Bianca Maria Salvetti, DNP, RN, CNS, CPNP

Abstract:

Background: The decision to begin gender affirming treatment (GAT), such as puberty blockers or hormone therapy, can be difficult and complex. Transgender and gender diverse youth (TGD) and their caregivers must learn and understand a large volume of information to participate in shared decision-making (SDM) regarding the decision to begin gender affirming treatment. One method to support SDM is the use of a decision aid (DA), to provide evidence-based information on treatment benefits, risks, and long-term effects. Currently, there are no DA to assist TGD youth and caregivers in the decision on whether to start GAT. Objectives: The aim of this project was to develop, implement, and evaluate the impact of a web-based DA on GAT in a pediatric academic medical center. Methods: Cross-sectional, pre- and post-intervention design. Participants included treatment naïve TGD youth aged 13-25 years or their caregivers. Eligible participants were evaluated for their pre-and post-intervention knowledge, fertility attitudes, and decisional conflict (DC), with acceptability of the intervention only being assessed post-intervention. Data were collected from March 2022 to May 2022 utilizing Research Electronic Data Capture (REDCap). Descriptive statistics were used to assess demographics and post-intervention survey responses and paired t-test to assess knowledge and DC pre- and post-intervention. Results: A total of 10 [6 TGD youth (mean 16.5 years, SD=2.2) and 4 caregivers (mean 45.5 years, SD=7.5)] participated in the study. The majority were assigned female at birth (70%) and identified as white (40%) or Latino/a/e/x (40%). All participants had high mean GAT knowledge (7.8 [SD=1.3] vs. 7.4 [SD=1.8], p=0.509) and low mean DC (18.1 [SD=19.9] vs. 10.9 [SD=12.9], p=0.187) scores pre- and post-intervention, respectively, with no significant difference. Caregivers had higher GAT knowledge and DC scores then TGD youth. The DA had no effect on knowledge in either group but showed reduced DC scores in both groups. The majority of participants (80%) found the DA useful for their decision-making process for GAT. Conclusion: This pilot study tested a newly developed web-based DA on GAT, which showed improved scores on DC but had no effect on knowledge among the users. The majority of participants found the DA information helpful in making their decision regarding GAT. Future studies are needed to verify findings in a larger, more diverse cohort of TGD youth and their caregivers.   

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