Physician Implementation of Gender-Affirmative Care Recommendations: Improving Patient Safety and Healthcare for Transgender and Gender Diverse Youth

Compared to their cisgender counterparts, transgender, and gender diverse youth (TGDY) disproportionately experience an increased risk for poor patient safety and healthcare disparities. TGDY report poorer mental and physical health and lower rates of utilization of preventive medicine. These health and healthcare disparities may be due to a lack of access to gender-affirming care – an integrative approach to providing developmentally appropriate healthcare and facilitating conversation and exploration of gender identity with patients and their families in a supportive environment. Gender-affirming care is associated with increased healthcare utilization, quality of life, and decreased rates of depression and suicidality among TGDY. In the United States, TGDY report difficulty finding gender-affirming providers as well as trans-specific healthcare. To meet the healthcare needs of TGDY, in 2018, the American Academy of Pediatrics (AAP) issued the policy statement, “Ensuring Comprehensive Care and Support for Transgender and Gender-Diverse Children and Adolescents” to provide clinical practice guidelines for physicians to provide gender-affirming care to youth. However, little is known about physicians’ knowledge, agreement, or perceived barriers to implementing the AAP recommendations. Further, TGDY in rural and fringe urban areas face unique healthcare challenges and experience greater discrimination and negligence in the healthcare setting, such as receiving delayed medical care. The specific aims of this study were: To assess (1a) pediatrician’s knowledge, agreement with, and perceived barriers of the AAP recommendations as well as provision of gender-affirming care (i.e., psychoeducation, patient interaction, providing care in a safe environment, and referrals) and (1b) if this differs based on practice setting urbanization level; to examine the role of provider characteristics and practice setting in explaining the variability in: (2a) AAP policy knowledge; (2b) agreement with the AAP Policy; and (2c) perceived implementation barriers of the AAP policy; and to examine the role of provider characteristics and practice setting in explaining physician’s provision of: (3a) total GAC; (3b) GAC psychoeducation; (3c) GAC patient interaction; (3d) GAC safe environment; and (3e) GAC referrals; when accounting for AAP policy knowledge, agreement, and perceived implementation barriers. In this study, 199 physicians were recruited to participate in an online survey. Findings from this study will inform efforts to improve healthcare safety, accessibility, and equitability for TDGY by informing the future development of a context-tailored, theory-based intervention to promote gender-affirming care in diverse geographical areas.