DONORS: LESSONS FROM OTHER HEALTH DISCIPLINES. T Butler-Foster1,2, ... http://fenwayhealth.org/documents/the-fenway-institute/handouts/Handout_7- ...
MITIGATING NEGATIVE EXPERIENCES FOR TRANS DONORS: LESSONS FROM OTHER HEALTH DISCIPLINES T Butler-Foster1,2, B Neil3, I Chin-Yee2,4,5, M Huang2, T Sivananth1,5, K Jackson1 1Arthur Labatt School of Nursing, Western University, Canada, 2Medical Affairs, Canadian Blood Services, Canada, 3Resource Management Supply Chain, Canadian Blood Services, Canada, 4Pathology and Laboratory Medicine, Schulich School of Medicine, Western University, Canada, 5London Health Sciences Centre, Canada
Trans is an umbrella term for individuals whose gender identity differs from the sex assigned to them at birth i.e. transgender, gender non-conforming, non-binary individuals1 Why is this an issue of importance? • Some trans donors describe poor donation experiences2 • May indicate staff challenges in sensitive care provision2 • Negative experiences can harm donors and the reputation of blood agencies • Trans = 0.6% population estimate3 • Literature is silent regarding culturally sensitive care provision for trans donors What is a systematic scoping review? • Starts with a broad question4 What is known about culturally sensitive care provision for trans individuals as investigated in other health care disciplines? • Assesses scope and breadth of research4 • Summarizes and disseminates research findings4 • Identifies research gaps in existing literature4 Methods • Arskey and O’Malley methodological scoping review framework 4 • CINAHAL, PubMed, and Scopus searched Oct to Nov, 2017 • Search terms “trans”, “healthcare”, “delivery”, “knowledge”, and “disparities” • Included: English North American studies published/using data collected in the last five years (to capture recent trans-inclusive discourse) • Excluded: medical intervention and population subset studies to match blood donor population
Results • 256 eligible studies → 8 met inclusion criteria5-12 • Studies spanned a variety of health care disciplines with varying degrees of trans patient exposure • Inductive thematic analysis revealed systemic and practice gaps Key Themes Practice gaps – that hindered relationships and diluted data (for institutions/research/statistics) as demonstrated through: • Rigid binary intake processes and uncertainty regarding how trans individuals are identified in the practice setting7,9,11,12 • Difficulties knowing when to ask and use pronouns5, 9-12 Systemic gaps - due to lack of trans specific education as evidenced by: • Confusion and conflating of key terms and pathologizing trans patients5-12 • Confusion regarding prevalence/desire to have gender affirming surgeries and when and how to discuss with patients6,8,11 • Lack of understanding of stigma generated by the health care environment for trans individuals and how stigma can elevate patient health risks9,10,12
Recommendations • Create inclusive environments and records7,9-12 • Ask all individuals their pronouns at the outset of the therapeutic relationship7,9,11,12 • Use a two-step intake process when trans patients must be identified. Ask all individuals 1) sex assigned at birth 2) their gender identity12-14 • Institutional and purpose built training regarding cultural safety and sensitivity for trans individuals5-12 • Further research is needed to determine the best way to implement educational interventions across large multidiscipline settings5-12 Conclusion • In the absence of transfusion medicine specific research this scoping review identified systematic and practice gaps across several health care disciplines and highlighted evidence based recommendations • Blood center specific research is needed to determine transferability of these findings • Further blood center specific research could improve provision of culturally sensitive care for trans donors References
1Glossary
of gender and transgender terms [Internet]. Boston: Fenway Health; 2010 [cited 2017 May 7]. Available from: http://fenwayhealth.org/documents/the-fenway-institute/handouts/Handout_7-C_Glossary_of_Gender_and_Transgender_Terms__fi.pdf 2Consultations with Trans and Gender NonBinary Communities — 2016 Summary Report. [Internet]. Ottawa: Canadian Blood Services; 2017 Mar [cited 2018 May 7]. Available from: https://blood.ca/sites/default/files/ConsultationReport_May2017.pdf 3Flores
A, Herman JL, Gates GJ, Brown TN. How many adults identify as transgender in the United States? The Williams Institute; 2016
[cited 2017 May 14] Available from: https://williamsinstitute.law.ucla.edu/wp-content/uploads/How-Many-Adults-Identify-as-Transgender-in-theUnited-States.pdf 4Arksey H, O'Malley L. Scoping studies: towards a methodological framework. International journal of social research methodology. 2005 Feb 1;8(1):19-32. 5Whitman CN, Han H. Clinician competencies: Strengths and limitations for work with transgender and gender non-conforming (TGNC) clients. International Journal of Transgenderism. 2017 Apr 3;18(2):154-71. 6Snelgrove JW, Jasudavisius AM, Rowe BW, Head EM, Bauer GR. “Completely out-at-sea” with “two-gender medicine”: A qualitative analysis of physician-side barriers to providing healthcare for transgender patients. BMC health services research. 2012 Dec;12(1):110. 7Chisolm-Straker M, Willging C, Daul AD, McNamara S, Sante SC, Shattuck DG, Crandall CS. Transgender and Gender-Nonconforming Patient in the Emergency Department: What Physicians Know, Think, and Do. Annals of emergency medicine. 2018 Feb 1;71(2):183-8.
8Johnston
CD, Shearer LS. Internal Medicine Resident Attitudes, Prior Education, Comfort, and Knowledge Regarding Delivering Comprehensive Primary Care to Transgender Patients. Transgender health. 2017 Jul 1;2(1):91-5. 9Carabez RM, Eliason MJ, Martinson M. Nurses' knowledge about transgender patient care: a qualitative study. Advances in Nursing Science. 2016 Jul 1;39(3):257-71. 10Beagan BL, Chiasson A, Fiske CA, Forseth SD, Hosein AC, Myers MR, Stang JE. Working with transgender clients: Learning from physicians and nurses to improve occupational therapy practice. Canadian journal of occupational therapy. 2013 Apr;80(2):82-91. 11Unger CA. Care of the transgender patient: a survey of gynecologists' current knowledge and practice. Journal of women's health. 2015 Feb 1;24(2):114-8. 12Carabez
R, Pellegrini M, Mankovitz A, Eliason M, Scott M. Does your organization use gender inclusive forms? Nurses' confusion about trans* terminology. Journal of clinical nursing. 2015 Nov 1;24(21-22):3306-17. 13
Cahill S, Makadon H. Sexual orientation and gender identity data collection in clinical settings and in electronic health records: A key to ending LGBT health disparities. LGBT health. 2014 Mar 1;1(1):34-41. M. Creating a safe and welcoming clinic environment [internet]. San Francisco(CA): Centre for Excellence In Transgender Health; 2016 Jun 17 [cited 2017 May 7] Available from: http://transhealth.ucsf.edu/trans?page= guidelines-clinic-environment 14 Deutsch
Presented at the International Society of Blood Transfusion Congress 2018
