Promoting trans patient autonomy in surgical preparation for phalloplasty and metoidioplasty: results from a community-based cross-sectional survey and implications for preoperative assessments.

IF 3 1区 哲学 Q1 ETHICS
Leo L Rutherford, Elijah R Castle, Noah Adams, Logan Berrian, Linden Jennings, Ayden Scheim, Aaron Devor, Nathan J Lachowsky
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引用次数: 0

Abstract

Background: Some transgender and nonbinary people undergo phalloplasty and/or metoidioplasty as part of their medical transition process. Across surgical disciplines, a variety of resources are used to assist patients who are preparing for surgeries, including educational materials, workshops, peer support, and lifestyle changes. For gender-affirming surgeries, patients undergoing assessments to discern whether they are ready to undergo the surgery, and to assist them in achieving preparedness when needed. Little research investigates what resources are useful in helping patients to feel prepared to undergo phalloplasty or metoidioplasty, and how assessments and resources can promote patient autonomy in the process. Respect for patient autonomy is one of the central tenets of ethical healthcare, yet historically, scholarship related to pre-surgical assessments for gender-affirming surgery has focused determining the ideal surgical candidate rather than respecting patient autonomy and ascertaining individual patient needs.

Methods: This study sought to fill this gap by utilizing data from PROGRESS (Patient-Reported Outcomes of Genital Reconstruction and Experiences of Surgical Satisfaction), a cross-sectional, community-based survey of trans and nonbinary adults from the United States of America and Canada who had undergone one or more of these surgeries.

Results: Results revealed most participants (86%, n = 186) felt prepared to undergo surgery, though the majority of our sample (53%, n = 105) did not find referral letter assessments to be helpful. Peer support such as online resources/blogs were rated as highly useful, along with surgical consults. In a multivariable logistic regression, higher perceived preparedness was associated with identifying as queer (inclusive of gay, bi and pansexual compared to being straight), and feeling that one's assessment process was useful (as opposed to not useful). Type of assessment was not significantly associated with preparedness; therefore, what is most useful when preparing for surgery may vary across individuals.

Conclusion: Healthcare professionals who interact with preparing patients should develop new or utilize existing resources to assist patients in identifying their preparation needs and achieving preparedness. Our data supports assessments that center surgical care planning rather than assessing level of gender dysphoria. Future longitudinal research could further refine which assessment processes are most effective in helping patients who are preparing for these surgeries. Assessments should ensure that patients are appropriately prepared to undergo and recover from surgery through a robust process of informed consent.

促进跨性别患者在阴茎成形术和输卵管成形术手术准备中的自主性:来自社区横断面调查的结果和术前评估的意义。
背景:一些跨性别和非二元性别的人接受阴茎成形术和/或子宫内膜成形术作为他们医疗转变过程的一部分。在外科学科中,各种各样的资源用于帮助准备手术的患者,包括教育材料,研讨会,同伴支持和生活方式的改变。对于性别确认手术,对患者进行评估,以确定他们是否准备好接受手术,并在需要时帮助他们做好准备。很少有研究调查哪些资源对帮助患者做好接受阴茎成形术或输卵管成形术的准备是有用的,以及评估和资源如何在这个过程中促进患者的自主性。尊重患者自主权是伦理医疗保健的核心原则之一,但从历史上看,与性别确认手术的术前评估相关的学术研究侧重于确定理想的手术候选人,而不是尊重患者自主权和确定患者的个人需求。方法:本研究试图通过利用PROGRESS(患者报告的生殖器重建结果和手术满意度)的数据来填补这一空白,PROGRESS是一项横断面、基于社区的调查,调查对象是来自美国和加拿大接受过一次或多次此类手术的跨性别和非二元性别成年人。结果:结果显示大多数参与者(86%,n = 186)感觉准备接受手术,尽管我们的大多数样本(53%,n = 105)不认为推荐信评估有帮助。在线资源/博客等同伴支持与外科咨询一起被评为非常有用。在多变量逻辑回归中,较高的感知准备与识别为酷儿(包括同性恋,双性恋和泛性恋,而不是异性恋)以及感觉评估过程有用(而不是无用)有关。评估类型与准备程度无显著相关性;因此,在准备手术时,什么是最有用的可能因人而异。结论:与准备患者互动的医疗保健专业人员应该开发新的或利用现有资源来帮助患者确定他们的准备需求并实现准备。我们的数据支持以手术护理计划为中心的评估,而不是评估性别焦虑的水平。未来的纵向研究可以进一步完善哪些评估过程在帮助准备手术的患者时最有效。评估应确保患者通过健全的知情同意程序为接受手术和术后康复做好适当准备。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
BMC Medical Ethics
BMC Medical Ethics MEDICAL ETHICS-
CiteScore
5.20
自引率
7.40%
发文量
108
审稿时长
>12 weeks
期刊介绍: BMC Medical Ethics is an open access journal publishing original peer-reviewed research articles in relation to the ethical aspects of biomedical research and clinical practice, including professional choices and conduct, medical technologies, healthcare systems and health policies.
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