SURGICAL READINESS CLASSES FOR GENDER AFFIRMATION SURGERIES IN AN INTEGRATED HEALTH CARE TRANSGENDER CLINIC
February 04, 20178:13 AM-February 04, 20178:26 AM
ConradWenzel, MSW ;
ShannonHuffaker, MSN NP;
SandChang, PhD ;
ChrisSprowles, BSN; RN ;
DanielGeer, MSW BC-DMT
Patients preparing for gender affirmation surgeries have varied access to accurate information about their surgical options as well as what to expect before, during and after surgery. While some patients conduct extensive research on their own prior to surgery, information available online and through peer networks may be inaccurate or may not reflect the most current surgical options or include pertinent post-operative care considerations. Furthermore, many patients have only brief encounters with their surgeon and so rely primarily on a printed set of instructions to guide their preparation and recovery. These limited educational opportunities can leave patients under-prepared for their surgical process.
To ensure that all patients have access to accurate and comprehensive pre-operative education, a multi-disciplinary group of providers at a large health maintenance organization in Northern California created standardized genital surgery curricula available to all patients accessing surgery through the centralized transgender clinic at Kaiser Permanente Northern California (KPNC). Patient satisfaction was assessed at the conclusion of each class to evaluate favorability and perceived utility of the content.
Materials and Methods:
An IRB exemption was approved by KPNC National Compliance in Research Support Program to anonymously survey patients on their satisfaction of the surgery readiness classes. The classes were administered by a team of medical, nursing, surgical, and mental health providers in single 2.5-hour sessions. Each class had 5-20 attendees and classes were held monthly beginning in November of 2015. Two separate curricula were developed: one focused on vaginoplasty and the other focused on metoidioplasty and phalloplasty. Content was organized into three primary subsections: anatomy and surgical options, readiness and preparation, and post-operative care. To increase the relevancy of the content, patients were asked to think about their own personal goals for surgery, fears and concerns, as well as to brainstorm questions for their surgeons. An evaluation tool using a Likert scale was administered to participants at the end of each class to assess favorability and self-perceived knowledge acquisition.
Patients who attended the surgery education program reported increased knowledge in all subject areas. Patient evaluations also indicated that after attending the program patients felt more prepared for their pre-surgical planning process. Patients described themselves as better informed about their surgical options, possible complications, and post-surgical care needs.
This pilot program demonstrated high favorability ratings for this clinic-based single session model. Surgery education programs are a cost-effective and simple intervention that can bolster the informed consent process by providing information about surgical options, surgical limitations, possible complications, preparation requirements, and aftercare considerations. As access to genital affirmation surgeries rapidly expands in the United States, it is critical to ensure that comprehensive patient education is integrated into all gender confirmation surgical pathways.