Abstract：
OBJECTIVE: To identify opportunities to improve sexual and reproductive health (SRH) care for transgender and gender diverse (TGD) cancer survivors by describing (1) challenges experienced when navigating SRH care and (2) strategies to help overcome these challenges.
METHODS: We enrolled a purposive sample of 17 adult TGD cancer survivors and 5 co-survivors. We aimed for a diverse sample across cancer experience, age, racial/ethnic background, sexual orientation, and gender identity. We conducted 90-min individual interviews via videoconference and used reflexive thematic analysis, guided by a focus on three social determinants of health.
RESULTS: Themes describing challenges were as follows: (1) Cancer treatment\'s impact on sexual health was insufficiently addressed by cancer care providers; (2) fertility-related information and conversations were complicated by gendered expectations and ultimately did not meet survivors\' needs; (3) feeling excluded and uncared-for in healthcare settings due to gendered language and lack of supportive services that met their needs; and (4) TGD survivors commonly reported high financial burden, negatively impacting their access to care. Strategies to overcome these challenges were (1) a solid social support network that can be integrated into the care team to meet the unique SRH needs of TGD survivors and (2) gender-affirming healthcare providers and environments to address SRH care needs and concerns.
CONCLUSIONS: TGD survivors and co-survivors desire improved access to gender-affirming SRH care in cancer survivorship.
CONCLUSIONS: Key opportunities to improve gender-affirming SRH care in cancer survivorship include fostering and engaging TGD survivors\' support networks and implementing system-level changes in cancer care settings.
METHODS: We enrolled a purposive sample of 17 adult TGD cancer survivors and 5 co-survivors. We aimed for a diverse sample across cancer experience, age, racial/ethnic background, sexual orientation, and gender identity. We conducted 90-min individual interviews via videoconference and used reflexive thematic analysis, guided by a focus on three social determinants of health.
RESULTS: Themes describing challenges were as follows: (1) Cancer treatment\'s impact on sexual health was insufficiently addressed by cancer care providers; (2) fertility-related information and conversations were complicated by gendered expectations and ultimately did not meet survivors\' needs; (3) feeling excluded and uncared-for in healthcare settings due to gendered language and lack of supportive services that met their needs; and (4) TGD survivors commonly reported high financial burden, negatively impacting their access to care. Strategies to overcome these challenges were (1) a solid social support network that can be integrated into the care team to meet the unique SRH needs of TGD survivors and (2) gender-affirming healthcare providers and environments to address SRH care needs and concerns.
CONCLUSIONS: TGD survivors and co-survivors desire improved access to gender-affirming SRH care in cancer survivorship.
CONCLUSIONS: Key opportunities to improve gender-affirming SRH care in cancer survivorship include fostering and engaging TGD survivors\' support networks and implementing system-level changes in cancer care settings.
摘要：
目标：通过描述（1）导航SRH护理时遇到的挑战和（2）帮助克服这些挑战的策略，确定改善跨性别和性别多样化（TGD）癌症幸存者的性健康和生殖健康（SRH）护理的机会。
方法：我们登记了17名成人TGD癌症幸存者和5名共同幸存者的目的样本。我们的目标是针对癌症经历的不同样本，年龄,种族/民族背景，性取向,和性别认同。我们通过视频会议进行了90分钟的个人访谈，并使用了反身性主题分析，以关注健康的三个社会决定因素为指导。
结果：描述挑战的主题如下：（1）癌症护理提供者没有充分解决癌症治疗对性健康的影响；（2）与生育相关的信息和对话因性别期望而变得复杂，最终无法满足幸存者的需求；（3）由于性别语言和缺乏满足其需求的支持性服务，在医疗保健环境中感到被排斥和无人照顾；（4）对他们获得护理的机会产生负面影响。克服这些挑战的策略是（1）可以整合到护理团队中的坚实的社会支持网络，以满足TGD幸存者的独特SRH需求；（2）确认性别的医疗保健提供者和环境，以解决SRH护理需求和问题。
结论：TGD幸存者和共同幸存者希望改善癌症幸存者获得性别确认SRH护理的机会。
结论：改善癌症幸存者性别确认SRH护理的主要机会包括培养和吸引TGD幸存者的支持网络，以及在癌症护理环境中实施系统级的改变。
方法：我们登记了17名成人TGD癌症幸存者和5名共同幸存者的目的样本。我们的目标是针对癌症经历的不同样本，年龄,种族/民族背景，性取向,和性别认同。我们通过视频会议进行了90分钟的个人访谈，并使用了反身性主题分析，以关注健康的三个社会决定因素为指导。
结果：描述挑战的主题如下：（1）癌症护理提供者没有充分解决癌症治疗对性健康的影响；（2）与生育相关的信息和对话因性别期望而变得复杂，最终无法满足幸存者的需求；（3）由于性别语言和缺乏满足其需求的支持性服务，在医疗保健环境中感到被排斥和无人照顾；（4）对他们获得护理的机会产生负面影响。克服这些挑战的策略是（1）可以整合到护理团队中的坚实的社会支持网络，以满足TGD幸存者的独特SRH需求；（2）确认性别的医疗保健提供者和环境，以解决SRH护理需求和问题。
结论：TGD幸存者和共同幸存者希望改善癌症幸存者获得性别确认SRH护理的机会。
结论：改善癌症幸存者性别确认SRH护理的主要机会包括培养和吸引TGD幸存者的支持网络，以及在癌症护理环境中实施系统级的改变。
