背景:确认性别的外科手术,例如,出生时被分配给女性的子宫腔成形术和子宫成形术,是复杂和多阶段的,涉及风险。考虑这些程序的个人会经历更大的不确定性或决策冲突,再加上难以找到值得信赖的信息。
目的:(1)探讨导致决策不确定性的因素和个体的需求,这些个体正在考虑进行子宫成形术和子宫成形术性别确认手术(MaPGAS),以及(2)为开发以患者为中心的辅助决策提供信息。
方法:本横断面研究基于混合方法。在MaPGAS决策的各个阶段,成年变性人和出生时被分配给女性的非二元个体从美国的2个研究中心招募参加半结构化访谈和在线性别健康调查。其中包括性别一致性的衡量标准,决策冲突,泌尿系统健康,和生活质量。训练有素的定性研究人员对问题进行了所有访谈,以探索渥太华决策支持框架的结构。
结果:结果包括MaPGAS的目标和优先事项,期望,知识,和决策需要,以及手术偏好在决策冲突中的变化,手术状态,和社会人口统计学变量。
结果:我们采访了26名参与者,并收集了39名参与者的调查数据(24名受访者,92%)在MaPGAS决策的各个阶段。在调查和访谈中,确认性别认同,站着小便,感觉,以及“通过”男性的能力成为决定接受MaPGAS的非常重要的因素。三分之一的受访者表示决策冲突。对所有来源的数据进行三角测量表明,当试图平衡通过手术过渡解决性别不安的强烈愿望与泌尿和性功能的风险和未知因素时,冲突最多。外观,和保存后的感觉。保险范围,年龄,接触外科医生,和健康问题进一步影响手术的偏好和时机。
结论:这些发现增加了那些考虑MaPGAS的人对决策需求和优先事项的理解,同时揭示了知识之间的新复杂性,个人因素,决策的不确定性。
■这项混合方法研究是由变性人和非二元社区成员共同开发的,为考虑MaPGAS的提供者和个人提供了重要的指导。研究结果为美国情况下的MaPGAS决策提供了丰富的定性见解。限制包括多样性和样本量低;两者都在正在进行的工作中得到解决。
结论:这项研究增加了对MaPGAS决策重要因素的理解,和结果正被用于指导开发以患者为中心的手术决策辅助和全国分布的知情调查修订。
Gender-affirming surgical procedures, such as metoidioplasty and
phalloplasty for those assigned female at birth, are complex and multistaged and involve risks. Individuals considering these procedures experience greater uncertainty or decisional conflict, compounded by difficulty finding trustworthy information.
(1) To explore the factors contributing to decisional uncertainty and the needs of individuals considering metoidioplasty and
phalloplasty gender-affirming surgery (MaPGAS) and (2) to inform development of a patient-centered decision aid.
This cross-sectional
study was based on mixed methods. Adult transgender men and nonbinary individuals assigned female at birth at various stages of MaPGAS decision making were recruited from 2 study sites in the United States to participate in semistructured interviews and an online gender health survey, which included measures of gender congruence, decisional conflict, urinary health, and quality of life. Trained qualitative researchers conducted all interviews with questions to explore constructs from the Ottawa decision support framework.
Outcomes included goals and priorities for MaPGAS, expectations, knowledge, and decisional needs, as well as variations in decisional conflict by surgical preference, surgical status, and sociodemographic variables.
We interviewed 26 participants and collected survey data from 39 (24 interviewees, 92%) at various stages of MaPGAS decision making. In surveys and interviews, affirmation of gender identity, standing to urinate, sensation, and the ability to \"pass\" as male emerged as highly important factors for deciding to undergo MaPGAS. A third of survey respondents reported decisional conflict. Triangulation of data from all sources revealed that conflict emerged most when trying to balance the strong desire to resolve gender dysphoria through surgical transition against the risks and unknowns in urinary and sexual function, appearance, and preservation of sensation post-MaPGAS. Insurance coverage, age, access to surgeons, and health concerns further influenced surgery preferences and timing.
The findings add to the understanding of decisional needs and priorities of those considering MaPGAS while revealing new complexities among knowledge, personal factors, and decisional uncertainty.
This mixed methods
study was codeveloped by members of the transgender and nonbinary community and yielded important guidance for providers and individuals considering MaPGAS. The results provide rich qualitative insights for MaPGAS decision making in US contexts. Limitations include low diversity and sample size; both are being addressed in work underway.
This
study increases understanding of the factors important to MaPGAS decision making, and results are being used to guide development of a patient-centered surgical decision aid and informed survey revision for national distribution.