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Kamran R, Chan C, Jackman VA, Lee AC, Suk Y, Jackman L, Ditkofsky N, Nguyen E, Probyn L, Doria AS. Transgender and Gender Diverse Medical Education in Radiology: A Systematic Review. Acad Radiol 2024:S1076-6332(24)00664-0. [PMID: 39304375 DOI: 10.1016/j.acra.2024.09.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2024] [Revised: 08/26/2024] [Accepted: 09/01/2024] [Indexed: 09/22/2024]
Abstract
RATIONALE AND OBJECTIVES Physicians report a lack of Transgender and Gender Diverse (TGD) health competency for medical imaging. This knowledge gap contributes to negative medical imaging experiences, discrimination, stigma, and diagnostic errors for TGD individuals. Medical education plays an important role in improving this. However, the current landscape and gaps in TGD medical education in radiology is underexplored. We aimed to fill the knowledge gap on the current state of TGD medical education in radiology. MATERIALS AND METHODS A PRISMA and SWiM guideline-compliant systematic review on TGD medical education in radiology was performed. Four databases were searched: Medline, Embase, Web of Science, and Scopus from inception to May 13, 2024. Article screening and extraction occurred independently and in duplicate. Narrative synthesis was performed on TGD medical education material in radiology, educational recommendations, barriers/enablers to education, and current guidelines. RESULTS A total of 4360 records were identified with 76 articles included. Most articles (52, 68%) were from the United States. Most articles aimed to provide recommendations for TGD medical education in radiology (53, 69.7%). Some articles focused on developing medical education (7, 9.2%), evaluating medical education (7, 9.2%), evaluating guidelines (8, 10.5%), or developing guidelines (3, 4%). Identified TGD medical education in radiology is inconsistent, focusing on terminology guides, clinical scenarios, and cultural sensitivity workshops. Many current guidelines for TGD medical imaging were developed through extrapolation of guidance for cisgender patients, demonstrating limited relevance and meaningfulness for TGD patients. CONCLUSION This systematic review identifies a need to develop consistent TGD medical educational material in radiology in partnership with TGD patients to cover patient perspectives and guidance for medical imaging considerations. Results can be used to identify TGD medical education resources in radiology which may be helpful, and guide development of future medical education.
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Affiliation(s)
- Rakhshan Kamran
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, United Kingdom
| | - Cynthia Chan
- Department of Family Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Victoria Anne Jackman
- Faculty of Medicine, Memorial University of Newfoundland, St John's, Newfoundland, Canada
| | - Ann C Lee
- Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Yujin Suk
- Department of Biochemistry and Biomedical Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Liam Jackman
- Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Noah Ditkofsky
- Department of Medical Imaging, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Elsie Nguyen
- Department of Medical Imaging, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Linda Probyn
- Department of Medical Imaging, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Andrea S Doria
- Department of Medical Imaging, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada; Department of Diagnostic and Interventional Radiology, The Hospital for Sick Children, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.
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2
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Vijapura C, Wahab R, Patel M, Miles RC, Brown AL. Breast/chest imaging findings and clinical considerations in transgender patients. Clin Radiol 2024:S0009-9260(24)00497-5. [PMID: 39322531 DOI: 10.1016/j.crad.2024.08.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2024] [Revised: 07/11/2024] [Accepted: 08/26/2024] [Indexed: 09/27/2024]
Abstract
The transgender population, a historically marginalized group, is growing in size, visibility, and cultural acceptance. However, lack of provider knowledge contributes to the disparities and discrimination that this group continues to face in the healthcare setting. Special considerations for transgender individuals undergoing imaging for breast/chest care can improve health equity, including appropriate evidence-based screening, tailored protocols, and inclusive radiology facilities. This article will focus on the imaging findings that can be seen in transgender patients during the course of gender-affirming care, which may involve hormone therapy and/or surgery. Relevant examples of benign and malignant pathologies that can be seen in transgender patients will be highlighted, and their imaging on mammogram, ultrasound, and magnetic resonance imaging (MRI) will be reviewed.
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Affiliation(s)
- C Vijapura
- University of Cincinnati, 3188 Bellevue Ave, Cincinnati, OH 45219, USA.
| | - R Wahab
- Vanderbilt University Medical Center, 1161 21(st) Avenue South, Nashville, TN 37232, USA.
| | - M Patel
- The Ohio State University Wexner Medical Center, 395 W. 12(th) Avenue, Columbus, OH 43210, USA.
| | - R C Miles
- Denver Health Medical Center, 777 Bannock Street, Denver, CO 80204, USA.
| | - A L Brown
- University of Cincinnati, 3188 Bellevue Ave, Cincinnati, OH 45219, USA.
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3
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Morrow K, Mackay S. Diagnostic radiography students' attitudes towards gender inclusive pregnancy status checks. Radiography (Lond) 2024; 30:784-792. [PMID: 38471393 DOI: 10.1016/j.radi.2024.02.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Revised: 02/26/2024] [Accepted: 02/27/2024] [Indexed: 03/14/2024]
Abstract
INTRODUCTION Radiographers are responsible for protecting foetuses against ionising radiation and must screen all individuals for pregnancy prior to a pelvic X-ray examination following new guidance from the Society of Radiographers. This includes male, female, transgender, non-binary and intersex patients. Student diagnostic radiographers learn to undertake this screening so this project was designed to understand their attitudes towards doing so. METHOD A qualitative study was conducted with third-year students on the BSc Diagnostic Radiography programme at a University in the North West of England. Following ethical approval, focus groups were conducted using open-ended questions to gain insight into how comfortably students conduct Inclusive Pregnancy Status (IPS) checks at seven National Health Service (NHS) Trust clinical placement sites. Students were also asked about their attitudes towards IPS checks. These data were analysed using Clarke and Braun's thematic analysis model. RESULTS The analysis of seven focus groups with nineteen participants yielded four themes: education, standardisation, fear of reaction, and placement involvement. Barriers to conducting IPS checks include a lack of staff encouragement as guidance is enforced at the employers' discretion, and a lack of awareness around transgender, non-binary and intersex (TNBI) inclusivity. Students showed a willingness to conduct IPS checks despite this. CONCLUSION Age and experience range of participants were limiting factors in this study. Students who had the opportunity to practice and were encouraged to conduct IPS checks on placement felt confident in doing so. IMPLICATIONS FOR PRACTICE More training and awareness should be provided surrounding LGBTQ + issues in healthcare. IPS checks should be standardised across placement sites to ensure equal learning opportunities.
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Affiliation(s)
- K Morrow
- University of Liverpool, Brownlow Hill, Liverpool, L69 3GB, UK.
| | - S Mackay
- University of Liverpool, Brownlow Hill, Liverpool, L69 3GB, UK.
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Mehta TS, Thompson J, Applegate JM, Wahab RA. Cultural Competence in the Care of LGBTQ+ Patients: A Primer for Breast/Chest Centers. JOURNAL OF BREAST IMAGING 2023; 5:473-479. [PMID: 38416897 DOI: 10.1093/jbi/wbad012] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Indexed: 03/01/2024]
Abstract
The number of individuals identifying as lesbian, gay, bisexual, transgender, queer/questioning (LGBTQ+) has doubled over the past 10 years, and this figure continues to rise. The LGBTQ+ community is diverse, encompassing a vast array of differences in gender identity and sexual orientation. Additionally, it is inclusive of people from all races, ethnicities, religions, and socioeconomic backgrounds. This intersectionality of identities and experiences impacts both access to health care and its delivery. Barriers to care for this population are multifactorial and include stigma, discrimination, bias, limited role models, issues with insurance coverage, lack of education and training for health care providers, and lack of research on LGBTQ+ health-related issues. Specific to breast cancer, the screening recommendations for this group are influenced not only by risk but also by gender-affirming hormonal and surgical therapies. This article will provide an overview of the LGBTQ+ population, review breast cancer screening compliance and recommendations, summarize the multitude of health disparities, and offer potential interventions to improve care delivery at the individual, facility, organizational, and health policy levels.
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Affiliation(s)
- Tejas S Mehta
- UMass Memorial Medical Center, Department of Radiology, Worcester, MA, USA
| | | | - Julia M Applegate
- The Ohio State University, Department of Women's, Gender and Sexuality Studies, Columbus, OH, USA
| | - Rifat A Wahab
- University of Cincinnati Medical Center, Department of Radiology, Cincinnati, OH, USA
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5
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Hayward JH. Updates in Transgender Breast Imaging. Semin Ultrasound CT MR 2023; 44:23-34. [PMID: 36792271 DOI: 10.1053/j.sult.2022.10.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Transgender patients are seen in breast imaging centers for routine screening mammography and diagnostic imaging of the symptomatic breast. This comprehensive review of transgender breast imaging aims to update the radiologist on appropriate terminology, breast cancer risk in different patient populations, screening guidelines, and diagnostic scenarios. The chapter concludes with practical tips on how to optimize the patient experience.
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Affiliation(s)
- Jessica H Hayward
- Department of Radiology and Biomedical Imaging, University of California, San Francisco.
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6
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Ramsey I, Kennedy K, Sharplin G, Eckert M, Peters MDJ. Culturally safe, appropriate, and high-quality breast cancer screening for transgender people: A scoping review. INTERNATIONAL JOURNAL OF TRANSGENDER HEALTH 2023; 24:174-194. [PMID: 37114110 PMCID: PMC10128429 DOI: 10.1080/26895269.2022.2155289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/19/2023]
Abstract
Background There is a recognized need for evidence to inform breast cancer screening guidelines and services for transgender people, who face barriers to accessing appropriate and inclusive health care. Aims This review summarized evidence for breast cancer risk and screening guidelines in transgender individuals, including the potential impact of gender-affirming hormone therapy (GAHT); factors that may influence screening decision-making and behaviors; and considerations for providing culturally safe, high-quality screening services. Methods A protocol was developed based on the Joanna Briggs Institute scoping review methodology. Searches were performed in Medline, Emcare, Embase, Scopus, and the Cochrane Library for articles reporting information on the provision of culturally safe, high-quality breast cancer screening services for transgender people. Results We identified 57 sources for inclusion: 13 cross-sectional studies, 6 case reports, 2 case series, 28 review or opinion articles, 6 systematic reviews, 1 qualitative study, and 1 book chapter. Evidence on rates of breast cancer screening among transgender people and the association between GAHT and breast cancer risk was inconclusive. Factors negatively associated with cancer screening behaviors included socioeconomic barriers, stigma, and lack of health provider awareness of transgender health issues. Breast cancer screening recommendations varied and were generally based on expert opinion due to the lack of clear evidence. Considerations for providing culturally safe care to transgender people were identified and mapped to the areas of workplace policies and procedures, patient information, clinic environment, professional conduct, communication, and knowledge and competency. Discussion Screening recommendations for transgender individuals are complicated by the lack of robust epidemiological data and clear understanding of the role GAHT may play in breast cancer pathogenesis. Guidelines have been developed based on expert opinion and are subsequently not uniform or evidence based. Further work is required to clarify and consolidate recommendations.
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Affiliation(s)
- Imogen Ramsey
- Rosemary Bryant AO Research Centre, Clinical & Health Sciences, University of South Australia, Adelaide, Australia
| | - Kate Kennedy
- Rosemary Bryant AO Research Centre, Clinical & Health Sciences, University of South Australia, Adelaide, Australia
| | - Greg Sharplin
- Rosemary Bryant AO Research Centre, Clinical & Health Sciences, University of South Australia, Adelaide, Australia
| | - Marion Eckert
- Rosemary Bryant AO Research Centre, Clinical & Health Sciences, University of South Australia, Adelaide, Australia
| | - Micah D. J. Peters
- Rosemary Bryant AO Research Centre, Clinical & Health Sciences, University of South Australia, Adelaide, Australia
- Faculty of Health and Medical Sciences, Adelaide Nursing School, The University of Adelaide, Adelaide, Australia
- The Centre for Evidence-based Practice South Australia (CEPSA): A JBI Centre of Excellence, Adelaide, Australia
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Lenderink-Carpenter A, Grimm LJ. What's in a Name? Moving Away From "Women's Imaging". J Am Coll Radiol 2022; 19:1336-1337. [PMID: 36265813 DOI: 10.1016/j.jacr.2022.08.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Revised: 08/13/2022] [Accepted: 08/18/2022] [Indexed: 11/05/2022]
Affiliation(s)
| | - Lars J Grimm
- Department of Radiology, Duke University Medical Center, Durham, North Carolina.
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Promoting Progress and Learning from Mistakes: Results of a Radiology Department LGBTQ Inclusion Audit. Acad Radiol 2022; 29:1833-1839. [PMID: 35466052 DOI: 10.1016/j.acra.2022.03.020] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2022] [Revised: 03/16/2022] [Accepted: 03/22/2022] [Indexed: 01/26/2023]
Abstract
RATIONALE AND OBJECTIVES As radiology programs seek to recruit and retain diverse and competitive applicants, it is important to critically review existing department policies to ensure they meet the needs of their residents. To evaluate a radiology program's inclusivity measures, an interdepartmental committee developed an "LGBTQ inclusion index" and performed an LGBTQ inclusion audit to identify gaps in policy and to craft proposals for administrative review. MATERIALS AND METHODS An LGBTQ inclusion index was compiled through the collaboration of an interdisciplinary committee of residents, faculty, institutional and community representatives. Five inclusion milestones were identified relating to department policy, department facilities, institutional culture, department culture, and community engagement. Milestones were scored as 0, for milestone not at all met, 1, for milestone partially met, and 2, for milestone completely met, with a total score of 10. Program scores were calculated for the 2018-2021 academic years. RESULTS The radiology program LGBTQ inclusion index score increased over the course of the study period. The program LGBTQ inclusion index score was 4 of 10 in 2018 and 2019, but after formation of an LGBTQ inclusion task force by the diversity and inclusion committee, increased to 7 of 10 in 2020. The LGBTQ inclusion audit identified several areas that required improvement and the committee drafted proposals to address these gaps. By 2021, the program scored 9 of 10 on the inclusion index. CONCLUSION Promoting an inclusive and affirming radiology department is an important step to providing culturally competent healthcare and mitigating health disparities. An LGBTQ inclusion audit and a robust department diversity committee can help to identify and address gaps in policy, facilities, and culture.
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Valente PK, Paine EA, Mellman W, Rael CT, MacCrate C, Bockting WO. Positive patient-provider relationships among transgender and nonbinary individuals in New York City. INTERNATIONAL JOURNAL OF TRANSGENDER HEALTH 2022; 24:247-262. [PMID: 37114109 PMCID: PMC10128430 DOI: 10.1080/26895269.2022.2136814] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/19/2023]
Abstract
Background: Transgender and nonbinary (TGNB) individuals have diverse health needs and may face disproportionate barriers to healthcare, including developing positive patient-provider relationships. While there is mounting evidence of gender-based stigma and discrimination in healthcare, little is known about how TGNB individuals develop positive patient-provider relationships. Aims: To examine TGNB individuals' interactions with healthcare providers and identify main characteristics of positive patient-providers relationships. Methods: We conducted semi-structured interviews with a purposive sample of 13 TGNB individuals in New York, NY. Interviews were transcribed verbatim and analyzed inductively for themes related to characteristics of positive and trusting relationships with healthcare providers. Results: Participants' mean age was 30 years (IQR = 13 years) and most participants were nonwhite (n = 12, 92%). Receiving peer referrals to specific clinics or providers helped many participants find providers perceived to be competent and created initial grounds for positive patient-provider relationships. Providers with whom participants had positive relationships commonly managed primary care and gender-affirming care and relied on a network of interdisciplinary providers for other specialized care. Providers who were positively evaluated were perceived to possess in-depth clinical knowledge on the issues they were responsible for managing, including gender-affirming interventions, particularly for TGNB patients who perceived themselves to be knowledgeable about TGNB-specific care. Provider and staff cultural competence and a TGNB-affirming clinic environment were also important, particularly early in the patient-provider relationship, and if combined with TGNB clinical competence. Discussion: Provider-focused training and education programs should combine components of TGNB clinical and cultural competence to facilitate development of positive relationships between TGNB patients and providers, thereby improving the health and wellbeing of TGNB people.
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Affiliation(s)
- Pablo K. Valente
- Division of Gender, Sexuality, and Health, New York State Psychiatric Institute/Columbia Psychiatry, New York, New York, USA
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, Rhode Island, USA
- Department of Allied Health Sciences, University of Connecticut, Waterbury, Connecticut, USA
| | - Emily Allen Paine
- Division of Gender, Sexuality, and Health, New York State Psychiatric Institute/Columbia Psychiatry, New York, New York, USA
| | - William Mellman
- Division of Gender, Sexuality, and Health, New York State Psychiatric Institute/Columbia Psychiatry, New York, New York, USA
| | - Christine T. Rael
- Division of Gender, Sexuality, and Health, New York State Psychiatric Institute/Columbia Psychiatry, New York, New York, USA
- College of Nursing, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Caitlin MacCrate
- Division of Gender, Sexuality, and Health, New York State Psychiatric Institute/Columbia Psychiatry, New York, New York, USA
| | - Walter O. Bockting
- Division of Gender, Sexuality, and Health, New York State Psychiatric Institute/Columbia Psychiatry, New York, New York, USA
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Yan TD, Mak LE, Carroll EF, Khosa F, Yong-Hing CJ. Gender-Inclusive Fellowship Naming and Equity, Diversity, and Inclusion in Radiology: An Analysis of Radiology Department Websites in Canada and the United States. Can Assoc Radiol J 2022; 73:473-477. [PMID: 35019762 DOI: 10.1177/08465371211066104] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Purpose: Transgender and gender non-binary (TGNB) individuals face numerous inequalities in healthcare and there is substantial work to be done in fostering TGNB culturally competent care in radiology. A radiology department's online presence and use of gender-inclusive language are essential in promoting an environment of equity, diversity, and inclusion (EDI). The naming of radiology fellowships and continuing medical education (CME) courses with terminology such as "Women's Imaging" indicates a lack of inclusivity to TGNB patients and providers, which could result in suboptimal patient care. Methods: We conducted a cross-sectional analysis of all institutions in Canada and the United States (US) offering training in Breast Imaging, Women's Imaging, or Breast and Body Imaging. Data was collected from each institution's radiology department website pertaining to fellowship names, EDI involvement, and CME courses. Results: 8 Canadian and 71 US radiology fellowships were identified. 75% of Canadian and 90% of US fellowships had gender-inclusive names. One (12.5%) Canadian and 29 (41%) US institutions had EDI Committees mentioned on their websites. Among institutions publicly displaying CME courses about breast/body or women's imaging, gender-inclusive names were used in only 1 (25%) of the Canadian CME courses, compared to 81% of the US institutions. Conclusions: Most institutions in Canada and the US have gender-inclusive names for their radiology fellowships pertaining to breast and body imaging. However, there is much opportunity to and arguably the responsibility for institutions in both countries to increase the impact and visibility of their EDI efforts through creation of department-specific committees and CME courses.
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Affiliation(s)
- Tyler D Yan
- Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Lauren E Mak
- Department of Radiology, University of Toronto, Toronto, ON, Canada
| | | | - Faisal Khosa
- Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada.,Department of Radiology, Vancouver General Hospital, Vancouver, BC, Canada
| | - Charlotte J Yong-Hing
- Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada.,Department of Diagnostic Imaging, BC Cancer, Vancouver, BC, Canada
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Wong WG, Curran P, Koetter P, Hoover T, Roden RC, Martin K. Are pediatric surgery clinics LGBTQ+ inclusive? J Pediatr Surg 2022; 57:104-110. [PMID: 34670677 DOI: 10.1016/j.jpedsurg.2021.09.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Accepted: 09/08/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE Creating inclusive LGBTQ+ environments is important in the provision of inclusive care. This cross sectional study assessed whether patient intake forms in pediatric surgery departments were LGBTQ+ inclusive (L-I). METHODS North American pediatric surgery departments affiliated with pediatric surgery fellowships or general surgery residencies were contacted to retrieve patient intake forms. Forms were assessed for LGBTQ+ inclusivity using a novel L-I scoring system consisting of 6 criteria: preferred name, pronouns, preferred language, gender identity, sex assigned at birth, and l-I guardianship. Institutions without intake forms were invited to comment on their use of l-I intake questions. RESULTS 59/125 programs responded to our query, 10 of which provided intake forms. Median l-I score was 2/6 points (range 1-4). l-I guardianship was the most common question asked. No intake form asked for pronouns. Of the 49 institutions without forms, 30.5% reported asking l-I questions during initial visits. Narratives from these institutions varied widely. Some institutions supported routine l-I questions while others stated l-I questions were unnecessary, irrelevant, and/or offensive. CONCLUSIONS Few North American pediatric surgery departments consistently ask l-I questions during the intake process. Comments questioning the appropriateness and necessity of l-I questions highlight the need for LGBTQ+ education. LEVEL OF EVIDENCE Level III. TYPE OF STUDY Cross sectional study.
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Affiliation(s)
- William G Wong
- Department of Pediatric Surgery, PennState Health Milton S. Hershey Medical Center, 500 University Drive, Hershey, PA, USA.
| | - Pierce Curran
- PennState College of Medicine, 500 University Drive, Hershey, PA, USA
| | - Paige Koetter
- PennState College of Medicine, 500 University Drive, Hershey, PA, USA
| | - Travis Hoover
- PennState College of Medicine, 500 University Drive, Hershey, PA, USA
| | - Rosemary Claire Roden
- Division of Adolescent Medicine, Department of Pediatrics, PennState Health Milton S. Hershey Medical Center, 12 Briarcrest Square, Hershey, PA 17033, USA
| | - Kathryn Martin
- Department of Pediatric Surgery, PennState Health Milton S. Hershey Medical Center, 500 University Drive, Hershey, PA, USA
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Sonnenblick EB, Lebron-Zapata L, Yang R, Dodelzon K, Sevilimedu V, Milch H, Dialani V, Dontchos BN, Destounis S, Grimm L. Breast Imaging for Transgender Individuals: Assessment of Current Practice and Needs. J Am Coll Radiol 2021; 19:221-231. [PMID: 34902332 DOI: 10.1016/j.jacr.2021.09.047] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2021] [Revised: 08/16/2021] [Accepted: 09/02/2021] [Indexed: 11/15/2022]
Abstract
PURPOSE The aim of this study was to investigate breast radiologists' practices related to recording sex and gender in the electronic medical record, knowledge and attitudes about breast cancer screening recommendations for transgender individuals, and experience and willingness to enter screening mammography data from transgender patients into databases that document service provision and outcomes of cancer detection protocols. METHODS A 19-question anonymous survey was distributed by e-mail to all active physician members of the Society of Breast Imaging. Response characteristics were assessed as frequencies and percentages and compared between groups using the Fisher exact test or χ2 test. The degree of agreement between questions was assessed using the McNemar test. RESULTS Four hundred one radiologists across the United States and Canada responded (response rate 18%). Recording birth-assigned sex distinct from gender identity was reported by 44 of 352 respondents (13%). Depending on geographic region, 38% to 62% of breast radiologists followed screening guidelines for transgender women, and 226 of 349 (65%) did not provide screening recommendations for transgender men. Of 400, 324 (81%) believed that the evidence base for screening transgender individuals is incomplete, and 247 of 352 (70%) were either unsure of or had no LGBTQ competency training. A majority (247 of 401 [62%]) of respondents reported that they would enroll transgender patients in existing or novel national databases. CONCLUSIONS In the practice of breast imaging, there is a substantial need to record nonbinary gender information. Breast radiologists differ in their practice and knowledge regarding screening of transgender women and men but expressed interest in contributing data to facilitate longitudinal databases needed to inform cancer screening guidelines.
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Affiliation(s)
- Emily B Sonnenblick
- Department of Diagnostic, Molecular and Interventional Radiology, Icahn School of Medicine at Mount Sinai, New York, New York.
| | - Lizza Lebron-Zapata
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Roger Yang
- Department of Radiology, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey
| | - Katerina Dodelzon
- Department of Radiology, Weill Cornell at NewYork-Presbyterian, New York, New York
| | - Varadan Sevilimedu
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Hannah Milch
- Department of Radiology, David Geffen School of Medicine at UCLA, Los Angeles, California
| | - Vandana Dialani
- Department of Radiology, Beth Israel Lahey Health, Boston, Massachusetts
| | - Brian N Dontchos
- Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts; Breast Imaging Division, Sutter Health, Sacramento, California
| | - Stamatia Destounis
- Elizabeth Wende Breast Care, University of Rochester Imaging Services, Rochester, New York
| | - Lars Grimm
- Department of Radiology, Duke University Medical Center, Durham, North Carolina
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13
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Saksena M, Warner ET, Chou SHS, Lamb L, Narayan A, Coopey S, Lehman CD. Imaging Evaluation of the Axilla-A National Survey of Clinical Practice Among Radiologists. JOURNAL OF BREAST IMAGING 2021; 3:676-686. [PMID: 38424938 DOI: 10.1093/jbi/wbab080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Indexed: 03/02/2024]
Abstract
OBJECTIVE To assess awareness and implementation of the American College of Surgeons Oncology Group Z0011 trial findings, approaches to axillary nodal imaging, and to identify differences in practice based on respondent characteristics. METHODS An online survey was distributed to members of the Society of Breast Imaging. Questions regarded demographics, evaluation approaches, and impact of the Z0011 trial. Poisson regression with robust standard errors to regression was used to generate multivariable-adjusted relative risks and 95% confidence intervals (CIs) for associations. RESULTS The response rate was 21.7% (430/2007). The majority (295/430, 68.6%) reported always performing axillary US in patients with a BI-RADS 4B, 4C, or 5 breast mass. Most respondents (299/430, 69.5%) were familiar with the findings of the Z0011 trial. Radiologists in academic practice were 0.67 (95% CI: 0.54-0.83) times less likely than private practice radiologists to perform axillary US in all masses and 1.31 (95% CI: 1.13-1.52) times more likely to be very familiar with the trial. Frequency of axillary US showed no association with time spent in breast imaging, years in practice, or presence of dedicated breast surgeons. Increased time in breast imaging and presence of dedicated breast surgeons was strongly associated with familiarity with the trial. No association was observed with years in practice. Most respondents (291/430, 67.7%) made little or no change to their practice based on trial findings. CONCLUSION There is wide variability in approaches to axillary nodal evaluation, demonstrating a need for improved education and guidelines for axillary imaging in breast cancer patients.
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Affiliation(s)
- Mansi Saksena
- Massachusetts General Hospital, Division of Breast Imaging, Boston, MA, USA
| | - Erica T Warner
- Massachusetts General Hospital and Harvard Medical School, Clinical Translational Epidemiology Unit, Boston, MA, USA
| | - Shinn-Huey S Chou
- Massachusetts General Hospital, Division of Breast Imaging, Boston, MA, USA
| | - Leslie Lamb
- Massachusetts General Hospital, Division of Breast Imaging, Boston, MA, USA
| | - Anand Narayan
- Massachusetts General Hospital, Division of Breast Imaging, Boston, MA, USA
| | - Suzanne Coopey
- Massachusetts General Hospital, Department of Surgery, Boston, MA, USA
| | - Constance D Lehman
- Massachusetts General Hospital, Division of Breast Imaging, Boston, MA, USA
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Perry H, Fang AJ, Tsai EM, Slanetz PJ. Imaging Health and Radiology Care of Transgender Patients: A Call to Build Evidence-Based Best Practices. J Am Coll Radiol 2021; 18:475-480. [PMID: 33663757 DOI: 10.1016/j.jacr.2020.10.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Accepted: 10/10/2020] [Indexed: 12/22/2022]
Abstract
Transgender people have a gender identity that differs from their natal sex and experience many forms of discrimination, including within the health care field. Although transgender patients only comprise 0.6% of the adult US population, they frequently require imaging evaluation. Few published articles provide data-driven research on optimizing education of the radiology care team and delivery of inclusive and respectful imaging care to this vulnerable population; existing data suggest prior areas of success and prior areas of failure. Here, we offer specific recommendations on how radiology care team members can better serve transgender patients and begin generating much needed evidence-based best practices to improve their imaging health and care.
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Affiliation(s)
- Hannah Perry
- Co-Division Chief/Medical Director of Breast Imaging, University of Vermont Medical Center, Larner College of Medicine, University of Vermont, Burlington, Vermont.
| | - Adam J Fang
- Division Director of Breast Imaging, Allegheny Health Network, Pittsburgh, Pennsylvania
| | - Erin M Tsai
- President, Vermont Radiological Society, University of Vermont Medical Center, Larner College of Medicine at the University of Vermont, Burlington, Vermont
| | - Priscilla J Slanetz
- Vice Chair of Academic Affairs and Associate Program Director, Diagnostic Radiology Residency, Department of Radiology, Boston University Medical Center, Boston, Massachusetts
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15
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Lau F, Antonio M, Davison K, Queen R, Devor A. A rapid review of gender, sex, and sexual orientation documentation in electronic health records. J Am Med Inform Assoc 2021; 27:1774-1783. [PMID: 32935124 PMCID: PMC7671624 DOI: 10.1093/jamia/ocaa158] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Revised: 06/19/2020] [Accepted: 07/22/2020] [Indexed: 12/27/2022] Open
Abstract
Objective The lack of precise and inclusive gender, sex, and sexual orientation (GSSO) data in electronic health records (EHRs) is perpetuating inequities of sexual and gender minorities (SGM). We conducted a rapid review on how GSSO documentation in EHRs should be modernized to improve the health of SGM. Materials and Methods We searched MEDLINE from 2015 to 2020 with terms for gender, sex, sexual orientation, and electronic health/medical records. Only literature reviews, primary studies, and commentaries from peer-reviewed journals in English were included. Two researchers screened citations and reviewed articles with help from a third to reach consensus. Covidence, Excel, and Atlas-TI were used to track articles, extract data, and synthesize findings, respectively. Results Thirty-five articles were included. The 5 themes to modernize GSSO documentation in EHRs were (1) creating an inclusive, culturally competent environment with precise terminology and standardized data collection; (2) refining guidelines for identifying and matching SGM patients with their care needs; (3) improving patient-provider relationships by addressing patient rights and provider competencies; (4) recognizing techno-socio-organizational aspects when implementing GSSO in EHRs; and (5) addressing invisibility of SGM by expanding GSSO research. Conclusions The literature on GSSO documentation in EHRs is expanding. While this trend is encouraging, there are still knowledge gaps and practical challenges to enabling meaningful changes, such as organizational commitments to ensure affirming environments, and coordinated efforts to address technical, organizational, and social aspects of modernizing GSSO documentation. The adoption of an inclusive EHR to meet SGM needs is a journey that will evolve over time.
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Affiliation(s)
- Francis Lau
- School of Health Information Science, University of Victoria, Victoria, Canada
| | - Marcy Antonio
- School of Health Information Science, University of Victoria, Victoria, Canada
| | - Kelly Davison
- School of Health Information Science, University of Victoria, Victoria, Canada
| | - Roz Queen
- School of Health Information Science, University of Victoria, Victoria, Canada
| | - Aaron Devor
- Department of Sociology, University of Victoria, Victoria, Canada
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16
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Stowell JT, Zavaletta VA, Carroll EF, Grimstad FW. Multidisciplinary approach to imaging for gender-affirming surgery: engaging surgeons, radiologists, and patients to ensure a positive imaging experience. ANNALS OF TRANSLATIONAL MEDICINE 2021; 9:610. [PMID: 33987308 DOI: 10.21037/atm-20-6431] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Medical imaging plays an integral role in the preoperative evaluation and postoperative management of transgender and gender diverse (TGD) patients who pursue gender-affirming surgery. Radiology department encounters can be a source of anxiety for patients of any demographic, including TGD patients. Although most imaging modalities are considered "non-invasive", certain imaging procedures and other aspects of the radiology encounter could be considered quite invasive to the TGD patient. The TGD patient may be worried that the imaging examination will have to address anatomy that they feel does not align with their gender identity, or reveal some abnormality or disheartening complication of their surgery. Simultaneously, the patient must also navigate potentially uncomfortable interactions with other patients in department waiting rooms, restrooms, and changing facilities as well as with radiology staff. As the referral source to imaging facilities, providers should advocate on behalf of their TGD patients. Referring providers should work with imaging facilities to ensure their patients will receive inclusive and affirming care and not be subject to discomfort on the part of gender identity or expression. Proactive and regular communication among radiology facilities, patients, and referring providers will ensure appropriate and sensitive care for this vulnerable population. A positive imaging experience can improve patient outcomes and the relationship between healthcare providers and the TGD community they serve.
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Affiliation(s)
- Justin T Stowell
- Department of Radiology, Mayo Clinic in Florida, Jacksonville, FL, USA
| | - Vaz A Zavaletta
- Department of Radiology, Division of Interventional Radiology, Emory University School of Medicine, Atlanta, GA, USA
| | | | - Frances W Grimstad
- Division of Pediatric and Adolescent Gynecology, Department of Surgery, Boston Children's Hospital, Boston, MA, USA.,Department of Obstetrics, Gynecology and Reproductive Biology, Harvard Medical School, Boston, MA, USA
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17
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Dodelzon K, Grimm LJ, Tran K, Dontchos BN, Destounis S, Dialani V, Dogan B, Sonnenblick E, Zuley M, Milch HS. Impact of COVID-19 on Breast Imaging Practice Operations and Recovery Efforts: A North American Study. JOURNAL OF BREAST IMAGING 2021; 3:156-167. [PMID: 38424821 PMCID: PMC7928933 DOI: 10.1093/jbi/wbab002] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Indexed: 11/12/2022]
Abstract
OBJECTIVE To assess the impact of the COVID-19 pandemic on breast imaging facilities' operations and recovery efforts across North America. METHODS A survey on breast imaging facilities' operations and strategies for recovery during the COVID-19 pandemic was distributed to the membership of the Society of Breast Imaging and National Consortium of Breast Centers from June 4, 2020, to July 14, 2020. A descriptive summary of responses was performed. Comparisons were made between demographic variables of respondents and questions of interest using a Pearson chi-square test. RESULTS There were 473 survey respondents (response rate of 13%). The majority of respondents (70%; 332/473) reported 80%-100% breast imaging volume reduction, with 94% (447/473) reporting postponement of screening mammography. The majority of respondents (97%; 457/473) continued to perform biopsies. There were regional differences in safety measures taken for staff (P = 0.004), with practices in the West more likely reporting no changes in the work environment compared to other regions. The most common changes to patients' experience included spacing out of furniture in waiting rooms (94%; 445/473), limiting visitors (91%; 430/473), and spacing out appointments (83%). A significantly higher proportion of practices in the Northeast (95%; 104/109) initiated patient scheduling changes compared to other regions (P = 0.004). CONCLUSION COVID-19 had an acute impact on breast imaging facilities. Although common national operational patterns emerged, geographic variability was notable in particular in recovery efforts. These findings may inform future best practices for delivering breast imaging care amid the ongoing and geographically shifting COVID-19 pandemic.
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Affiliation(s)
- Katerina Dodelzon
- Weill Cornell at NewYork-Presbyterian, Department of Radiology, New York, NYUSA
| | - Lars J Grimm
- Duke University Medical Center, Department of Radiology, Durham, NC, USA
| | - Khai Tran
- SutterHealth, Breast Imaging Division, Sacramento, CA, USA
| | - Brian N Dontchos
- Massachusetts General Hospital, Department of Radiology, Boston, MA, USA
| | - Stamatia Destounis
- Elizabeth Wende Breast Care, Department of Radiology, Rochester, NY, USA
| | - Vandana Dialani
- Beth Israel Lahey Health, Department of Radiology, Boston, MA, USA
| | - Basak Dogan
- The University of Texas Southwestern Medical Center, Department of Radiology, Dallas, TX, USA
| | - Emily Sonnenblick
- Icahn School of Medicine at Mount Sinai, Department of Radiology, New York, NY, USA
| | - Margarita Zuley
- University of Pittsburgh, Department of Radiology, Pittsburgh, PA, USA
| | - Hannah S Milch
- David Geffen School of Medicine at UCLA, Department of Radiology, Los Angeles, CA, USA
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18
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19
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Survey of Experiences of Transgender and Gender Nonbinary Patients During Imaging Encounters and Opportunities for Improvement. AJR Am J Roentgenol 2020; 215:1136-1142. [DOI: 10.2214/ajr.19.22558] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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20
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21
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Huang SY, Zhang M, David M. Radiology's Engagement with Transgender Breast Imaging: Review of Radiology Practice Websites and Publications. JOURNAL OF BREAST IMAGING 2020; 2:147-151. [PMID: 38424886 DOI: 10.1093/jbi/wbz081] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2019] [Indexed: 03/02/2024]
Abstract
To assess engagement with transgender breast health among radiology investigators and providers, we analyzed: (1) trends in medical research regarding transgender breast health, and (2) breast imaging practices' websites, for inclusion of the word transgender and mention of services specifically for transgender patients. We viewed the analyses of both research articles and general websites as two real-world measures of engagement among the professional community, in contrast to surveys whose responses rely on the compliance of recipients. A PubMed search performed for the text words transgender breast cancer, Lesbian-Gay-Bisexual-Transgender (LGBT) breast cancer, and transgender breast imaging. Our search yielded 48 unique relevant publications from 2010-2019. While research publications regarding transgender breast health have been become more numerous since 2015, it is still a relatively small field of study. Websites were analyzed for mention of transgender breast health needs and were reviewed for gender-neutral language and design. Of the 20 breast imaging centers listed as top choices by a national consumer group in 2019, none of their websites included the term transgender. Likewise, of the 21 centers in New York City and in San Francisco listed using the Google search engine, none included the term transgender. Despite its growing importance, issues related to transgender breast imaging are not well addressed in the radiology literature or in the radiology community, even though more transgender patients are presenting to breast centers for imaging. Radiologists need to be aware of imaging recommendations for these patients and display sensitivity to specific patient concerns.
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Affiliation(s)
- Siu-Yuan Huang
- New York Medical College, Department of Radiology, Valhalla, NY
| | - Meng Zhang
- Albert Einstein College of Medicine, Department of Radiology, Bronx, NY
| | - Miriam David
- New York Medical College, Department of Radiology, Valhalla, NY
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22
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Lee AY, Plecha D, Woodard GA, Price ER, Hayward JH, Mark S, Joe BN. Utilization of Patient Navigators in Breast Imaging Facilities Across the United States: A Survey of Breast Imaging Radiologists. JOURNAL OF BREAST IMAGING 2020; 2:16-21. [PMID: 38424997 DOI: 10.1093/jbi/wbz078] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Accepted: 10/29/2019] [Indexed: 03/02/2024]
Abstract
OBJECTIVE To assess the utilization of patient navigators at breast imaging facilities across the United States. METHODS An online survey was distributed to physician members of the Society of Breast Imaging. Questions encompassed use of patient navigators in breast imaging including: presence and qualifications, roles in patient care, perceived benefits, and barriers. Data were analyzed to identify the overall prevalence of patient navigators, their responsibilities and qualifications, and the impact on breast imaging centers. RESULTS Three-hundred and eighty-five board-certified radiologists practicing in the United States completed the survey. The most common practice types were private practice (52%; 201/385) and academic (29%; 110/385). The majority (67%; 256/385) employed navigators, and the most common qualification was a registered nurse (78%; 200/256). Navigators were used for a variety of patient communication and care coordination roles, most commonly to provide educational resources (86%; 219/256), assist patients with scheduling appointments (80%; 205/256), explain the biopsy process (76%;195/256), and communicate biopsy results (64%). Nearly all (99%; 254/256) respondents ranked patient navigators as valuable to extremely valuable in improving patient care and indicated they would recommend implementation of a patient navigation program to other breast imaging practices. The most common barrier to employing a navigator was the financial cost. CONCLUSION Patient navigators have been widely adopted in breast imaging practices across the United States, with two-thirds of respondents reporting use of a navigator. Although navigator roles varied by practice, nearly all radiologists utilizing patient navigators found that they positively impact patient care and would recommend them to other breast imaging practices.
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Affiliation(s)
- Amie Y Lee
- University of California San Francisco, Department of Radiology and Biomedical Imaging, San Francisco, CA
| | - Donna Plecha
- University Hospitals: Cleveland Medical Center, Department of Radiology, Cleveland, OH
| | | | - Elissa R Price
- University of California San Francisco, Department of Radiology and Biomedical Imaging, San Francisco, CA
| | - Jessica H Hayward
- University of California San Francisco, Department of Radiology and Biomedical Imaging, San Francisco, CA
| | - Sueanne Mark
- University of California San Francisco, Department of Radiology and Biomedical Imaging, San Francisco, CA
| | - Bonnie N Joe
- University of California San Francisco, Department of Radiology and Biomedical Imaging, San Francisco, CA
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23
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Parikh U, Mausner E, Chhor CM, Gao Y, Karrington I, Heller SL. Breast Imaging in Transgender Patients: What the Radiologist Should Know. Radiographics 2020; 40:13-27. [DOI: 10.1148/rg.2020190044] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Affiliation(s)
- Ujas Parikh
- From the Department of Radiology, New York University School of Medicine, 160 E 34th St, New York, NY 10016
| | - Elizabeth Mausner
- From the Department of Radiology, New York University School of Medicine, 160 E 34th St, New York, NY 10016
| | - Chloe M. Chhor
- From the Department of Radiology, New York University School of Medicine, 160 E 34th St, New York, NY 10016
| | - Yiming Gao
- From the Department of Radiology, New York University School of Medicine, 160 E 34th St, New York, NY 10016
| | - Ian Karrington
- From the Department of Radiology, New York University School of Medicine, 160 E 34th St, New York, NY 10016
| | - Samantha L. Heller
- From the Department of Radiology, New York University School of Medicine, 160 E 34th St, New York, NY 10016
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24
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Abstract
It is important for the practicing primary care provider to become familiar with the unique health care needs for people who identify as transgender men, transgender women, and non-binary people, who are all within the scope of practice of a general obstetrician-gynecologist and other primary care providers. A review of the unique health needs and essential terminology is presented. This knowledge is a basic foundation to develop a welcoming and inclusive practice for people who are gender nonconforming. This fund of knowledge is essential the practicing primary care providers and support staff.
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25
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Stowell JT, Grimstad FW, Kirkpatrick DL, Brown LR, Flores EJ. Serving the Needs of Transgender and Gender-Diverse Persons in Radiology. J Am Coll Radiol 2019; 16:533-535. [DOI: 10.1016/j.jacr.2018.12.050] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2018] [Revised: 12/22/2018] [Accepted: 12/26/2018] [Indexed: 12/01/2022]
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