"Ditch the white coats": What LGBTQ+ patients prefer in their primary care provider

Feeling 'not enough' or 'too much': Exploring how LGBTQ+ adults experiencing disability navigate Canadian health contexts

Disability and LGBTQ+ communities experience healthcare disparities, however, most research has looked at these communities separately which erases the unique health experiences of people who belong to both. This project sought to explore intersections between gender, sexuality and disability within Canadian health contexts through three life-story interviews with seven adults (aged 25-35; 21 interviews total) who identified as LGBTQ+ and experiencing disability. Thematic narrative analysis resulted in interrelated themes associated with axes of self-identification that demonstrated how participants navigated tensions between being perceived as not disabled, trans and/or queer 'enough' or 'too much' within healthcare settings. Participants relayed stories of strategically omitting and/or sharing aspects of their intersectional identities with healthcare providers to receive the care they needed. This study, in demonstrating some of the difficult compromises and decisions LGBTQ+ adults who experience disability navigate to access healthcare, highlights how ableism, cis-heterosexism and racism intertwine to shape medical systems.

The New Frontier of Adult Neurodevelopmental Care: Individual and Caregiver Values

Background and Objectives

There are few specialists that serve adults with neurodevelopmental disabilities (NDD), and most adults with NDD receive care from providers without specialty training in NDD. Care for this population is highly variable, and patient and caregiver priorities in this age group are not well known. We aimed to explore individual and caregiver values around adult neurodevelopmental care.

Methods

In this qualitative study, a qualitative analyst conducted 22 semistructured virtual interviews from September 2021 to February 2022 with randomly selected adults with NDD and/or their caregivers. Each individual with NDD had at least one appointment in the adult NDD clinic, which started in October 2020. Interviews were recorded and professionally transcribed. An inductive codebook was developed and reconciled through an iterative process; transcripts were coded in Atlas.ti with 20% double-coding. Major themes were developed through team discussion.

Results

Most interviewees were caregivers of patients with NDD (12); 9 interviews were with patient/caregiver dyads; 1 interview was with a patient alone. Three main themes emerged from the interviews. (1) Value in providers who are curious, engaged, and knowledgeable about NDD-related conditions, which individuals and caregivers referred to as "Unicorn Providers." (2) Value in a connected and coordinated web of care. (3) Value in comfortable and adaptable clinic spaces. They value clinical environments that foster patient success during visits.

Discussion

The need for adult neurodevelopmental care is growing as more individuals with NDD are living into adulthood. Better understanding of patient and caregiver values can help shape this emerging field to meet the needs of this unique, often overlooked and underserved, population.

Factors associated with communication preferences in transgender and/or gender-diverse individuals - a survey study

INTRODUCTION

As communication should be adapted to the individual, the aim of this study was to explore possible factors related to communication preferences in transgender and/or gender-diverse individuals.

METHODS

A survey study was conducted in September 2022. Communication preferences were assessed using the CommTrans questionnaire, which included two scales: emotional resonance and gender-related communication. Additionally, we assessed gender, age, relationship status, number of self-reported minorities, health literacy, mental health, and own communication style. Analyses were conducted using multiple linear regression analyses.

RESULTS

A total of 223 individuals completed the survey, of whom 139 (58.2 %) identified as non-binary. Participants valued emotional resonance moderately high (Mean.: 70.6; SD.: 19.5) and gender-related preferences in the middle range (Mean 57.4; SD.: 27.2). As regards emotional resonance, not identifying with a minority was associated with a lower importance of doctors' response to patients emotions. Furthermore, having a self-confident communication style as a transgender and/or gender-diverse individual was related to a lower perceived importance in gender-related communication, while identifying as non-binary was related with a greater importance.

CONCLUSION

Our findings might help to expand doctors' knowledge, and thus help them to provide patient-centered care for transgender and/or gender-diverse individuals.

Health Communication Preferences of Transgender and Gender-Diverse Individuals - Development and First Psychometric Evaluation of the CommTrans Questionnaire

Patient-doctor communication is an important component of patient-centered care and should be adapted to the target group. Adapting communication to transgender and gender-diverse individuals is particularly difficult, as little is known about the preferences of this group. Thus, the aim of the study was to develop a questionnaire to assess the communication preferences of the target group. Based on a qualitative study, an item pool was created, which was tested in a survey in September 2022. An item analysis was conducted and items with unacceptable characteristics were removed. The remaining item pool was examined with an explorative factor analysis. The sample consisted of N = 264 individuals. Of the initial k = 43 items, k = 9 items remained in the final factor analysis. The final two factor solution explained 60.7% of the variance. The factors describe the emotional resonance in communication (Cronbach's α = .74; e.g. "My medical doctors should be happy for me when my treatment progresses positively.") as well as gender-related communication (Cronbach's α = .85; e.g. "My medical doctors should introduce themselves with pronouns."). Overall, the questionnaire captures the communication preferences of transgender and gender-diverse individuals in medical conversations. It covers two important topics for the target group, but further validation is necessary.

Exploring communication preferences of trans and gender diverse individuals-A qualitative study

BACKGROUND

Trans and gender-diverse individuals experience adverse health outcomes that might be due, in addition to other factors, to stigma and discrimination in the health care sector. At the same time, the concept of person-centred care acknowledges the role of patient-physician communication in health care outcomes. This study aims to explore patient-physician communication preferences in trans and gender-diverse individuals.

METHOD

A qualitative interview study was conducted, including N = 10 participants between February and March 2022. Participants were interviewed using a semi-structured interview guideline, based on previous knowledge in person-centred care and sample specific communication. Participants were asked about their experiences and wishes in patient-physician centeredness. Analyses were conducting using a qualitative content analysis strategy.

RESULTS

Mean age was 29.3 years; n = 6 participants identified themselves within the binary gender concept, while n = 4 identified themselves with a non-binary gender. Communication preferences for patient-physician communication were categorised into four themes: general communication aspects (e.g. active listening); the role of gender during appointments (e.g. appropriate/inappropriate addressing); gender-neutral language (e.g. experiences use of gender neutral language by physicians); own communication style (e.g. early outing and justification). Furthermore, possible contextual factors of patient-physician communication where found (e.g. trusting relationship).

CONCLUSION

Adding knowledge to communication preferences of trans and gender-diverse individuals, this study was able to identify preferences that are specific to the sample as well as preferences that differ from the cis-gendered population. However, it remains unclear how the patient-physician communication preferences affects health care utilization and outcomes.

TRIAL REGISTRATION

German Clinical Trial Register (DRKS00026249).