, environmental, and educational changes. However, it is unclear whether health systems are making these changes and what the impact may be for transgender and non-binary youth. Objective To explore perspectives of transgender and non-binary patients regarding the current state of gender inclusive care at our medical center and identify areas for improvement. Design/Methods A qualitative study was conducted at a large academic center. Participants aged 13-21 years were recruited from the Center for Gender Affirming Care to participate in a semi-structured interview and demographics survey regarding their experiences across various clinical settings within the medical center. Interviews were audio-recorded and transcribed verbatim. Survey results were analyzed using descriptive statistics. Two independent coders reviewed the transcripts, developed a preliminary coding scheme, and reached consensus on any coding discrepancies. ATLAS.ti® was used for thematic analysis. Results Thirty participants completed an interview and survey. Mean age of participants was 17 years, with 30% identifying as female/trans female, 47% male/trans male, and 23% identifying as nonbinary or gender fluid. Several key themes emerged. Overall participants are satisfied with their care and attributed improvements to societal progress and systems/environmental changes. Parent advocacy and diversity among staff promoted positive and affirming experiences. However, participants identified personnel, systems, and environmental areas needing improvement including: 1) Provider training on use of pronouns, gender affirming terminology, and exam techniques, 2) Reliable and accurate display of chosen name and pronouns in the electronic medical record (EMR) and patient labels, and standardized check-in processes to prevent misnaming/misgendering, 3) Desire for more LGBTQ-inclusive décor and resources. Conclusions While national recommendations were published more than 5 years ago, it is clear from our participants that not all recommendations have been implemented consistently across all clinical settings. Eliciting feedback from patients may provide tangible ways to improve care for this population. Presentation: Saturday, June 11, 2022 12:45 p.m. - 1:00 p.m.