1
|
Mediå LM, Fauske L, Sigurdardottir S, Billaud Feragen KJ, Waehre A. Differences of sex development and surgical decisions: focus group interviews with health care professionals in Norway. Health Psychol Behav Med 2024; 12:2371134. [PMID: 38979393 PMCID: PMC11229732 DOI: 10.1080/21642850.2024.2371134] [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: 11/30/2023] [Accepted: 06/12/2024] [Indexed: 07/10/2024] Open
Abstract
Background Differences of Sex Development (DSD) are congenital conditions where the chromosomal, gonadal and anatomical sex characteristics do not strictly belong to male or female categories, or that belong to both at the same time. Surgical interventions for individuals with DSD remain controversial, among affected individuals, caregivers, and health-care providers. A lack of evidence in support of, for deferring, or for avoiding surgery complicates the decision-making process. This study explores Norwegian health-care professionals' (HCPs) perspectives on decision-making in DSD-related surgeries and the dilemmas they are facing in this process. Methods Focus group interviews with 14 HCPs integrated into or collaborating with multidisciplinary DSD teams were analyzed using reflexive thematic analysis. Results Two overarching dilemmas shed light on the intricate considerations and challenges that HCPs encounter when guiding affected individuals and caregivers through surgical decision-making processes in the context of DSD. The first theme describes how shared decision-making was found to be influenced by fear of stigma and balancing the interplay between concepts of normality, personal experiences and external expectations when navigating the child's and caregivers' needs. The second theme illuminated dilemmas due to a lack of evidence-based practice. The core concepts within each theme were the dilemmas health-care professionals face during consultations with caregivers and affected individuals. Conclusion HCPs were aware of the controversies with DSD-related surgeries. However, they struggled to reconcile knowledge with parents' wishes for surgery and faced dilemmas making decisions in the best interests of the child. This study draws attention to the benefits of increased knowledge on the consequences of performing or withholding surgery as well as incorporating tools enabling shared decision-making between HCPs and affected individuals/caregivers.
Collapse
Affiliation(s)
- Line Merete Mediå
- Women’s and Children’s Division, Centre for Rare Disorders, Oslo University Hospital, Oslo, Norway
- Department of Interdisciplinary Health Sciences, Institute of Health and Society, University of Oslo, Oslo, Norway
| | - Lena Fauske
- Department of Interdisciplinary Health Sciences, Institute of Health and Society, University of Oslo, Oslo, Norway
- Department of Oncology, Norwegian Radium Hospital, Oslo University Hospital, Oslo, Norway
| | - Solrun Sigurdardottir
- Women’s and Children’s Division, Centre for Rare Disorders, Oslo University Hospital, Oslo, Norway
| | | | - Anne Waehre
- Department of Child and Adolescent Psychiatry, Oslo University Hospital and Institute of Clinical Medicine, Oslo, Norway
| |
Collapse
|
2
|
Traino KA, Ciciolla LM, Perez MN, Chaney JM, Welch G, Baskin LS, Buchanan CL, Chan YM, Cheng EY, Coplen DE, Wisniewski AB, Mullins LL. Trajectories of illness uncertainty among parents of children with atypical genital appearance due to differences of sex development. J Pediatr Psychol 2024:jsae043. [PMID: 38857449 DOI: 10.1093/jpepsy/jsae043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2023] [Revised: 04/14/2024] [Accepted: 05/25/2024] [Indexed: 06/12/2024] Open
Abstract
OBJECTIVE The present study aimed to identify distinct trajectories of parental illness uncertainty among parents of children born with atypical genital appearance due to a difference of sex development over the first year following diagnosis. It was hypothesized that four trajectory classes would emerge, including "low stable," "high stable," "decreasing," and "increasing" classes, and that select demographic, familial, and medical factors would predict these classes. METHODS Participants included 56 mothers and 43 fathers of 57 children born with moderate to severe genital atypia. Participants were recruited from eleven specialty clinics across the U.S. Growth mixture modeling (GMM) approaches, controlling for parent dyad clustering, were conducted to examine classes of parental illness uncertainty ratings over time. RESULTS A three-class GMM was identified as the best-fitting model. The three classes were interpreted as "moderate stable" (56.8%), "low stable" (33.0%), and "declining" (10.3%). Findings suggest possible diagnostic differences across trajectories. CONCLUSIONS Findings highlight the nature of parents' perceptions of ambiguity and uncertainty about their child's diagnosis and treatment the year following their child's birth/diagnosis. Future research is needed to better understand how these trajectories might shift over the course of the child's development. Results support the development of tailored, evidence-based interventions to address coping with uncertainty among families raising a child with chronic health needs.
Collapse
Affiliation(s)
- Katherine A Traino
- Department of Psychology, Center for Pediatric Psychology, Oklahoma State University, Stillwater, OK, United States
| | - Lucia M Ciciolla
- Department of Psychology, Center for Pediatric Psychology, Oklahoma State University, Stillwater, OK, United States
| | - Megan N Perez
- Division of Oncology, The Children's Hospital of Philadelphia, Philadelphia, PA, United States
| | - John M Chaney
- Department of Psychology, Center for Pediatric Psychology, Oklahoma State University, Stillwater, OK, United States
| | - Ginger Welch
- Department of Human Development and Family Sciences, Oklahoma State University, Stillwater, OK, United States
| | - Laurence S Baskin
- Department of Urology, University of California San Francisco Medical Center, San Francisco, CA, United States
| | - Cindy L Buchanan
- Department of Psychiatry, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | - Yee-Ming Chan
- Division of Endocrinology, and Harvard Medical School, Boston Children's Hospital, Boston, MA, United States
| | - Earl Y Cheng
- Department of Urology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, United States
| | - Douglas E Coplen
- Division of Urologic Surgery, St. Louis Children's Hospital, St Louis, MO, United States
| | - Amy B Wisniewski
- Department of Psychology, Center for Pediatric Psychology, Oklahoma State University, Stillwater, OK, United States
| | - Larry L Mullins
- Department of Psychology, Center for Pediatric Psychology, Oklahoma State University, Stillwater, OK, United States
| |
Collapse
|
3
|
Alderson J, Thornton M, Skae M, Jones J, Nicoll N, Harcourt D, Woodward M, Crowne EC. Parental concerns about genital differences in children with congenital adrenal hyperplasia persist regardless of the selected intervention. J Sex Med 2024; 21:361-366. [PMID: 38481013 DOI: 10.1093/jsxmed/qdae024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Revised: 01/20/2024] [Accepted: 02/04/2024] [Indexed: 05/03/2024]
Abstract
BACKGROUND Congenital Adrenal Hyperplasia (CAH) due to 21-hydroxylase deficiency (21HD) can affect the in utero development of the genital anatomy of people with the 46XX karyotype. Health professionals engage parents in decision-making regarding managing genitals with this difference, including genital surgery options and patient communication. AIM We sought to investigate parental communication with their daughters regarding clitoral size variation related to neonatal CAH. METHODS Semistructured in-person interviews of 24 parents of chromosomal XX children with clitoral size variation attributable to a neonatal CAH diagnosis comprised 3 management categories: (1) clitoral reduction surgery (RS) (7 parents, 9 children), (2) clitoral concealment surgery (CS) (8 parents, 8 children), and no surgery on or around the clitoris (NS) (9 parents, 7 children). OUTCOMES Four representative themes, Obvious Choice, Still Different, Parental Burden, and Ignorance Is Bliss, were common across all 3 treatment groups. RESULTS For most parents, none of the 3 options of genital appearance alteration via clitoral reduction, clitoral concealment surgery, or avoidance of clitoral surgery ameliorated concerns, with most parents expressing an aversion to educating their child on the topic of genital differences, past treatment, or future function. CLINICAL IMPLICATIONS Reliance on surgical treatment pathways to manage this psychosocial concern is ineffective in alleviating parental uncertainty without the application of psychosocial interventions. STRENGTHS AND LIMITATIONS This was a qualitative study but was limited to parents of children with a specific genital difference, without direct exploration of parental values regarding the clitoris or the application of adequate psychosocial care. CONCLUSION Healthcare services must have an impact on parental ability to engage in essential communication with their children in cases such as clitoral size variation related to neonatal CAH. Improved communication skills allow parents to engage in more genuine decision-making and adapt to enduring genital reality, including possible future sexual challenges for their adult child, without resorting to burdensome strategies focused on attempts to perpetuate a benevolent ignorance.
Collapse
Affiliation(s)
- Julie Alderson
- University Hospitals Bristol and Weston NHS Foundation Trust, Bristol BS1 3NU, United Kingdom
| | - Maia Thornton
- University of the West of England, Stoke Gifford, Bristol BS16 1QY, United Kingdom
| | - Mars Skae
- Manchester University NHS Foundation Trust, Cobbett House Manchester Royal Infirmary, Manchester M13 9WL, United Kingdom
| | - Julie Jones
- Manchester University NHS Foundation Trust, Cobbett House Manchester Royal Infirmary, Manchester M13 9WL, United Kingdom
| | - Nicky Nicoll
- University Hospitals Bristol and Weston NHS Foundation Trust, Bristol BS1 3NU, United Kingdom
| | - Diana Harcourt
- University of the West of England, Stoke Gifford, Bristol BS16 1QY, United Kingdom
| | - Mark Woodward
- University Hospitals Bristol and Weston NHS Foundation Trust, Bristol BS1 3NU, United Kingdom
| | - Elizabeth C Crowne
- University Hospitals Bristol and Weston NHS Foundation Trust, Bristol BS1 3NU, United Kingdom
| |
Collapse
|
4
|
Baig A. Supporting parents of children born with differences in sex development. Arch Dis Child 2024; 109:438-443. [PMID: 38123911 DOI: 10.1136/archdischild-2023-326299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2023] [Accepted: 12/07/2023] [Indexed: 12/23/2023]
Affiliation(s)
- Anya Baig
- Royal Free London NHS Foundation Trust, London, UK
| |
Collapse
|
5
|
Aekka A, Weisman AG, Papadakis J, Yerkes E, Baker J, Keswani M, Weinstein J, Finlayson C. Clinical utility of early rapid genome sequencing in the evaluation of patients with differences of sex development. Am J Med Genet A 2024; 194:351-357. [PMID: 37789729 DOI: 10.1002/ajmg.a.63377] [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: 06/15/2023] [Revised: 08/08/2023] [Accepted: 08/09/2023] [Indexed: 10/05/2023]
Abstract
Establishing an early and accurate genetic diagnosis among patients with differences of sex development (DSD) is crucial in guiding the complex medical and psychosocial care they require. Genetic testing routinely utilized in clinical practice for this population is predicated upon physical exam findings and biochemical and endocrine profiling. This approach, however, is inefficient and unstandardized. Many patients with DSD, particularly those with 46,XY DSD, never receive a molecular genetic diagnosis. Rapid genome sequencing (rGS) is gaining momentum as a first-tier diagnostic instrument in the evaluation of patients with DSD given its ability to provide greater diagnostic yield and timely results. We present the case of a patient with nonbinary genitalia and systemic findings for whom rGS identified a novel variant of the WT1 gene and resulted in a molecular diagnosis within two weeks of life. This timeframe of diagnosis for syndromic DSD is largely unprecedented at our institution. Rapid GS expedited mobilization of a multidisciplinary medical team; enabled early understanding of clinical trajectory; informed planning of medical and surgical interventions; and guided individualized psychosocial support provided to the family. This case highlights the potential of early rGS in transforming the evaluation and care of patients with DSD.
Collapse
Affiliation(s)
- Apoorva Aekka
- Division of Endocrinology, Ann and Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Allison Goetsch Weisman
- Division of Genetics, Genomics, and Metabolism, Ann and Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Jaclyn Papadakis
- Department of Psychiatry and Behavioral Health, Ann and Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Elizabeth Yerkes
- Division of Urology, Ann and Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Joshua Baker
- Division of Genetics, Genomics, and Metabolism, Ann and Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Mahima Keswani
- Division of Nephrology, Ann and Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Joanna Weinstein
- Division of Hematology, Oncology, Neuro-Oncology and Stem Cell Transplantation, Ann and Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Courtney Finlayson
- Division of Endocrinology, Ann and Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| |
Collapse
|
6
|
Suorsa-Johnson K, Delaney RK, Fagerlin A, Sandberg DE. Editorial: Shared Decision Making in Pediatric Differences/Disorders of Sex Development. FRONTIERS IN UROLOGY 2023; 3:1281181. [PMID: 37885905 PMCID: PMC10601991 DOI: 10.3389/fruro.2023.1281181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/28/2023]
Affiliation(s)
- Kristina Suorsa-Johnson
- Division of Psychiatry and Behavioral Health, Department of Pediatrics, University of Utah Spencer Fox Eccles School of Medicine, Salt Lake City, Utah, USA
| | - Rebecca K. Delaney
- Department of Population Health Sciences, University of Utah Spencer Fox Eccles School of Medicine, Salt Lake City, USA
| | - Angela Fagerlin
- Department of Population Health Sciences, University of Utah Spencer Fox Eccles School of Medicine, Salt Lake City, USA
- Veterans Administration Health Services Research and Development Informatics, Decision-Enhancement and Analytic Sciences Center, Veterans Administration Salt Lake City Health Care System, Salt Lake City, Utah, USA
| | - David E. Sandberg
- Susan B. Meister Child Health Evaluation & Research (CHEAR) Center, University of Michigan, Ann Arbor, USA
- Division of Pediatric Psychology, Department of Pediatrics, University of Michigan Medical School, Ann Arbor, Michigan, USA
| |
Collapse
|
7
|
Moyer DN, Suorsa-Johnson KI, Weidler EM, Ernst MM. Information sharing in differences of sex development: The creation of a caregiver-support tool. FAMILIES, SYSTEMS & HEALTH : THE JOURNAL OF COLLABORATIVE FAMILY HEALTHCARE 2023; 41:256-264. [PMID: 36066861 PMCID: PMC9985666 DOI: 10.1037/fsh0000724] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
INTRODUCTION Social support can be a protective factor against the negative mental health outcomes experienced by some parents and caregivers of children with differences of sex development (DSD). However, established social support networks can be difficult to access due to caregiver hesitancy to share information with others about their child's diagnosis. Health care providers in the field of DSD, and particularly behavioral health providers, are well positioned to help caregivers share information with the important people in their lives in order to access needed social support. This article summarizes the development of a clinical tool to help clinicians facilitate discussions regarding information sharing with caregivers of children with DSD. METHOD Members of the psychosocial workgroup for the DSD -Translational Research Network completed a survey about their experiences facilitating information sharing discussions with caregivers of children with DSD and other health populations. The results of this survey were used to develop a clinical tool using ongoing iterative feedback from workgroup members, based on principles of user-centered design and quality improvement. RESULTS Workgroup members consider information sharing an important aspect of working with caregivers of children with DSD. Additional resources and tools were identified as potentially helpful to these discussions. DISCUSSION The DSD Sharing Health Information Powerfully-Team Version (SHIP-T) is a resource tool for DSD health care team members to utilize in hospital and ambulatory settings to help caregivers of children with DSD share information with their social support networks. The final SHIP-T is included in this article. (PsycInfo Database Record (c) 2023 APA, all rights reserved).
Collapse
Affiliation(s)
| | | | - Erica M. Weidler
- Division of Pediatric Surgery, Phoenix Children’s Hospital
- Accord Alliance, USA
| | - Michelle M. Ernst
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children’s Hospital Medical Center
| | | |
Collapse
|
8
|
Gardner M, Brinkman WB, Carley M, Liang N, Lightfoot S, Pinkelman K, Speiser PW, Schafer-Kalkhoff T, Suorsa-Johnson KI, VanderBrink B, Weidler EM, Wisniewski J, Stacey D, Sandberg DE. Decisional Support Needed when Facing Tough Decisions: Survey of Parents with Children having Differences of Sex Development. FRONTIERS IN UROLOGY 2023; 3:1089077. [PMID: 37920725 PMCID: PMC10621652 DOI: 10.3389/fruro.2023.1089077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2023]
Abstract
Introduction Parents of infants and young children newly diagnosed with differences of sex development (DSD) commonly face medical and psychosocial management decisions at a time when they are first learning about the condition and cannot consult their child for input. The aim of this study was to identify areas of greatest need for parental decisional support. Methods 34 parents of children receiving care for DSD at one of three US children's hospitals participated in a survey to learn what clinical and psychosocial decisions needed to be made on behalf of their child. Parents were then asked to identify and focus on a "tough" decision and respond to questions assessing factors affecting decision-making, decision-making preferences, decisional conflict, and decision regret. Descriptive analyses were conducted. Results Decisions about surgery and aspects of sharing information about their child's condition with others were the two most frequently reported decisions overall, experienced by 97% and 88% of parents, as well as most frequently nominated as tough decisions. Many parents reported mild to moderate levels of decisional conflict (59%) and decision regret (74%). Almost all parents (94%) reported experiencing at least one factor as interfering with decision-making (e.g., "worried too much about choosing the 'wrong' option"). Parents universally reported a desire to be involved in decision-making - preferably making the final decision primarily on their own (79%), or together with their child's healthcare providers (21%). The majority of parents judged healthcare providers (82%) and patient/family organizations (58%) as trustworthy sources of information. Discussion Parents of children with DSD encounter medical, surgical, and psychosocial management decisions. Despite difficulties including emotional distress and informational concerns (including gaps and overload), parents express strong desires to play key roles in decision-making on behalf of their children. Healthcare providers can help identify family-specific needs through observation and inquiry in the clinical context. Together with families, providers should focus on specific clinical management decisions and support parental involvement in making decisions on behalf of young children with DSD.
Collapse
Affiliation(s)
- Melissa Gardner
- Susan B. Meister Child Health Evaluation and Research Center, Department of Pediatrics, University of Michigan Medical School, Ann Arbor, MI, USA
| | - William B. Brinkman
- Division of General and Community Pediatrics, Cincinnati Children’s Hospital Medical Center, Cincinnati, USA
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, USA
| | - Meg Carley
- Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Noi Liang
- Patient / parent / caregiver stakeholder partners, Denver, CO, USA
| | | | - Kendra Pinkelman
- Patient / parent / caregiver stakeholder partners, Ann Arbor, MI, USA
| | - Phyllis W. Speiser
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, USA
- Feinstein Institute for Medical Research, Manhasset, New York, USA
| | | | | | - Brian VanderBrink
- Division of Urology, Cincinnati Children’s Hospital Medical Center, Cincinnati, USA
| | - Erica M. Weidler
- Division of Pediatric Surgery, Phoenix Children’s Hospital, Phoenix, AZ
- Accord Alliance, USA
| | | | - Dawn Stacey
- Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- School of Nursing, University of Ottawa, Ottawa, ON, Canada
| | - David E. Sandberg
- Susan B. Meister Child Health Evaluation and Research Center, Department of Pediatrics, University of Michigan Medical School, Ann Arbor, MI, USA
- Accord Alliance, USA
- Division of Pediatric Psychology, Department of Pediatrics, University of Michigan Medical School, Ann Arbor, MI, USA
| |
Collapse
|
9
|
The Association between Surgeon Dissatisfaction with Infant Genital Appearance and Surgical Decision-Making Surrounding Clitoroplasty. J Pediatr Adolesc Gynecol 2023; 36:3-4. [PMID: 36336140 DOI: 10.1016/j.jpag.2022.10.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Accepted: 10/24/2022] [Indexed: 11/05/2022]
|
10
|
Hanna CA, Cummins A, Fox D. Babies born with ambiguous genitalia: Developing an educational resource for Australian midwives. Women Birth 2023; 36:e142-e149. [PMID: 35697608 DOI: 10.1016/j.wombi.2022.05.007] [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: 03/12/2022] [Revised: 05/02/2022] [Accepted: 05/30/2022] [Indexed: 01/25/2023]
Abstract
PROBLEM AND BACKGROUND The birth of a baby with ambiguous genitalia is rare and usually unexpected. Parents often receive inconsistent language from health-professionals after the birth. Initial interaction with the birth team has long-term consequences for families with babies born with ambiguous genitalia. AIM Understand the current practices on the day of birth and explore knowledge gaps for midwives regarding babies born with ambiguous genitalia. Develop educational content that can enable midwives to respond appropriately when the sex of a baby is unclear. METHODS This study included two phases, utilising qualitative descriptive research design with semi-structured interviews to understand the experiences of midwives caring for babies with ambiguous genitalia and their families. The findings informed the development a midwifery educational resource using these qualitative findings. FINDINGS Our analysis of 14 interviews with Australian midwives identified that they had no formal education to support families with a baby with ambiguous genitalia. Emotional support, advocacy and medical information translation were areas midwives perceived as essential skills to support these families. DISCUSSION Midwives provide a unique role in parental birth experiences. Themes that arose emphasised their psychosocial support role but lacked formal education and guidance on this topic. Midwives had learnt from the media about babies born with ambiguous genitalia and wanted evidence-based education to support parents. Midwife education focusing on both psychosocial and clinical care for parents and their baby with ambiguous genitalia is crucial. CONCLUSION Midwives can play a pivotal role in supporting parents with a baby with ambiguous genitalia. Themes from this qualitative study informed the development of a midwifery education digital resource.
Collapse
Affiliation(s)
- Chloe A Hanna
- Department of Gynaecology, Royal Children's Hospital, Melbourne, Australia; Reproductive Development Laboratory, Murdoch Children's Research Institute Melbourne, Australia; Department of Paediatrics, University of Melbourne, Australia.
| | - Allison Cummins
- Department of Midwifery, School of Nursing and Midwifery, College of Medicine, Health and Wellbeing, University of Newcastle, Australia
| | - Deborah Fox
- Centre for Midwifery, Child and Family Health, University of Technology Sydney, Australia
| |
Collapse
|
11
|
Alderson J, Skae M, Crowne EC. Why do parents recommend clitoral surgery? Parental perception of the necessity, benefit, and cost of early childhood clitoral surgery for congenital adrenal hyperplasia (CAH). Int J Impot Res 2023; 35:56-60. [PMID: 35672389 DOI: 10.1038/s41443-022-00578-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Revised: 04/21/2022] [Accepted: 04/27/2022] [Indexed: 11/09/2022]
Abstract
Historically, medical management of Congenital Adrenal Hyperplasia (CAH) in girls typically involved feminising surgery, which meant reducing the size and/or visibility of the enlarged clitoris. This practice may have become less routine but remains a common response to genital differences associated with CAH. Parents typically give permission for the child to undergo surgery in early childhood and recommend other parents facing a similar situation do the same. The current report is based on a qualitative content analysis of interviews with sixteen parents whose daughters with CAH had undergone one of two forms of clitoral surgery. We observed that: (i) some parents were initially unconcerned about their child's genital presentation; (ii) in general, clitoral surgery was considered as a readily available and natural response to the child's bodily difference; (iii) the parents acknowledged that there would be some risk but anticipated various benefits; and (iv) there was an absence of ethical considerations when the parents evaluated the various effects of surgery afterwards. We conclude from our analysis that parents of girls with CAH may not receive psychologically and ethically informed counselling to encourage critical reflections prior to authorizing genital surgery.
Collapse
Affiliation(s)
- Julie Alderson
- University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK.
| | - Mars Skae
- Manchester University NHS Foundation Trust, Manchester, UK
| | - Elizabeth C Crowne
- University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
| |
Collapse
|
12
|
Suorsa-Johnson KI, Gardner MD, Brinkman W, Carley M, Gruppen L, Liang N, Lightfoot S, Pinkelman K, Speiser PW, VanderBrink B, Wisniewski J, Sandberg DE, Stacey D. A survey of healthcare professionals' perceptions of the decisional needs of parents with an infant born with a disorder/difference of sex development. J Pediatr Urol 2023; 19:39-49. [PMID: 36244898 PMCID: PMC10603597 DOI: 10.1016/j.jpurol.2022.09.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Revised: 08/05/2022] [Accepted: 09/18/2022] [Indexed: 02/07/2023]
Abstract
INTRODUCTION Parents of infants born with differences in sex development (DSD) face many difficult decisions. As part of a larger project designed to develop educational interventions to promote shared decision making, this study assessed healthcare professionals' (HCPs) perceptions of parental decision-making needs when an infant is born with a DSD. METHODS A cross-sectional web-based survey following the Ottawa Decision Support Framework was conducted in two waves, between October 2020 and June 2022. Survey domains included: common DSD decisions, indicators of parents' decisional needs, and resources and approaches to support parental decision making. Eligible participants were HCPs working within interprofessional pediatric DSD centers in the USA. Up to three reminders were sent. Descriptive analysis was conducted. RESULTS 71 HCPs participated; most (>90%) reported parents experience signs of decisional conflict including feeling unsure, worrying about what could go wrong, and fear of choosing a "wrong," irreversible option. The majority (90%) reported parents experience strong emotions interfering with their receptivity to information or deliberation. The majority (>70%) identified inadequate parental knowledge of the DSD as a barrier to decision making, coupled with information overload (>90%). HCPs rated several factors as "very" important, including: parents having information on benefits, harms, and other features of options (93%), having information about all the available options (87%), and having access to providers to discuss the options (84%). Providers endorsed using a variety of approaches to support parents' decision making; however, access to decision aids was not universally rated as highly important (very, 44%; somewhat, 46%; a little, 10%). IMPLICATIONS Overall, HCPs expressed favorable attitudes toward supporting active parental participation in medical decision making. Opportunities for enhanced support of shared decision making included: a) recognizing and addressing parental emotional distress and informational overload at a time when parents need to consider complex options for their infant or young child; and b) the need for HCPs to encourage values clarification in decision-making encounters with parents.
Collapse
Affiliation(s)
- Kristina I Suorsa-Johnson
- Department of Pediatrics, Division of Psychiatry and Behavioral Health, University of Utah Spencer Fox Eccles School of Medicine, Salt Lake City, UT, USA
| | - Melissa D Gardner
- Susan B. Meister Child Health Evaluation & Research (CHEAR) Center, University of Michigan, Ann Arbor, MI, USA
| | - William Brinkman
- Division of General and Community Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA; Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Meg Carley
- Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Larry Gruppen
- Department of Learning Health Sciences, University of Michigan Medical School, Ann Arbor, MI, USA
| | | | | | | | - Phyllis W Speiser
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA; Feinstein Institute for Medical Research, Manhasset, NY, USA
| | - Brian VanderBrink
- Division of Urology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | | | - David E Sandberg
- Susan B. Meister Child Health Evaluation & Research (CHEAR) Center, University of Michigan, Ann Arbor, MI, USA; Department of Pediatrics, Division of Pediatric Psychology, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Dawn Stacey
- Ottawa Hospital Research Institute, Ottawa, ON, Canada; School of Nursing, University of Ottawa, Ottawa, ON, Canada.
| |
Collapse
|
13
|
Roen K. Hypospadias surgery: understanding parental emotions, decisions and regrets. Int J Impot Res 2023; 35:67-71. [PMID: 34987180 DOI: 10.1038/s41443-021-00508-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Accepted: 11/22/2021] [Indexed: 11/09/2022]
Abstract
This paper builds an argument about genital surgery in the context of medical treatment of children and young people with variations in sex characteristics. First, I set out what is known from existing research including psychological research, surgical follow-up studies and parental regret studies. Second, I present an analysis of surgeons' talk about children, young people and parents in relation to genital surgery. This paper focuses most specifically on hypospadias surgery, but the argumentation is relevant for other kinds of genital surgery carried out in the context of genital variations. The questions guiding this paper are: what research evidence supports hypospadias surgery and what research evidence brings this surgery into question? How might a new interpretation of the evidence, in light of psychosocial research and human rights concerns, contribute to a new perspective on elective genital surgery on minors with variations in sex characteristics? I draw out implications for clinicians supporting parents to decide whether a surgical pathway is the best option for their child.
Collapse
Affiliation(s)
- Katrina Roen
- School of Social Sciences, University of Waikato, Aotearoa, New Zealand.
| |
Collapse
|
14
|
Integration of child life services in the delivery of multi-disciplinary differences in Sexual Development (DSD) and Congenital Adrenal Hyperplasia (CAH) care. J Pediatr Urol 2022; 18:612.e1-612.e6. [PMID: 36031554 DOI: 10.1016/j.jpurol.2022.08.001] [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: 11/17/2021] [Revised: 04/25/2022] [Accepted: 08/02/2022] [Indexed: 12/14/2022]
Abstract
INTRODUCTION Multiple studies have demonstrated the benefit of incorporating certified child life specialist (CCLS) services in various aspects of pediatric care. Although the significance of psychosocial support of patients with Disorders of Sexual Development (DSD) and Congenital Adrenal Hyperplasia (CAH) is increasingly recognized, the involvement of CCLS services into the DSD and CAH multidisciplinary care model has yet to be described. OBJECTIVE To evaluate the feasibility, acceptability, and patient and family experience of routinely incorporating CCLS services into the multidisciplinary DSD and CAH care model. STUDY DESIGN As part of a quality improvement initiative, CCLS services were routinely incorporated in the multidisciplinary DSD and CAH clinics at our institution. Encounters for patients seen in clinic between July 2018 through October 2019 were reviewed for demographic information, DSD diagnosis classification, CCLS documentation, and whether an exam under anesthesia (EUA) was required due to an incomplete clinical exam. CCLS documentation was reviewed for assessments, interventions, whether patients tolerated their physical exams, time of CCLS services, and additional CCLS support beyond the physical exam. All patients were limited to one physical exam per clinic visit. RESULTS Out of the 45 encounters with CCLS involvement, 42 (93.3%) exams were well-tolerated. CCLS assessments considered patient development, communication considerations, temperament, medical stressors, coping preferences, and patient preferences for activities and distractions. Interventions included preparing patients for their physical exams, encouragement before and during exams, addressing patient stressors, distractions and coping mechanisms, and advocating for the patient. No patients required an EUA. DISCUSSION The CCLS aimed to provide families with a sense of control during clinic visits and teach them to advocate for themselves. The CCLS helped prepare and distract patients for their clinic visit and addressed the sensitive nature of the physical exam by focusing on the emotional and development needs of patients. CCLS contributions to a positive patient experience are consistent with multiple studies demonstrating the benefit of CCLS services for pediatric care. This quality improvement initiative ultimately helped to create a positive experience for patients and families. CONCLUSION This study demonstrates the feasibility, acceptability, and positive impact of CCLS services in the delivery of patient and family-centered care for patients with DSD and CAH as part of the multidisciplinary team model.
Collapse
|
15
|
Coleman E, Radix AE, Bouman WP, Brown GR, de Vries ALC, Deutsch MB, Ettner R, Fraser L, Goodman M, Green J, Hancock AB, Johnson TW, Karasic DH, Knudson GA, Leibowitz SF, Meyer-Bahlburg HFL, Monstrey SJ, Motmans J, Nahata L, Nieder TO, Reisner SL, Richards C, Schechter LS, Tangpricha V, Tishelman AC, Van Trotsenburg MAA, Winter S, Ducheny K, Adams NJ, Adrián TM, Allen LR, Azul D, Bagga H, Başar K, Bathory DS, Belinky JJ, Berg DR, Berli JU, Bluebond-Langner RO, Bouman MB, Bowers ML, Brassard PJ, Byrne J, Capitán L, Cargill CJ, Carswell JM, Chang SC, Chelvakumar G, Corneil T, Dalke KB, De Cuypere G, de Vries E, Den Heijer M, Devor AH, Dhejne C, D'Marco A, Edmiston EK, Edwards-Leeper L, Ehrbar R, Ehrensaft D, Eisfeld J, Elaut E, Erickson-Schroth L, Feldman JL, Fisher AD, Garcia MM, Gijs L, Green SE, Hall BP, Hardy TLD, Irwig MS, Jacobs LA, Janssen AC, Johnson K, Klink DT, Kreukels BPC, Kuper LE, Kvach EJ, Malouf MA, Massey R, Mazur T, McLachlan C, Morrison SD, Mosser SW, Neira PM, Nygren U, Oates JM, Obedin-Maliver J, Pagkalos G, Patton J, Phanuphak N, Rachlin K, Reed T, Rider GN, Ristori J, Robbins-Cherry S, Roberts SA, Rodriguez-Wallberg KA, Rosenthal SM, Sabir K, Safer JD, Scheim AI, Seal LJ, Sehoole TJ, Spencer K, St Amand C, Steensma TD, Strang JF, Taylor GB, Tilleman K, T'Sjoen GG, Vala LN, Van Mello NM, Veale JF, Vencill JA, Vincent B, Wesp LM, West MA, Arcelus J. Standards of Care for the Health of Transgender and Gender Diverse People, Version 8. INTERNATIONAL JOURNAL OF TRANSGENDER HEALTH 2022; 23:S1-S259. [PMID: 36238954 PMCID: PMC9553112 DOI: 10.1080/26895269.2022.2100644] [Citation(s) in RCA: 583] [Impact Index Per Article: 291.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
Abstract
Background: Transgender healthcare is a rapidly evolving interdisciplinary field. In the last decade, there has been an unprecedented increase in the number and visibility of transgender and gender diverse (TGD) people seeking support and gender-affirming medical treatment in parallel with a significant rise in the scientific literature in this area. The World Professional Association for Transgender Health (WPATH) is an international, multidisciplinary, professional association whose mission is to promote evidence-based care, education, research, public policy, and respect in transgender health. One of the main functions of WPATH is to promote the highest standards of health care for TGD people through the Standards of Care (SOC). The SOC was initially developed in 1979 and the last version (SOC-7) was published in 2012. In view of the increasing scientific evidence, WPATH commissioned a new version of the Standards of Care, the SOC-8. Aim: The overall goal of SOC-8 is to provide health care professionals (HCPs) with clinical guidance to assist TGD people in accessing safe and effective pathways to achieving lasting personal comfort with their gendered selves with the aim of optimizing their overall physical health, psychological well-being, and self-fulfillment. Methods: The SOC-8 is based on the best available science and expert professional consensus in transgender health. International professionals and stakeholders were selected to serve on the SOC-8 committee. Recommendation statements were developed based on data derived from independent systematic literature reviews, where available, background reviews and expert opinions. Grading of recommendations was based on the available evidence supporting interventions, a discussion of risks and harms, as well as the feasibility and acceptability within different contexts and country settings. Results: A total of 18 chapters were developed as part of the SOC-8. They contain recommendations for health care professionals who provide care and treatment for TGD people. Each of the recommendations is followed by explanatory text with relevant references. General areas related to transgender health are covered in the chapters Terminology, Global Applicability, Population Estimates, and Education. The chapters developed for the diverse population of TGD people include Assessment of Adults, Adolescents, Children, Nonbinary, Eunuchs, and Intersex Individuals, and people living in Institutional Environments. Finally, the chapters related to gender-affirming treatment are Hormone Therapy, Surgery and Postoperative Care, Voice and Communication, Primary Care, Reproductive Health, Sexual Health, and Mental Health. Conclusions: The SOC-8 guidelines are intended to be flexible to meet the diverse health care needs of TGD people globally. While adaptable, they offer standards for promoting optimal health care and guidance for the treatment of people experiencing gender incongruence. As in all previous versions of the SOC, the criteria set forth in this document for gender-affirming medical interventions are clinical guidelines; individual health care professionals and programs may modify these in consultation with the TGD person.
Collapse
Affiliation(s)
- E Coleman
- Institute for Sexual and Gender Health, Department of Family Medicine and Community Health, University of Minnesota Medical School, Minneapolis, MN, USA
| | - A E Radix
- Callen-Lorde Community Health Center, New York, NY, USA
- Department of Medicine, NYU Grossman School of Medicine, New York, NY, USA
| | - W P Bouman
- Nottingham Centre for Transgender Health, Nottingham, UK
- School of Medicine, University of Nottingham, Nottingham, UK
| | - G R Brown
- James H. Quillen College of Medicine, East Tennessee State University, Johnson City, TN, USA
- James H. Quillen VAMC, Johnson City, TN, USA
| | - A L C de Vries
- Department of Child and Adolescent Psychiatry, Amsterdam UMC Location Vrije Universiteit Amsterdam, Amsterdam, Netherlands
- Center of Expertise on Gender Dysphoria, Amsterdam UMC Location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - M B Deutsch
- Department of Family & Community Medicine, University of California-San Francisco, San Francisco, CA, USA
- UCSF Gender Affirming Health Program, San Francisco, CA, USA
| | - R Ettner
- New Health Foundation Worldwide, Evanston, IL, USA
- Weiss Memorial Hospital, Chicago, IL, USA
| | - L Fraser
- Independent Practice, San Francisco, CA, USA
| | - M Goodman
- Emory University Rollins School of Public Health, Atlanta, GA, USA
| | - J Green
- Independent Scholar, Vancouver, WA, USA
| | - A B Hancock
- The George Washington University, Washington, DC, USA
| | - T W Johnson
- Department of Anthropology, California State University, Chico, CA, USA
| | - D H Karasic
- University of California San Francisco, San Francisco, CA, USA
- Independent Practice at dankarasic.com
| | - G A Knudson
- University of British Columbia, Vancouver, Canada
- Vancouver Coastal Health, Vancouver, Canada
| | - S F Leibowitz
- Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
| | - H F L Meyer-Bahlburg
- New York State Psychiatric Institute, New York, NY, USA
- Department of Psychiatry, Columbia University, New York, NY, USA
| | | | - J Motmans
- Transgender Infopunt, Ghent University Hospital, Gent, Belgium
- Centre for Research on Culture and Gender, Ghent University, Gent, Belgium
| | - L Nahata
- Department of Pediatrics, The Ohio State University College of Medicine, Columbus, OH, USA
- Endocrinology and Center for Biobehavioral Health, The Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, OH, USA
| | - T O Nieder
- University Medical Center Hamburg-Eppendorf, Interdisciplinary Transgender Health Care Center Hamburg, Institute for Sex Research, Sexual Medicine and Forensic Psychiatry, Hamburg, Germany
| | - S L Reisner
- Harvard Medical School, Boston, MA, USA
- Harvard T. H. Chan School of Public Health, Boston, MA, USA
| | - C Richards
- Regents University London, UK
- Tavistock and Portman NHS Foundation Trust, London, UK
| | | | - V Tangpricha
- Division of Endocrinology, Metabolism & Lipids, Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA
- Atlanta VA Medical Center, Decatur, GA, USA
| | - A C Tishelman
- Boston College, Department of Psychology and Neuroscience, Chestnut Hill, MA, USA
| | - M A A Van Trotsenburg
- Bureau GenderPRO, Vienna, Austria
- University Hospital Lilienfeld-St. Pölten, St. Pölten, Austria
| | - S Winter
- School of Population Health, Curtin University, Perth, WA, Australia
| | - K Ducheny
- Howard Brown Health, Chicago, IL, USA
| | - N J Adams
- University of Toronto, Ontario Institute for Studies in Education, Toronto, Canada
- Transgender Professional Association for Transgender Health (TPATH)
| | - T M Adrián
- Asamblea Nacional de Venezuela, Caracas, Venezuela
- Diverlex Diversidad e Igualdad a Través de la Ley, Caracas, Venezuela
| | - L R Allen
- University of Nevada, Las Vegas, NV, USA
| | - D Azul
- La Trobe Rural Health School, La Trobe University, Bendigo, Australia
| | - H Bagga
- Monash Health Gender Clinic, Melbourne, Victoria, Australia
- Monash University, Melbourne, Victoria, Australia
| | - K Başar
- Department of Psychiatry, Hacettepe University, Ankara, Turkey
| | - D S Bathory
- Independent Practice at Bathory International PLLC, Winston-Salem, NC, USA
| | - J J Belinky
- Durand Hospital, Guemes Clinic and Urological Center, Buenos Aires, Argentina
| | - D R Berg
- National Center for Gender Spectrum Health, Institute for Sexual and Gender Health, Department of Family Medicine and Community Health, University of Minnesota Medical School, Minneapolis, MN, USA
| | - J U Berli
- Oregon Health & Science University, Portland, OR, USA
| | - R O Bluebond-Langner
- NYU Langone Health, New York, NY, USA
- Hansjörg Wyss Department of Plastic Surgery, New York, NY, USA
| | - M-B Bouman
- Center of Expertise on Gender Dysphoria, Amsterdam UMC Location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Department of Plastic Surgery, Amsterdam UMC Location Vrije Universiteit Amsterdam, , Amsterdam, Netherlands
| | - M L Bowers
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Mills-Peninsula Medical Center, Burlingame, CA, USA
| | - P J Brassard
- GrS Montreal, Complexe CMC, Montreal, Quebec, Canada
- Université de Montreal, Quebec, Canada
| | - J Byrne
- University of Waikato/Te Whare Wānanga o Waikato, Hamilton/Kirikiriroa, New Zealand/Aotearoa
| | - L Capitán
- The Facialteam Group, Marbella International Hospital, Marbella, Spain
| | | | - J M Carswell
- Harvard Medical School, Boston, MA, USA
- Boston's Children's Hospital, Boston, MA, USA
| | - S C Chang
- Independent Practice, Oakland, CA, USA
| | - G Chelvakumar
- Nationwide Children's Hospital, Columbus, OH, USA
- The Ohio State University, College of Medicine, Columbus, OH, USA
| | - T Corneil
- School of Population & Public Health, University of British Columbia, Vancouver, BC, Canada
| | - K B Dalke
- Penn State Health, PA, USA
- Penn State College of Medicine, Hershey, PA, USA
| | - G De Cuypere
- Center for Sexology and Gender, Ghent University Hospital, Gent, Belgium
| | - E de Vries
- Nelson Mandela University, Gqeberha, South Africa
- University of Cape Town, Cape Town, South Africa
| | - M Den Heijer
- Center of Expertise on Gender Dysphoria, Amsterdam UMC Location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Department of Endocrinology, Amsterdam UMC Location Vrije Universiteit Amsterdam, , Amsterdam, Netherlands
| | - A H Devor
- University of Victoria, Victoria, BC, Canada
| | - C Dhejne
- ANOVA, Karolinska University Hospital, Stockholm, Sweden
- Department of Medicine Huddinge, Karolinska Institutet, Stockholm, Sweden
| | - A D'Marco
- UCTRANS-United Caribbean Trans Network, Nassau, The Bahamas
- D M A R C O Organization, Nassau, The Bahamas
| | - E K Edmiston
- University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - L Edwards-Leeper
- Pacific University, Hillsboro, OR, USA
- Independent Practice, Beaverton, OR, USA
| | - R Ehrbar
- Whitman Walker Health, Washington, DC, USA
- Independent Practice, Maryland, USA
| | - D Ehrensaft
- University of California San Francisco, San Francisco, CA, USA
| | - J Eisfeld
- Transvisie, Utrecht, The Netherlands
| | - E Elaut
- Center for Sexology and Gender, Ghent University Hospital, Gent, Belgium
- Department of Clinical Experimental and Health Psychology, Ghent University, Gent, Belgium
| | - L Erickson-Schroth
- The Jed Foundation, New York, NY, USA
- Hetrick-Martin Institute, New York, NY, USA
| | - J L Feldman
- Institute for Sexual and Gender Health, Institute for Sexual and Gender Health, Department of Family Medicine and Community Health, University of Minnesota Medical School, Minneapolis, MN, USA
| | - A D Fisher
- Andrology, Women Endocrinology and Gender Incongruence, Careggi University Hospital, Florence, Italy
| | - M M Garcia
- Department of Urology, Cedars-Sinai Medical Center, Los Angeles, CA, USA
- Departments of Urology and Anatomy, University of California San Francisco, San Francisco, CA, USA
| | - L Gijs
- Institute of Family and Sexuality Studies, Department of Neurosciences, KU Leuven, Leuven, Belgium
| | | | - B P Hall
- Duke University Medical Center, Durham, NC, USA
- Duke Adult Gender Medicine Clinic, Durham, NC, USA
| | - T L D Hardy
- Alberta Health Services, Edmonton, Alberta, Canada
- MacEwan University, Edmonton, Alberta, Canada
| | - M S Irwig
- Harvard Medical School, Boston, MA, USA
- Beth Israel Deaconess Medical Center, Boston, MA, USA
| | | | - A C Janssen
- Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
- Northwestern Feinberg School of Medicine, Chicago, IL, USA
| | - K Johnson
- RMIT University, Melbourne, Australia
- University of Brighton, Brighton, UK
| | - D T Klink
- Department of Pediatrics, Division of Pediatric Endocrinology, Ghent University Hospital, Gent, Belgium
- Division of Pediatric Endocrinology and Diabetes, ZNA Queen Paola Children's Hospital, Antwerp, Belgium
| | - B P C Kreukels
- Center of Expertise on Gender Dysphoria, Amsterdam UMC Location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Department of Medical Psychology, Amsterdam UMC Location Vrije Universiteit Amsterdam, , Amsterdam, Netherlands
| | - L E Kuper
- Department of Psychiatry, Southwestern Medical Center, University of Texas, Dallas, TX, USA
- Department of Endocrinology, Children's Health, Dallas, TX, USA
| | - E J Kvach
- Denver Health, Denver, CO, USA
- University of Colorado School of Medicine, Aurora, CO, USA
| | - M A Malouf
- Malouf Counseling and Consulting, Baltimore, MD, USA
| | - R Massey
- WPATH Global Education Institute
- Department of Psychiatry & Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA
| | - T Mazur
- Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA
- John R. Oishei Children's Hospital, Buffalo, NY, USA
| | - C McLachlan
- Professional Association for Transgender Health, South Africa
- Gender DynamiX, Cape Town, South Africa
| | - S D Morrison
- Division of Plastic Surgery, Seattle Children's Hospital, Seattle, WA, USA
- Division of Plastic Surgery, Department of Surgery, University of Washington Medical Center, Seattle, WA, USA
| | - S W Mosser
- Gender Confirmation Center, San Francisco, CA, USA
- Saint Francis Memorial Hospital, San Francisco, CA, USA
| | - P M Neira
- Johns Hopkins Center for Transgender Health, Baltimore, MD, USA
- Johns Hopkins Medicine Office of Diversity, Inclusion and Health Equity, Baltimore, MD, USA
| | - U Nygren
- Division of Speech and Language Pathology, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
- Speech and Language Pathology, Medical Unit, Karolinska University Hospital, Stockholm, Sweden
| | - J M Oates
- La Trobe University, Melbourne, Australia
- Melbourne Voice Analysis Centre, East Melbourne, Australia
| | - J Obedin-Maliver
- Stanford University School of Medicine, Department of Obstetrics and Gynecology, Palo Alto, CA, USA
- Department of Epidemiology and Population Health, Stanford, CA, USA
| | - G Pagkalos
- Independent PracticeThessaloniki, Greece
- Military Community Mental Health Center, 424 General Military Training Hospital, Thessaloniki, Greece
| | - J Patton
- Talkspace, New York, NY, USA
- CytiPsychological LLC, San Diego, CA, USA
| | - N Phanuphak
- Institute of HIV Research and Innovation, Bangkok, Thailand
| | - K Rachlin
- Independent Practice, New York, NY, USA
| | - T Reed
- Gender Identity Research and Education Society, Leatherhead, UK
| | - G N Rider
- National Center for Gender Spectrum Health, Institute for Sexual and Gender Health, Department of Family Medicine and Community Health, University of Minnesota Medical School, Minneapolis, MN, USA
| | - J Ristori
- Andrology, Women Endocrinology and Gender Incongruence, Careggi University Hospital, Florence, Italy
| | | | - S A Roberts
- Harvard Medical School, Boston, MA, USA
- Division of Endocrinology, Boston's Children's Hospital, Boston, MA, USA
| | - K A Rodriguez-Wallberg
- Department of Reproductive Medicine, Karolinska University Hospital, Stockholm, Sweden
- Department of Oncology-Pathology, Karolinska Institute, Stockholm, Sweden
| | - S M Rosenthal
- Division of Pediatric Endocrinology, UCSF, San Francisco, CA, USA
- UCSF Child and Adolescent Gender Center
| | - K Sabir
- FtM Phoenix Group, Krasnodar Krai, Russia
| | - J D Safer
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Mount Sinai Center for Transgender Medicine and Surgery, New York, NY, USA
| | - A I Scheim
- Epidemiology and Biostatistics, Dornsife School of Public Health, Drexel University, Philadelphia, PA, USA
- Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, Western University, Ontario, Canada
| | - L J Seal
- Tavistock and Portman NHS Foundation Trust, London, UK
- St George's University Hospitals NHS Foundation Trust, London, UK
| | | | - K Spencer
- National Center for Gender Spectrum Health, Institute for Sexual and Gender Health, Department of Family Medicine and Community Health, University of Minnesota Medical School, Minneapolis, MN, USA
| | - C St Amand
- University of Houston, Houston, TX, USA
- Mayo Clinic, Rochester, MN, USA
| | - T D Steensma
- Center of Expertise on Gender Dysphoria, Amsterdam UMC Location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Department of Medical Psychology, Amsterdam UMC Location Vrije Universiteit Amsterdam, , Amsterdam, Netherlands
| | - J F Strang
- Children's National Hospital, Washington, DC, USA
- George Washington University School of Medicine, Washington, DC, USA
| | - G B Taylor
- Atrium Health Department of Obstetrics and Gynecology, Division of Female Pelvic Medicine and Reconstructive Surgery, Charlotte, NC, USA
| | - K Tilleman
- Department for Reproductive Medicine, Ghent University Hospital, Gent, Belgium
| | - G G T'Sjoen
- Center for Sexology and Gender, Ghent University Hospital, Gent, Belgium
- Department of Endocrinology, Ghent University Hospital, Gent, Belgium
| | - L N Vala
- Independent Practice, Campbell, CA, USA
| | - N M Van Mello
- Center of Expertise on Gender Dysphoria, Amsterdam UMC Location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Department of Obstetrics and Gynaecology, Amsterdam UMC Location Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - J F Veale
- School of Psychology, University of Waikato/Te Whare Wānanga o Waikato, Hamilton/Kirikiriroa, New Zealand/Aotearoa
| | - J A Vencill
- Department of Psychiatry & Psychology, Mayo Clinic, Rochester, MN, USA
- Division of General Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | - B Vincent
- Trans Learning Partnership at https://spectra-london.org.uk/trans-learning-partnership, UK
| | - L M Wesp
- College of Nursing, University of Wisconsin MilwaukeeMilwaukee, WI, USA
- Health Connections Inc., Glendale, WI, USA
| | - M A West
- North Memorial Health Hospital, Robbinsdale, MN, USA
- University of Minnesota, Minneapolis, MN, USA
| | - J Arcelus
- School of Medicine, University of Nottingham, Nottingham, UK
- Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain
| |
Collapse
|
16
|
Wechsung K, Marshall L, Jürgensen M, Neumann U. Diagnosis of DSD in Children—Development of New Tools for a Structured Diagnostic and Information Management Program within the Empower-DSD Study. J Clin Med 2022; 11:jcm11133859. [PMID: 35807147 PMCID: PMC9267843 DOI: 10.3390/jcm11133859] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Revised: 06/23/2022] [Accepted: 06/27/2022] [Indexed: 02/04/2023] Open
Abstract
Background: Current recommendations define a structured diagnostic process, transparent information, and psychosocial support by a specialized, multi-professional team as central in the care for children and adolescents with genital variations and a suspected difference of sex development (DSD). The active involvement of the child and their parents in shared decision-making should result in an individualized care plan. So far, this process has not been standardized. Methods: Within the Empower-DSD study, a team of professionals and representatives of patient advocacy groups developed a new diagnostic and information management program based on current recommendations and existing patient information. Results: The information management defines and standardizes generic care elements for the first weeks after a suspected DSD diagnosis. Three different tools were developed: a guideline for the specialized multiprofessional team, a personal health record and information kit for the child with DSD and their family, and a booklet for medical staff not specialized in DSD. Conclusions: The new information management offers guidance for patients and professionals during the first weeks after a DSD diagnosis is suspected. The developed tools’ evaluation will provide further insight into the diagnostic and information-sharing process as well as into all of the involved stakeholders’ needs.
Collapse
Affiliation(s)
- Katja Wechsung
- Department for Pediatric Endocrinology and Diabetology, Center for Chronic Sick Children, Charité-Universitätsmedizin Berlin, Augustenburger Platz 1, 13353 Berlin, Germany;
- Correspondence:
| | - Louise Marshall
- Division of Pediatric Endocrinology and Diabetes, Department of Pediatrics and Adolescent Medicine, University of Lübeck, Ratzeburger Allee 160, 23538 Luebeck, Germany; (L.M.); (M.J.)
| | - Martina Jürgensen
- Division of Pediatric Endocrinology and Diabetes, Department of Pediatrics and Adolescent Medicine, University of Lübeck, Ratzeburger Allee 160, 23538 Luebeck, Germany; (L.M.); (M.J.)
| | - Uta Neumann
- Department for Pediatric Endocrinology and Diabetology, Center for Chronic Sick Children, Charité-Universitätsmedizin Berlin, Augustenburger Platz 1, 13353 Berlin, Germany;
- Institute for Experimental Pediatric Endocrinology, Charité-Universitätsmedizin Berlin, Augustenburger Platz 1, 13353 Berlin, Germany
| | | |
Collapse
|
17
|
Lucas-Herald AK, Scougall K, Ahmed SF. Delivery of multidisciplinary care in the field of differences and disorders of sex development (DSD). Expert Rev Endocrinol Metab 2022; 17:225-234. [PMID: 35535380 DOI: 10.1080/17446651.2022.2072829] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Accepted: 04/28/2022] [Indexed: 10/18/2022]
Abstract
INTRODUCTION Differences and disorders of sex development (DSD) are a diverse group of conditions, which often present in early childhood and may require input from a group of experts in a wide range of clinical fields. Clinical guidance in this field recommends that these experts function as a multidisciplinary team (MDT) within which each expert has a defined role, which ensures an integrated and streamlined approach to the care of affected individuals. AREAS COVERED This review will focus on the benefits of multidisciplinary care for people with DSD, as well as the challenges that may be faced. EXPERT OPINION Core members of the MDT for people with DSD include endocrinologists, surgeons, psychologists, geneticists, specialist nurses, radiologists, and gynecologists, although many other health-care professionals may also be pertinent, at different stages of the patient's life. With greater acceptance of remote and digital health-care technology, there is a need to review the traditional concepts of the clinical MDT so that new care models can be explored for effective and efficient delivery of complex care.
Collapse
Affiliation(s)
| | - Kathryn Scougall
- Developmental Endocrinology Research Group, University of Glasgow, Glasgow, UK
| | - S Faisal Ahmed
- Developmental Endocrinology Research Group, University of Glasgow, Glasgow, UK
| |
Collapse
|
18
|
Blankstein U, McGrath M, Randhawa H, Braga LH. A survey of parental perceptions and attitudes related to disclosure in hypospadias repair. J Pediatr Urol 2022; 18:178.e1-178.e7. [PMID: 35181223 DOI: 10.1016/j.jpurol.2022.01.009] [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] [Revised: 01/13/2022] [Accepted: 01/14/2022] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Boys with hypospadias often undergo reconstructive surgery to improve cosmetic appearance and functional outcomes. While the ethics of physician-patient disclosure of illness are clear, parent-child disclosure is more ambiguous. There is a paucity of research regarding the parental disclosure of past urological procedures, specifically hypospadias repair. Our objective was to determine the rate of parental disclosure in boys undergoing hypospadias repair, and to evaluate the parental perspectives regarding concerns and amount of support in relation. METHODS A web-based questionnaire was distributed to parents of 240 hypospadias patients at our pediatric urology outpatient clinic over 12 months. The questionnaire assessed intent to disclose, decisional regret, and cosmetic perception. Data was analyzed using descriptive statistics and chi-square analyses. RESULTS Two hundred and twenty-three survey responses were collected. The majority of respondents were urban dwellers (72.2%), and the mothers of the child (80.9%). Distal hypospadias was the most common variant of condition (62.7%). When asked if they plan to disclose the repair to their child, 93% said "yes", and of those, the optimal mean age of disclosure was 7.49 ± 4.30 years. Ninety percent reported that they were not offered guidance on how/when to disclose, and 43% thought they would benefit from support on this. There was a significant difference in nervousness to disclose if the condition was distal versus proximal (χ2 = 15.19, p=<0.01), with proximal being more nervous. A significant difference was also observed regarding disclosure support with proximal being more likely to want formal support (χ2 = 4.55, p = 0.03). DISCUSSION AND CONCLUSIONS As hypothesized, the majority of parents intended to disclose their son's surgery to them, but no statistically significant difference was seen between those with a distal vs. proximal repair. Additionally, demographic characteristics which were hypothesized to influence this decision (e.g., parents' level of education and relationship to the child) did not discriminate parental intent to disclose. To our knowledge, this is the first study to evaluate perceptions and attitudes around disclosure in patients with hypospadias and their families. The majority of respondents were planning to disclose the operation to their child, and were not offered any guidance or support as to the optimal way to disclose. Half of those parents thought they could benefit from resources to help them with this process. Further research is required to understand the impact of disclosure and to create tools to help caregivers with this responsibility.
Collapse
Affiliation(s)
- Udi Blankstein
- Division of Urology, McMaster University, Hamilton, Ontario, Canada
| | - Melissa McGrath
- Division of Urology, McMaster University, Hamilton, Ontario, Canada; McMaster Pediatric Surgery Research Collaborative, Department of Surgery, McMaster University, Hamilton, Ontario, Canada
| | | | - Luis H Braga
- Division of Urology, McMaster University, Hamilton, Ontario, Canada; McMaster Pediatric Surgery Research Collaborative, Department of Surgery, McMaster University, Hamilton, Ontario, Canada; Deparment of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada.
| |
Collapse
|
19
|
Sandberg DE, Gardner M. Differences/Disorders of Sex Development: Medical Conditions at the Intersection of Sex and Gender. Annu Rev Clin Psychol 2022; 18:201-231. [PMID: 35216524 PMCID: PMC10170864 DOI: 10.1146/annurev-clinpsy-081219-101412] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Defined as congenital conditions in which development of chromosomal, gonadal, or anatomic sex is atypical, differences or disorders of sex development (DSDs) comprise many discrete diagnoses ranging from those associated with few phenotypic differences between affected and unaffected individuals to those where questions arise regarding gender of rearing, gonadal tumor risk, genital surgery, and fertility. Controversies exist in numerous areas including how DSDs are conceptualized, how to refer to the set of conditions and those affected by them, and aspects of clinical management that extend from social media to legislative bodies, courts of law, medicine, clinical practice, and scholarly research in psychology and sociology. In addition to these aspects, this review covers biological and social influences on psychosocial development and adjustment, the psychosocial and psychosexual adaptation of people born with DSDs, and roles for clinical psychologists in the clinical management of DSDs. Expected final online publication date for the Annual Review of Clinical Psychology, Volume 18 is May 2022. Please see http://www.annualreviews.org/page/journal/pubdates for revised estimates.
Collapse
Affiliation(s)
- David E Sandberg
- Susan B. Meister Child Health Evaluation and Research Center, University of Michigan Medical School, Ann Arbor, Michigan, USA;
| | - Melissa Gardner
- Susan B. Meister Child Health Evaluation and Research Center, University of Michigan Medical School, Ann Arbor, Michigan, USA;
| |
Collapse
|
20
|
Suorsa-Johnson KI, Gardner MD, Baskin A, Gruppen LD, Rose A, Rutter MM, Schafer-Kalkhoff T, Stacey D, van Leeuwen KD, Weidler EM, Sandberg DE. Defining successful outcomes and preferences for clinical management in differences/disorders of sex development: Protocol overview and a qualitative phenomenological study of stakeholders' perspectives. J Pediatr Urol 2022; 18:36.e1-36.e17. [PMID: 34876378 PMCID: PMC8983568 DOI: 10.1016/j.jpurol.2021.10.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2021] [Revised: 08/25/2021] [Accepted: 10/25/2021] [Indexed: 02/03/2023]
Abstract
INTRODUCTION Utilizing a qualitative phenomenological design, the Defining Successful Outcomes and Trade-offs study examined stakeholder perspectives regarding optimal healthcare delivery and outcomes for individuals with a difference/disorder of sex development (DSD). OBJECTIVE We describe study methods and provide an overview of themes and subthemes. STUDY DESIGN Interviews were conducted with individuals with a DSD (n = 24), parents of those with a DSD (n = 19), healthcare providers (n = 37), and others (n = 30). Primary questions regarding clinical management of patients with DSD were: "What is a successful outcome?" and "How do you achieve it?" RESULTS Themes included: understanding of DSD diagnosis and self-efficacy in management is necessary but complex; patient and family psychological well-being; support from others versus being stigmatized; affected person experiences physical health and accepts the implications of their condition; complexities in DSD decision making, roles and expectations; and knowledgeable providers and multidisciplinary teams are essential, notwithstanding persisting barriers. Participants recognized competing values potentially forcing trade-offs in decision making. DISCUSSION Recognition of diverse and sometimes conflicting perspectives regarding optimal pathways of care and outcomes - both within and among those with DSD and their providers -promises to enhance shared decision making. CONCLUSION Diverse perspectives and perceptions of trade-offs associated with DSD healthcare emphasize the need to tailor care for patients and families.
Collapse
Affiliation(s)
- Kristina I Suorsa-Johnson
- Department of Pediatrics, University of Michigan Medical School, Division of Pediatric Psychology, Ann Arbor, USA; Child Health Evaluation & Research (CHEAR) Center, University of Michigan, Ann Arbor, USA
| | - Melissa D Gardner
- Department of Pediatrics, University of Michigan Medical School, Division of Pediatric Psychology, Ann Arbor, USA; Child Health Evaluation & Research (CHEAR) Center, University of Michigan, Ann Arbor, USA
| | - Alison Baskin
- Department of Pediatrics, University of Michigan Medical School, Division of Pediatric Psychology, Ann Arbor, USA
| | - Larry D Gruppen
- Department of Learning Health Sciences, University of Michigan Medical School, Ann Arbor, USA
| | - Angela Rose
- Child Health Evaluation & Research (CHEAR) Center, University of Michigan, Ann Arbor, USA
| | - Meilan M Rutter
- Division of Endocrinology, Cincinnati Children's Hospital Medical Center, Cincinnati, USA; Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, USA; Accord Alliance, USA
| | - Tara Schafer-Kalkhoff
- Division of Endocrinology, Cincinnati Children's Hospital Medical Center, Cincinnati, USA
| | - Dawn Stacey
- Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Canada; School of Nursing, University of Ottawa, Ottawa, Canada
| | - Kathleen D van Leeuwen
- Division of Pediatric Surgery, Phoenix Children's Hospital, Phoenix, USA; Accord Alliance, USA
| | - Erica M Weidler
- Division of Pediatric Surgery, Phoenix Children's Hospital, Phoenix, USA; Accord Alliance, USA
| | - David E Sandberg
- Department of Pediatrics, University of Michigan Medical School, Division of Pediatric Psychology, Ann Arbor, USA; Child Health Evaluation & Research (CHEAR) Center, University of Michigan, Ann Arbor, USA; Accord Alliance, USA.
| |
Collapse
|
21
|
Fisher RS, Espeleta HC, Baskin LS, Buchanan CL, Chan YM, Cheng EY, Coplen DE, Diamond DA, Nokoff NJ, Palmer BW, Poppas DP, Scott Reyes KJ, Tishelman A, Wolfe-Christensen C, Mullins LL, Wisniewski AB. Decisional regret about surgical and non-surgical issues after genitoplasty among caregivers of female infants with CAH. J Pediatr Urol 2022; 18:27-33. [PMID: 34742644 PMCID: PMC8983419 DOI: 10.1016/j.jpurol.2021.10.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Revised: 09/24/2021] [Accepted: 10/04/2021] [Indexed: 02/07/2023]
Abstract
INTRODUCTION Caregivers of female infants with congenital adrenal hyperplasia (CAH) often confront complex medical decision-making (e.g., early feminizing genitoplasty). OBJECTIVE This study aimed to evaluate the relevant medical decisions and subsequent decisional regret of caregivers following their child's genitoplasty. STUDY DESIGN Caregivers (N = 55) were recruited from multidisciplinary treatment programs for participation in a longitudinal study. Qualitative data was collected at 6-12 months following feminizing genitoplasty to evaluate caregiver-reported decision points across their child's treatment. Quantitative exploratory analysis evaluated pre-operative predictors of subsequent decisional regret. DISCUSSION When prompted about their decision-making and potential regret, most caregivers (n = 32, 80%) reported that their daughter's genital surgery was their primary medical decision. Specific themes regarding genital surgery included the timing and type of surgery. Most caregivers reported no decisional regret (62%), with 38% reporting some level of regret. Greater pre-operative illness uncertainty predicted heightened decisional regret at follow-up, p = .001. CONCLUSION Two-thirds of caregivers of female infants with CAH reported not regretting their decision-making. Nevertheless, over one-third of caregivers reported some level of regret, suggesting the need for improvements in shared decision-making processes. Many, but not all, families reported that this regret was related to surgical decision-making. Reducing caregiver illness uncertainty (e.g., providing clear information to families) may increase their satisfaction with decision-making. Further research is needed to determine how the evolving care practices surrounding early genitoplasty will impact families.
Collapse
Affiliation(s)
- Rachel S Fisher
- Oklahoma State University, Department of Psychology, Center for Pediatric Psychology, Stillwater, OK, USA
| | - Hannah C Espeleta
- Medical University of South Carolina, College of Nursing, Charleston, SC, USA
| | - Laurence S Baskin
- University of California San Francisco Medical Center, Department of Urology, San Francisco, CA, USA
| | - Cindy L Buchanan
- University of Colorado Anschutz Medical Campus, Department of Psychiatry, Aurora, CO, USA
| | - Yee-Ming Chan
- Boston Children's Hospital, Division of Endocrinology, Department of Pediatrics, Harvard Medical School, Department of Pediatrics, Boston, MA, USA
| | - Earl Y Cheng
- Ann & Robert H. Lurie Children's Hospital of Chicago, Department of Urology, Chicago, IL, USA
| | - Douglas E Coplen
- St. Louis Children's Hospital, Division of Urologic Surgery, St. Louis, MO, USA
| | | | - Natalie J Nokoff
- University of Colorado Anschutz Medical Campus, Department of Pediatrics, Division of Endocrinology, Aurora, CO, USA
| | - Blake W Palmer
- Cook Children's Medical Center, Department of Pediatric Urology, Fort Worth, TX, USA
| | - Dix P Poppas
- New York Presbyterian Weill Cornell Medicine, Department of Urology, Komansky Children's Hospital, New York, NY, USA
| | - Kristy J Scott Reyes
- Cook Children's Medical Center, Department of Pediatric Urology, Fort Worth, TX, USA
| | | | | | - Larry L Mullins
- Oklahoma State University, Department of Psychology, Center for Pediatric Psychology, Stillwater, OK, USA
| | - Amy B Wisniewski
- Oklahoma State University, Department of Psychology, Center for Pediatric Psychology, Stillwater, OK, USA.
| |
Collapse
|
22
|
Boucher NA, Alkazemi MH, Tejwani R, Routh JC. Parents of Children with Newly Diagnosed Disorders of Sex Development Identify Major Concerns: A Qualitative Study. Urology 2022; 164:218-223. [PMID: 35038494 DOI: 10.1016/j.urology.2022.01.001] [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: 08/15/2021] [Revised: 12/29/2021] [Accepted: 01/02/2022] [Indexed: 10/19/2022]
Abstract
OBJECTIVES To develop a conceptual framework to understand and define the impact of DSD diagnosis and management from the perspective of parents of recently diagnosed children. METHODS Semi-structured interviews were conducted with parents of children diagnosed with 46 XX, 46 XY, or chromosomal DSD including complete or partial androgen insensitivity, congenital adrenal hyperplasia, or 5-alpha reductase deficiency. Analysis was completed using content analysis with an inductive approach by three coders. RESULTS Parents of six patients agreed to be interviewed, consistent with saturation points for prior similar studies; a total of 16 recurring themes were identified which were further grouped by similarity and categorized into one of three meta-themes: a) personal impact (effect of diagnosis on parents psyche, happiness, gender/sexual identity, anatomic function, mental health), b) family impact (relationships with parents/siblings, parental guilt); and c) societal impact (bullying, need for secrecy, future desirability, societal openness to DSD individuals). CONCLUSIONS Personal, family, and societal concerns amongst parents following a DSD diagnosis have significant potential psychosocial impacts for both parents as well children. The nexus between these categories provides a framework for approaching diagnosis and management of DSD and has implications for patients, families, and clinicians. Improved resource allocation, education, and clinical tools conceived through this framework may considerably alleviate potent psychosocial stressors for parents of children born with DSD.
Collapse
Affiliation(s)
- Nathan A Boucher
- Duke University, Sanford School of Public Policy, Durham, NC, USA; Duke University, School of Medicine, Durham, NC, USA; Durham VA Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), Durham VA Health System, Durham, NC, USA; Duke-Margolis Center for Health Policy, Durham, NC, USA.
| | | | - Rohit Tejwani
- Duke University, School of Medicine, Durham, NC, USA; Division of Urologic Surgery, Duke University School of Medicine, Durham, NC
| | - Jonathan C Routh
- Duke University, School of Medicine, Durham, NC, USA; Division of Urologic Surgery, Duke University School of Medicine, Durham, NC
| |
Collapse
|
23
|
Claahsen - van der Grinten HL, Speiser PW, Ahmed SF, Arlt W, Auchus RJ, Falhammar H, Flück CE, Guasti L, Huebner A, Kortmann BBM, Krone N, Merke DP, Miller WL, Nordenström A, Reisch N, Sandberg DE, Stikkelbroeck NMML, Touraine P, Utari A, Wudy SA, White PC. Congenital Adrenal Hyperplasia-Current Insights in Pathophysiology, Diagnostics, and Management. Endocr Rev 2022; 43:91-159. [PMID: 33961029 PMCID: PMC8755999 DOI: 10.1210/endrev/bnab016] [Citation(s) in RCA: 157] [Impact Index Per Article: 78.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2021] [Indexed: 11/19/2022]
Abstract
Congenital adrenal hyperplasia (CAH) is a group of autosomal recessive disorders affecting cortisol biosynthesis. Reduced activity of an enzyme required for cortisol production leads to chronic overstimulation of the adrenal cortex and accumulation of precursors proximal to the blocked enzymatic step. The most common form of CAH is caused by steroid 21-hydroxylase deficiency due to mutations in CYP21A2. Since the last publication summarizing CAH in Endocrine Reviews in 2000, there have been numerous new developments. These include more detailed understanding of steroidogenic pathways, refinements in neonatal screening, improved diagnostic measurements utilizing chromatography and mass spectrometry coupled with steroid profiling, and improved genotyping methods. Clinical trials of alternative medications and modes of delivery have been recently completed or are under way. Genetic and cell-based treatments are being explored. A large body of data concerning long-term outcomes in patients affected by CAH, including psychosexual well-being, has been enhanced by the establishment of disease registries. This review provides the reader with current insights in CAH with special attention to these new developments.
Collapse
Affiliation(s)
| | - Phyllis W Speiser
- Cohen Children’s Medical Center of NY, Feinstein Institute, Northwell Health, Zucker School of Medicine, New Hyde Park, NY 11040, USA
| | - S Faisal Ahmed
- Developmental Endocrinology Research Group, School of Medicine Dentistry & Nursing, University of Glasgow, Glasgow, UK
| | - Wiebke Arlt
- Institute of Metabolism and Systems Research (IMSR), College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
- Department of Endocrinology, Queen Elizabeth Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Richard J Auchus
- Division of Metabolism, Endocrinology, and Diabetes, Departments of Internal Medicine and Pharmacology, University of Michigan, Ann Arbor, MI 48109, USA
| | - Henrik Falhammar
- Department of Molecular Medicine and Surgery, Karolinska Intitutet, Stockholm, Sweden
- Department of Endocrinology, Karolinska University Hospital, Stockholm, Sweden
| | - Christa E Flück
- Pediatric Endocrinology, Diabetology and Metabolism, Inselspital, Bern University Hospital, University of Bern, 3010 Bern, Switzerland
| | - Leonardo Guasti
- Centre for Endocrinology, William Harvey Research Institute, Bart’s and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Angela Huebner
- Division of Paediatric Endocrinology and Diabetology, Department of Paediatrics, Universitätsklinikum Dresden, Technische Universität Dresden, Dresden, Germany
| | - Barbara B M Kortmann
- Radboud University Medical Centre, Amalia Childrens Hospital, Department of Pediatric Urology, Nijmegen, The Netherlands
| | - Nils Krone
- Department of Oncology and Metabolism, University of Sheffield, Sheffield, UK
- Department of Medicine III, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Deborah P Merke
- National Institutes of Health Clinical Center and the Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, MD 20892, USA
| | - Walter L Miller
- Department of Pediatrics, Center for Reproductive Sciences, and Institute for Human Genetics, University of California, San Francisco, CA 94143, USA
| | - Anna Nordenström
- Department of Women’s and Children’s Health, Karolinska Institutet, Stockholm, Sweden
- Pediatric Endocrinology, Karolinska University Hospital, Stockholm, Sweden
| | - Nicole Reisch
- Medizinische Klinik IV, Klinikum der Universität München, Munich, Germany
| | - David E Sandberg
- Department of Pediatrics, Susan B. Meister Child Health Evaluation and Research Center, University of Michigan, Ann Arbor, MI 48109, USA
| | | | - Philippe Touraine
- Department of Endocrinology and Reproductive Medicine, Center for Rare Endocrine Diseases of Growth and Development, Center for Rare Gynecological Diseases, Hôpital Pitié Salpêtrière, Sorbonne University Medicine, Paris, France
| | - Agustini Utari
- Division of Pediatric Endocrinology, Department of Pediatrics, Faculty of Medicine, Diponegoro University, Semarang, Indonesia
| | - Stefan A Wudy
- Steroid Research & Mass Spectrometry Unit, Laboratory of Translational Hormone Analytics, Division of Paediatric Endocrinology & Diabetology, Justus Liebig University, Giessen, Germany
| | - Perrin C White
- Division of Pediatric Endocrinology, UT Southwestern Medical Center, Dallas TX 75390, USA
| |
Collapse
|
24
|
Charron M, Saulnier K, Palmour N, Gallois H, Joly Y. Intersex Stigma and Discrimination: Effects on Patient-Centred Care and Medical Communication. CANADIAN JOURNAL OF BIOETHICS 2022. [DOI: 10.7202/1089782ar] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
|
25
|
Ahmed SF, Achermann J, Alderson J, Crouch NS, Elford S, Hughes IA, Krone N, McGowan R, Mushtaq T, O'Toole S, Perry L, Rodie ME, Skae M, Turner HE. Society for Endocrinology UK Guidance on the initial evaluation of a suspected difference or disorder of sex development (Revised 2021). Clin Endocrinol (Oxf) 2021; 95:818-840. [PMID: 34031907 DOI: 10.1111/cen.14528] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2021] [Revised: 04/30/2021] [Accepted: 05/13/2021] [Indexed: 11/26/2022]
Abstract
It is paramount that any child or adolescent with a suspected difference or disorder of sex development (DSD) is assessed by an experienced clinician with adequate knowledge about the range of conditions associated with DSD and is discussed with the regional DSD service. In most cases, the paediatric endocrinologist within this service acts as the first point of contact but involvement of the regional multidisciplinary service will also ensure prompt access to specialist psychology and nursing care. The underlying pathophysiology of DSD and the process of delineating this should be discussed with the parents and affected young person with all diagnostic tests undertaken in a timely fashion. Finally, for rare conditions such as these, it is imperative that clinical experience is shared through national and international clinical and research collaborations.
Collapse
Affiliation(s)
- S Faisal Ahmed
- Developmental Endocrinology Research Group, School of Medicine, Dentistry and Nursing, University of Glasgow, Glasgow, UK
- Royal Hospital for Children, NHS Greater Glasgow & Clyde, Glasgow, UK
- Office for Rare Conditions, School of Medicine, Dentistry and Nursing, University of Glasgow, Glasgow, UK
| | - John Achermann
- Genetics & Genomic Medicine Research and Teaching Department, UCL Great Ormond Street Institute of Child Health, London, UK
| | - Julie Alderson
- Psychological Health Services, University Hospitals Bristol & Weston NHS Foundation Trust, Bristol, UK
| | - Naomi S Crouch
- Department of Women's Health, St Michael's Hospital, University Hospitals Bristol & Weston NHS Foundation Trust, Bristol, UK
| | | | - Ieuan A Hughes
- DSDFamilies, UK
- Department of Paediatrics, University of Cambridge, Cambridge, UK
| | - Nils Krone
- Academic Unit of Child Health, Department of Oncology and Metabolism, University of Sheffield, Sheffield, UK
| | - Ruth McGowan
- Developmental Endocrinology Research Group, School of Medicine, Dentistry and Nursing, University of Glasgow, Glasgow, UK
- West of Scotland Centre for Genomic Medicine, NHS Greater Glasgow & Clyde, Glasgow, UK
| | - Talat Mushtaq
- Department of Paediatric Endocrinology, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Stuart O'Toole
- Royal Hospital for Children, NHS Greater Glasgow & Clyde, Glasgow, UK
- Department of Paediatric Urology, Royal Hospital for Children, NHS Greater Glasgow & Clyde, Glasgow, UK
| | - Leslie Perry
- Department of Clinical Biochemistry, Croydon University Hospital, London, UK
| | - Martina E Rodie
- Royal Hospital for Children, NHS Greater Glasgow & Clyde, Glasgow, UK
- Office for Rare Conditions, School of Medicine, Dentistry and Nursing, University of Glasgow, Glasgow, UK
- Department of Neonatology, Queen Elizabeth University Hospital, Glasgow, UK
| | - Mars Skae
- Department of Paediatric Endocrinology, Royal Manchester Children's Hospital, Manchester University NHS Foundation Trust, Manchester, UK
| | - Helen E Turner
- Oxford Centre for Diabetes, Endocrinology and Metabolism, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| |
Collapse
|
26
|
Traino KA, Baudino MN, Kraft JD, Basile NL, Dattilo TM, Davis MP, Buchanan C, Cheng EY, Poppas DP, Wisniewski AB, Mullins LL. Factor Analysis of the Stigma Scale-Parent Version in Pediatric Disorders/Differences of Sex Development. STIGMA AND HEALTH 2021; 6:390-396. [PMID: 35497259 PMCID: PMC9053364 DOI: 10.1037/sah0000346] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2023]
Abstract
Stigma is a salient experience for both caregivers/parents and individuals with Disorders/Differences of Sex Development (DSD) as evidenced through qualitative and preliminary quantitative reports. However, few validated measures of associative stigma (i.e., vicarious stigma experienced through close association with someone who is socially stigmatized) for parents of children with DSD exist. The present study aims to (1) determine the factor structure of the adapted Stigma Scale - Parent, and (2) examine convergent validity of the factor structure with measures of parent psychosocial adjustment. Confirmatory factor analytic results revealed two factors: a parent-focused factor and a child-focused factor. The parent-focused factor demonstrated convergent validity with parent adjustment measures, but the child-focused factor did not. Together, these results indicate that parent-focused and child-focused stigma are distinct factors, with parent-focused associative stigma being related to parent adjustment following DSD diagnosis. Future research should further refine this measure to determine predictive validity and clinical value.
Collapse
Affiliation(s)
| | | | - Jacob D. Kraft
- Psychology Department, Oklahoma State University, Stillwater, OK
| | - Nathan L. Basile
- Psychology Department, Oklahoma State University, Stillwater, OK
| | | | - Morgan P. Davis
- Psychology Department, Oklahoma State University, Stillwater, OK
| | - Cindy Buchanan
- University of Colorado Anschutz Medical Campus, Department of Psychiatry, Aurora, CO
| | - Earl Y. Cheng
- Ann & Robert H. Lurie Children’s Hospital of Chicago, Department of Urology, Chicago, IL
| | - Dix P. Poppas
- Phyllis & David Komansky Center for Children’s Health of New York Presbyterian Hospital Weill Cornell Medical Center
| | | | - Larry L. Mullins
- Psychology Department, Oklahoma State University, Stillwater, OK
| |
Collapse
|
27
|
Miano P, Di Salvo G, Lavaggi M. An undermined therapeutic alliance: A case study. PSYCHODYNAMIC PRACTICE 2021. [DOI: 10.1080/14753634.2021.1972035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Paola Miano
- Department of Psychology, Educational Science and Human Movement, University of Palermo, Italy
| | | | - Massimo Lavaggi
- Associazione Consultorio Transgenere, Torre Del Lago Puccini, Italy
| |
Collapse
|
28
|
Lampalzer U, Briken P, Schweizer K. Psychosocial care and support in the field of intersex/diverse sex development (dsd): counselling experiences, localisation and needed improvements. Int J Impot Res 2021; 33:228-242. [PMID: 33727692 PMCID: PMC7985030 DOI: 10.1038/s41443-021-00422-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Revised: 02/12/2021] [Accepted: 02/22/2021] [Indexed: 12/11/2022]
Abstract
From different sides, there is a call for better psychosocial care and counselling in the field of diverse sex development (dsd). However, studies on the specific demands, deficits and needed improvements regarding those services are rare. This exploratory online study aimed at investigating counselling experiences and the ideas that different groups of participants have concerning the localisation of counselling structures and improving care. Quantitative and qualitative data (N = 630) were analysed within a mixed methods framework. The participants included experts of experience resp. patients with different intersex/dsd conditions (n = 40), parents of children with dsd (n = 27), professional psychosocial counsellors (n = 321) and experts in the field including medical practitioners, psychologists, natural and social scientists as well as others involved, e.g., students or relatives (n = 56). The results show a gap between receiving psychosocial and medical care in the group of adult lived-experience experts, who had received less psychosocial care than medical interventions. The findings also reveal important tasks of psychosocial care. A focus was set on parental experiences. Helpful aspects reported were talking with other parents of children with intersex/dsd, aspects missed were assistance in supporting the individual development of their children. The majority of all participants (58%) held the view that, apart from multidisciplinary competence centres, there also have to be easily accessible counselling services which offer support in everyday life. The participants named increasing quality and quantity as necessary improvements in counselling structures for children and adults with intersex/dsd and their families. Implications are drawn for the specific tasks and target groups of psychosocial care and needed research in intersex healthcare over life span.
Collapse
Affiliation(s)
- Ute Lampalzer
- Institute for Sex Research, Sexual Medicine and Forensic Psychiatry, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Peer Briken
- Institute for Sex Research, Sexual Medicine and Forensic Psychiatry, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | | |
Collapse
|
29
|
Roberts CM, Sharkey CM, Bakula DM, Perez MN, Delozier AJ, Austin PF, Baskin LS, Chan YM, Cheng EY, Diamond DA, Fried AJ, Kropp B, Lakshmanan Y, Meyer SZ, Meyer T, Nokoff NJ, Palmer BW, Paradis A, Reyes KJS, Tishelman A, Williot P, Wolfe-Christensen C, Yerkes EB, Aston C, Wisniewski AB, Mullins LL. Illness Uncertainty Longitudinally Predicts Distress Among Caregivers of Children Born With DSD. J Pediatr Psychol 2021; 45:1053-1062. [PMID: 32929478 DOI: 10.1093/jpepsy/jsaa069] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Revised: 07/18/2020] [Accepted: 07/20/2020] [Indexed: 12/31/2022] Open
Abstract
OBJECTIVE A subset of parents of children with disorders/differences of sex development (DSD) including ambiguous genitalia experience clinically elevated levels of anxious and depressive symptoms. Research indicates that uncertainty about their child's DSD is associated with parent psychosocial distress; however, previous studies have been cross-sectional or correlational in nature. The current study is the first to examine the longitudinal trajectory of the relationship between caregiver-perceived uncertainty about their child's DSD and caregiver anxious and depressive symptoms across the first 12 months following genital surgery in young children, or if surgery was not performed, the first 12 months following study entry. METHODS One hundred and thirteen caregivers (Mage = 32.12; 57.5% mothers; 72.6% Caucasian) of children (N = 70; Mage = 9.81 months; 65.7% female) with DSD were recruited from 12 DSD specialty clinics in the United States. Caregivers completed psychosocial measures at baseline, 6 and 12 months following genitoplasty, or study entry if parents elected not to have surgery for their child. RESULTS Caregiver illness uncertainty and both anxious and depressive symptoms were highest at baseline and decreased over time (ps < .05). Caregiver illness uncertainty predicted symptoms of anxious and depressive symptoms across all time points (ps < .05). CONCLUSIONS Caregivers' perceptions of uncertainty about their child's DSD are highest soon after diagnosis, and uncertainty continues to predict both anxious and depressive symptoms across time. Thus, the initial diagnostic period is a critical time for psychological assessment and intervention, with parent illness uncertainty being an important clinical target.
Collapse
Affiliation(s)
- Caroline M Roberts
- Center for Pediatric Psychology, Department of Psychology, Oklahoma State University
| | - Christina M Sharkey
- Center for Pediatric Psychology, Department of Psychology, Oklahoma State University
| | - Dana M Bakula
- Center for Pediatric Psychology, Department of Psychology, Oklahoma State University
| | - Megan N Perez
- Center for Pediatric Psychology, Department of Psychology, Oklahoma State University
| | | | | | - Laurence S Baskin
- Department of Urology, University of California San Francisco Medical Center
| | - Yee-Ming Chan
- Division of Endocrinology, Department of Pediatrics, Harvard Medical School, Boston Children's Hospital
| | - Earl Y Cheng
- Department of Urology, Ann & Robert H. Lurie Children's Hospital of Chicago
| | - David A Diamond
- Department of Urology, Boston Children's Hospital, Harvard Medical School
| | - Allyson J Fried
- Pediatric Urology of Western New York, John R. Oishei Children's Hospital
| | | | | | - Sabrina Z Meyer
- Pediatric Urology of Western New York, John R. Oishei Children's Hospital
| | - Theresa Meyer
- Department of Urology, Ann & Robert H. Lurie Children's Hospital of Chicago
| | - Natalie J Nokoff
- Department of Endocrinology, Children's Hospital Colorado, University of Colorado Anschutz Medical Campus
| | - Blake W Palmer
- Department of Pediatric Urology, Cook Children's Medical Center
| | | | | | - Amy Tishelman
- Department of Urology, Boston Children's Hospital, Harvard Medical School.,Department of Psychiatry, Boston Children's Hospital, Harvard Medical School
| | - Pierre Williot
- Pediatric Urology of Western New York, John R. Oishei Children's Hospital
| | | | - Elizabeth B Yerkes
- Department of Urology, Ann & Robert H. Lurie Children's Hospital of Chicago
| | - Christopher Aston
- Department of Pediatrics, University of Oklahoma Health Sciences Center
| | - Amy B Wisniewski
- Center for Pediatric Psychology, Department of Psychology, Oklahoma State University
| | - Larry L Mullins
- Center for Pediatric Psychology, Department of Psychology, Oklahoma State University
| |
Collapse
|
30
|
Perez MN, Clawson AH, Baudino MN, Austin PF, Baskin LS, Chan YM, Cheng EY, Coplen D, Diamond DA, Fried AJ, Kolon T, Kropp B, Lakshmanan Y, Meyer T, Nokoff NJ, Palmer BW, Paradis A, Poppas DP, Reyes KJS, Williot P, Wolfe-Christensen C, Yerkes EB, Wisniewski AB, Mullins LL. Distress Trajectories for Parents of Children With DSD: A Growth Mixture Model. J Pediatr Psychol 2021; 46:588-598. [PMID: 33594414 DOI: 10.1093/jpepsy/jsab004] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Revised: 12/06/2020] [Accepted: 01/09/2021] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVE This study identifies trajectories of parent depressive symptoms after having a child born with genital atypia due to a disorder/difference of sex development (DSD) or congenital adrenal hyperplasia (CAH) and across the first year postgenitoplasty (for parents who opted for surgery) or postbaseline (for parents who elected against surgery for their child). Hypotheses for four trajectory classes were guided by parent distress patterns previously identified among other medical conditions. METHODS Participants included 70 mothers and 50 fathers of 71 children diagnosed with a DSD or CAH with reported moderate to high genital atypia. Parents were recruited from 11 US DSD specialty clinics within 2 years of the child's birth and prior to genitoplasty. A growth mixture model (GMM) was conducted to identify classes of parent depressive symptoms over time. RESULTS The best fitting model was a five-class linear GMM with freely estimated intercept variance. The classes identified were termed "Resilient," "Recovery," "Chronic," "Escalating," and "Elevated Partial Recovery." Four classes have previously been identified for other pediatric illnesses; however, a fifth class was also identified. The majority of parents were classified in the "Resilient" class (67.6%). CONCLUSIONS This study provides new knowledge about the trajectories of depressive symptoms for parents of children with DSD. Future studies are needed to identify developmental, medical, or familial predictors of these trajectories.
Collapse
Affiliation(s)
- Megan N Perez
- Center for Pediatric Psychology, Psychology Department, Oklahoma State University
| | - Ashley H Clawson
- Center for Pediatric Psychology, Psychology Department, Oklahoma State University
| | - Marissa N Baudino
- Center for Pediatric Psychology, Psychology Department, Oklahoma State University
| | | | - Laurence S Baskin
- Department of Urology, University of California San Francisco Medical Center
| | - Yee-Ming Chan
- Division of Endocrinology, Department of Pediatrics, Harvard Medical School and Boston Children's Hospital
| | - Earl Y Cheng
- Department of Urology, Ann & Robert H. Lurie Children's Hospital of Chicago
| | | | - David A Diamond
- Department of Urology, Boston Children's Hospital, Harvard Medical School
| | - Allyson J Fried
- Pediatric Urology of Western New York, John R. Oishei Children's Hospital
| | - Thomas Kolon
- Division of Urology, Children's Hospital of Philadelphia
| | - Bradley Kropp
- Department of Pediatric Urology, Cook Children's Medical Center
| | | | - Theresa Meyer
- Department of Urology, Ann & Robert H. Lurie Children's Hospital of Chicago
| | - Natalie J Nokoff
- Department of Endocrinology, Children's Hospital Colorado, University of Colorado Anschutz Medical Campus
| | - Blake W Palmer
- Department of Pediatric Urology, Cook Children's Medical Center
| | | | - Dix P Poppas
- Department of Urology, New York Presbyterian Weill Cornell Medicine
| | | | - Pierre Williot
- Pediatric Urology of Western New York, John R. Oishei Children's Hospital
| | | | - Elizabeth B Yerkes
- Department of Urology, Ann & Robert H. Lurie Children's Hospital of Chicago
| | - Amy B Wisniewski
- Center for Pediatric Psychology, Psychology Department, Oklahoma State University
| | - Larry L Mullins
- Center for Pediatric Psychology, Psychology Department, Oklahoma State University
| |
Collapse
|
31
|
Veale J. The associations of genital-normalizing surgery and assigned gender in predicting gender outcomes: A pooled nested case study analysis of 282 adults with differences of sex development in 58 academic articles. UROLOGICAL SCIENCE 2021. [DOI: 10.4103/uros.uros_65_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
|
32
|
Roen K, Carlquist E, Prøitz L. 'Does anyone else have this?' The role of emotion in forum discussions about medical conditions affecting sex characteristics. CULTURE, HEALTH & SEXUALITY 2021; 23:52-67. [PMID: 32031507 DOI: 10.1080/13691058.2019.1688867] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/20/2019] [Accepted: 10/31/2019] [Indexed: 06/10/2023]
Abstract
When people experience rare medical conditions or variations, searching online may be the only way to find others with similar experiences. This study examines what happens when people do just that. The dataset for the research has been generated from online posts by people living with variations of sex characteristics, which some call intersex variations. Our analysis focuses on how emotion appears in online posts, how affect becomes embodied in digital contexts, and how norms are negotiated as people relate to one another about the variations that some of them experience. We offer an analysis grounded in digital affect theory to contribute to health research literature. We suggest how health researchers and healthcare providers might develop more nuanced understandings of the emotional realities of people living with variations of sex characteristics.
Collapse
Affiliation(s)
- Katrina Roen
- Department of Psychology, University of Oslo, Oslo, Norway
| | - Erik Carlquist
- Department of Psychology, University of Oslo, Oslo, Norway
- Department of Psychology, Bjørknes University College, Oslo, Norway
| | - Lin Prøitz
- Department of Psychology, University of Oslo, Oslo, Norway
- Faculty of Business, Languages, and Social Sciences, Østfold University College, Halden, Norway
| |
Collapse
|
33
|
Zainuddin AA, Grover SR, Soon CH, Ghani NAA, Mahdy ZA, Manaf MRA, Shamsuddin K. A Multicenter Cross-Sectional Study of Malaysian Females With Congenital Adrenal Hyperplasia: Their Body Image and Their Perspectives on Feminizing Surgery. J Pediatr Adolesc Gynecol 2020; 33:477-483. [PMID: 32376362 DOI: 10.1016/j.jpag.2020.04.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2019] [Revised: 04/14/2020] [Accepted: 04/27/2020] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To explore the impact of congenital adrenal hyperplasia (CAH) on body image in Malaysian females with CAH and to understand the perspectives of these young women and their parents toward feminizing genitoplasty (FG). DESIGN Multi-center cross-sectional study. SETTING Two tertiary medical centers in Malaysia. PARTICIPANTS A total of 59 patients with CAH who were raised as females and more than 10 years old, and their parents. METHODS The CAH respondents completed the validated and translated Body Image Disturbance Questionnaires (BIDQ). All CAH respondents and their parents underwent semi-structured interviews to explore their views on FG. MAIN OUTCOME MEASURES Body image disturbance score and perspectives on FG. RESULTS The 59 CAH respondents consisted of 12 children, 29 adolescents, and 18 adults. The majority were of Malay ethnicity (64.4%) with classical CAH (98.3%) and had undergone FG (n = 55, 93.2%). For the BIDQ scores, the median score (interquartile range) for general body image was 1.29 (0.71), range 1.00-3.29, whereas the genital appearance score was 1.07 (0.39), range 1.00-4.29, revealing a greater concern for general body parts over genitalia. With regards to FG, it was perceived as necessary. Infancy and early childhood were perceived as the best timing for first FG by both respondents and parents, most preferring single-stage over 2-stage surgery. CONCLUSIONS General body appearance concerns were greater than for genital appearance, with more impact on the patients' lives. Contrary to much international opinion, feminizing surgery was perceived as necessary and appropriate by CAH respondents and their families, and should be offered in infancy or early childhood. Future qualitative studies are recommended.
Collapse
Affiliation(s)
- Ani Amelia Zainuddin
- Department of Obstetrics and Gynecology, UKM Medical Center, The National University of Malaysia (UKM), Kuala Lumpur, Malaysia.
| | - Sonia Regina Grover
- Department of Pediatric Adolescent Gynecology, Royal Children's Hospital Melbourne, University of Melbourne, Melbourne, Australia
| | - Chong Hong Soon
- Department of Obstetrics and Gynecology, UKM Medical Center, The National University of Malaysia (UKM), Kuala Lumpur, Malaysia
| | - Nur Azurah Abdul Ghani
- Department of Obstetrics and Gynecology, UKM Medical Center, The National University of Malaysia (UKM), Kuala Lumpur, Malaysia
| | - Zaleha Abdullah Mahdy
- Department of Obstetrics and Gynecology, UKM Medical Center, The National University of Malaysia (UKM), Kuala Lumpur, Malaysia
| | - Mohammad Rizal Abdul Manaf
- Department of Community Health, UKM Medical Center The National University of Malaysia (UKM), Kuala Lumpur, Malaysia
| | - Khadijah Shamsuddin
- Department of Community Health, UKM Medical Center The National University of Malaysia (UKM), Kuala Lumpur, Malaysia
| |
Collapse
|
34
|
Lampalzer U, Briken P, Schweizer K. Dealing With Uncertainty and Lack of Knowledge in Diverse Sex Development: Controversies on Early Surgery and Questions of Consent. Sex Med 2020; 8:472-489. [PMID: 32507554 PMCID: PMC7471094 DOI: 10.1016/j.esxm.2020.03.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2019] [Revised: 03/04/2020] [Accepted: 03/10/2020] [Indexed: 02/07/2023] Open
Abstract
INTRODUCTION Diverse sex development (dsd) is an umbrella term for different congenital conditions with incongruence of chromosomal, gonadal, and phenotypic sex characteristics. These are accompanied by various uncertainties concerning health-related, medical, psychosocial, and legal issues that raise controversial discussion. AIM The aim of this exploratory study was to investigate 3 questions: What are the most controversial and disputed issues in the context of intersex/dsd? Which issues are associated with the biggest knowledge gaps? Which issues involve the greatest difficulty or uncertainty in decision-making? A further aim was to investigate whether the group of persons concerned, the parents of intersex children, and the group of experts in the field had differing views regarding these questions. METHODS A self-developed questionnaire was distributed among persons concerned, parents of children with intersex/dsd, and experts in the field. It contained open and multiple-choice questions. The answers from 29 participants were entered into data analysis. A mixed-method approach was applied. Quantitative data were analysed descriptively. Qualitative data were analysed according to the principles of qualitative content analysis. MAIN OUTCOME MEASURE Participants answered questions on the most controversial and disputed issues, issues associated with the biggest knowledge gaps, and issues associated with the most difficulty or uncertainty in decision-making. RESULTS The findings indicate that controversial issues and uncertainties mainly revolve around surgical interventions but also around the question of how to adequately consider the consent of minors and how to deal with intersex in the family. Significant differences were found between persons concerned and parents vs academic experts in the field regarding the perceptions of procedure of diagnostic investigation and/or treatment in adulthood, on legal questions concerning marriage/registered civil partnerships, and on lack of psychosocial counseling close to place of residence. CONCLUSION The necessity of irreversible gonadal and genital surgery in early childhood is still a matter of strong controversy. To ensure the improvement in well-being of intersex persons, including a sexual health perspective, the positive acceptance of bodily variance is an important prerequisite. Psychosocial support regarding one-time decisions as well as ongoing and changing issues of everyday life appears to be an important means in reaching overall quality of life. Lampalzer U, Briken P, Schweizer K. Dealing With Uncertainty and Lack of Knowledge in Diverse Sex Development: Controversies on Early Surgery and Questions of Consent-A Pilot Study. Sex Med 2020;8:472-489.
Collapse
Affiliation(s)
- Ute Lampalzer
- Institute for Sex Research, Sexual Medicine and Forensic Psychiatry, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
| | - Peer Briken
- Institute for Sex Research, Sexual Medicine and Forensic Psychiatry, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Katinka Schweizer
- Institute for Sex Research, Sexual Medicine and Forensic Psychiatry, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| |
Collapse
|
35
|
Godfrey LM. Mental health outcomes among individuals with 46,XY disorders of sex development: A systematic review. J Health Psychol 2020; 26:40-59. [PMID: 32133887 DOI: 10.1177/1359105320909863] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
This review summarizes research on the mental health outcomes of genetic males with a disorder of sex development (46,XY DSD). Databases were systematically searched, yielding 19 studies included in this review. Results varied widely, with mental health outcomes ranging from very poor to similar to comparison groups. A small number of studies demonstrated that patients with hypospadias or complete androgen insensitivity syndrome reported better mental health than patients with other 46,XY (DSD) diagnoses. Future studies should include larger samples of patients within a similar developmental stage, display results separately by DSD diagnosis and gender identity, and consider the potential impact of medical/surgical events on their mental health.
Collapse
|
36
|
Szymanski KM, Salama AK, Whittam B, Frady H, Cain MP, Rink RC. Beyond changing diapers: stress and decision-making among parents of girls with congenital adrenal hyperplasia seeking consultation about feminizing genital restoration surgery. J Pediatr Urol 2019; 15:653-658. [PMID: 31685391 DOI: 10.1016/j.jpurol.2019.09.022] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2019] [Accepted: 09/27/2019] [Indexed: 10/25/2022]
Abstract
INTRODUCTION/BACKGROUND The impact of having a child with atypical genitalia due to a life-threating chronic medical condition like congenital adrenal hyperplasia (CAH) is poorly understood. OBJECTIVE The aim of the study was to determine parental stress and impact of CAH on parental decisions, including decisions regarding female genital restoration surgery (FGRS). STUDY DESIGN The authors surveyed consecutive parents of girls with CAH ≤3 years presenting at a tertiary referral center for FGRS consultation (2016-2019). The survey was developed by three families of daughters with CAH and six clinicians. Nine potentially stressful past experiences were rated on a 6-point Likert scale ('not at all' to 'extremely' stressful). Overall parental stress and strain (broader negative consequences) were reported using validated instruments (Perceived Stress Scale and Caregiver Strain Questionnaire Short Form, respectively). Impact of CAH on past decisions about childcare, social interactions, and who changes diapers were also assessed. Non-parametric tests were used for analysis. RESULTS Twenty-nine parents (median age: 32years) of 22 consecutive children participated (Prader 3/4/5: 59.1%/36.4%/4.5%). After the study, 20 girls (90.9%) underwent FGRS at a median age of 8 months. The most stressful experiences were having an adrenal crisis ('very much' stressful), waiting for the CAH diagnosis, and making sense of the diagnosis (both 'quite a bit') (Figure 1). Remaining issues were 'somewhat' stressful. Deciding whether to proceed with FGRS was ranked as the least stressful issue. Overall parental stress was similar to overall stress previously reported by spousal caregivers of stroke or heart failure survivors (P ≥ 0.15). Overall parental strain was similar to parents of adolescents receiving mental health counseling (P = 0.77). Congenital adrenal hyperplasia impacted decisions about babysitting, daycare, who changed diapers, and choosing a pediatrician (P ≤ 0.02), but did not impact parental social interactions (P ≥ 0.11). Diapers were typically changed by parents (100.0%) and grandmothers (50.0%). Parents anticipated that some individuals currently not allowed to change diapers would be allowed after FGRS: grandfathers (+18.2%), aunts/uncles (+27.3-32.8%), cousins (+18.2%), and family friends (+45.5%). DISCUSSION The authors present the first assessment of parental stress with respect to different aspects of care of a daughter with CAH. Larger studies are required to determine if the parental stress associated with these experiences varies over time and how these stressors rank relative to each other through the child's development. CONCLUSION Parents experience multiple stressors after having a daughter with CAH. Parental stress surrounding a decision about FGRS appears less severe than events pertaining to the diagnosis and medical management of CAH. Congenital adrenal hyperplasia impacts multiple parental decisions.
Collapse
Affiliation(s)
- Konrad M Szymanski
- Division of Pediatric Urology, Riley Hospital for Children at IU Health, IN, USA.
| | - Amr K Salama
- Division of Pediatric Urology, Riley Hospital for Children at IU Health, IN, USA
| | - Benjamin Whittam
- Division of Pediatric Urology, Riley Hospital for Children at IU Health, IN, USA
| | - Heather Frady
- Division of Pediatric Urology, Riley Hospital for Children at IU Health, IN, USA
| | - Mark P Cain
- Division of Pediatric Urology, Riley Hospital for Children at IU Health, IN, USA
| | - Richard C Rink
- Division of Pediatric Urology, Riley Hospital for Children at IU Health, IN, USA
| |
Collapse
|
37
|
Timmermans S, Yang A, Gardner M, Keegan CE, Yashar BM, Fechner PY, Shnorhavorian M, Vilain E, Siminoff LA, Sandberg DE. Gender destinies: assigning gender in Disorders of Sex Development-Intersex clinics. SOCIOLOGY OF HEALTH & ILLNESS 2019; 41:1520-1534. [PMID: 31225650 DOI: 10.1111/1467-9566.12974] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
Based on audio recordings of consultations in three U.S. paediatric multidisciplinary Disorders of Sex Development-Intersex clinics, we examine the process of gender assignment of children with "atypical" genitalia. Rather than fully determined by the presence of biological sex traits, the gender assignment discussion hinges on how clinician and parent collaboratively imagine different aspects of what constitutes being a gendered person. They orient towards the potential for sexual intimacy, fertility, gender dysphoria, stigma, and gonadal cancer risk. While these futures remain inherently uncertain, clinicians and parents plan to mobilise gender socialisation and medical interventions to render their choice of gender a self-fulfilling prophecy. Gender destinies capture that the child always had a specific, innate gender awaiting discovery, and presumes a project for medical and social monitoring, intervention, correction, and optimisation.
Collapse
Affiliation(s)
| | - Ashelee Yang
- Department of Sociology-UCLA, Los Angeles, CA, USA
| | - Melissa Gardner
- Department of Pediatrics & Communicable Diseases, University of Michigan, Ann Arbor, MI, USA
| | - Catherine E Keegan
- Department of Pediatric Genetics, University of Michigan, Ann Arbor, MI, USA
| | - Beverly M Yashar
- Department of Human Genetics, University of Michigan, Ann Arbor, MI, USA
| | | | | | - Eric Vilain
- Children's Research Institute, Children's National Medical Center, Washington, DC, USA
| | - Laura A Siminoff
- College of Public Health, Temple University, Philadelphia, PA, USA
| | - David E Sandberg
- Department of Pediatrics & Communicable Diseases, University of Michigan, Ann Arbor, MI, USA
| |
Collapse
|
38
|
Abstract
Differences of sex development (DSD) include a variety of complex congenital genitourinary abnormalities-whether sporadic or hereditary. The 2006 DSD Consensus Statement and 2016 Update Consensus Statement encourage better communication among providers, between providers and parents, as well as among providers, parents, and patients when developmentally appropriate.1,2 However, a lack of clear communication about the diagnosis and its sequelae may occur at three levels: (1) disclosure from DSD patients' families to their physician, (2) disclosure from patients to their families/communities, and (3) disclosure from the physician to the DSD patient. Additionally, there is a paucity of research available on how culture can impact disclosure among individuals with DSDs. This article discusses disclosure among the various stakeholders and briefly explores the impact of cultural expectations and beliefs with regards to disclosure.
Collapse
Affiliation(s)
- Erica M. Weidler
- Corresponding author: Address, Phoenix Children’s Hospital, 1919 E. Thomas Rd., Phoenix, Arizona 85016,
| | | |
Collapse
|
39
|
Sandberg DE, Gardner M, Kopec K, Urbanski M, Callens N, Keegan CE, Yashar BM, Fechner PY, Shnorhavorian M, Vilain E, Timmermans S, Siminoff LA. Development of a decision support tool in pediatric Differences/Disorders of Sex Development. Semin Pediatr Surg 2019; 28:150838. [PMID: 31668291 PMCID: PMC6911706 DOI: 10.1016/j.sempedsurg.2019.150838] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Decisions about how best to clinically care for young children born with Disorders of Sex Development (DSD) can be challenging because some decisions are irreversible, have lasting physical and mental health effects, and are frequently made before the affected person is able to participate in decision-making. This multi-stage study involved (1) the development of a web-based decision support tool (DST) for parents of infants or young children and the clinicians caring for them; (2) the assessment of communications and decision making between DSD specialists and parents both before and after introduction of the DST; and (3) interviews with a broad range of stakeholders regarding optimizing the DST and integrating it into usual care. Experience over the course of the 3 stages of this research suggests the need for further refinement of the DST to increase acceptability to all stakeholder groups, the necessity to address misperceptions by providers that they are already accomplishing all aspects of SDM in regular care without a DST and misunderstandings by parents that decisions are unnecessary because only a single option is apparent, and to better incorporate the tool into regular clinic workflow.
Collapse
Affiliation(s)
- David E Sandberg
- Department of Pediatrics, Child Health, Evaluation and Research (CHEAR) Center, University of Michigan, 300 N Ingalls Bldg, 6C23, Ann Arbor, MI 48109, United States.
| | - Melissa Gardner
- Department of Pediatrics, Child Health, Evaluation and Research (CHEAR) Center, University of Michigan, 300 N Ingalls Bldg, 6C23, Ann Arbor, MI 48109, United States
| | | | - Megan Urbanski
- Social and Behavioral Sciences, Temple University, United States
| | - Nina Callens
- Department of Pediatrics, Child Health Evaluation and Research (CHEAR) Center, Belgian American Educational Foundation (BAEF Inc), University of Michigan, United States
| | | | - Beverly M Yashar
- Department of Human Genetics, University of Michigan, United States
| | | | - Margarett Shnorhavorian
- Department of Urology, Division of Pediatric Urology, Seattle Children's Hospital, University of Washington, United States
| | - Eric Vilain
- Children's National Health System, Center for Genetic Medicine Research, Children's Research Institute, United States
| | - Stefan Timmermans
- Department of Sociology, University of California Los Angeles, United States
| | - Laura A Siminoff
- Department of Social and Behavioral Sciences, College of Public Health, Temple University, United States
| |
Collapse
|
40
|
Weidler EM, Baratz A, Muscarella M, Hernandez SJ, van Leeuwen K. A shared decision-making tool for individuals living with complete androgen insensitivity syndrome. Semin Pediatr Surg 2019; 28:150844. [PMID: 31668289 PMCID: PMC7208826 DOI: 10.1016/j.sempedsurg.2019.150844] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Reports exist regarding a gradual approach to the care of patients with differences of sexual development. Each patient and family have different values and styles of learning that have to be taken into account. The goals of care should include education about the condition, counseling of the patient and family, and a complete outlining of treatment options. Motivated by a call from the 2010 Health Reform Law for the use of shared decision-making tools and the emphasis placed on these issues by the DSD Consensus Statement, we sought to develop and implement such tools for the DSD population.1-3 Thus, we developed an organized checklist for providers to share with a patients and families affected by CAIS, beginning with the initial visit. The development of the document enlisted input from physicians, clinical coordinator, advocacy groups and affected individuals. It allows providers to explain the process of care and develop a plan for delivery of that care over multiple visits spanning six months or more. The checklist is divided into five sections: 1) An overview addressing how much information is desired and in what manner the patient prefers to obtain information; 2) A preferred words list so that the patient can choose nomenclature that is most comfortable; 3) A list of topics to review over the course of multiple visits; 4) A list of questions to be answered by the providers or other resources over time, and; 5) A list of concerns to be addressed before surgical intervention is considered. An organized approach to long-term delivery of compassionate care and accurate information can be facilitated for patients with CAIS by the use of a shared decision-making checklist. Documentation of the care delivery process can stimulate referral to peer support and promote fully informed consent for treatment decisions. The use of the checklist should encourage trust in the provider, as well as aid in identifying and addressing stressors for the patient and family. The checklist will be updated and revised as new treatments and advanced technology emerges.
Collapse
Affiliation(s)
- Erica M. Weidler
- Division of Pediatric Surgery, Phoenix Children’s Hospital, 1919 E. Thomas Rd., Phoenix, AZ, United States
| | - Arlene Baratz
- Androgen Insensitivity Syndrome-Differences of Sex Development Support Group, Duncan, OK, United States,Interact Advocates for Intersex Youth, Sudbury, MA, United States
| | - Miriam Muscarella
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA 94305, United States
| | - S. Janett Hernandez
- Division of Pediatric Surgery, Phoenix Children’s Hospital, 1919 E. Thomas Rd., Phoenix, AZ, United States
| | - Kathleen van Leeuwen
- Division of Pediatric Surgery, Phoenix Children's Hospital, 1919 E. Thomas Rd., Phoenix, AZ, United States.
| |
Collapse
|
41
|
Crerand CE, Kapa HM, Litteral JL, Nahata L, Combs B, Indyk JA, Jayanthi VR, Chan YM, Tishelman AC, Hansen-Moore J. Parent perceptions of psychosocial care for children with differences of sex development. J Pediatr Urol 2019; 15:522.e1-522.e8. [PMID: 31353277 DOI: 10.1016/j.jpurol.2019.06.024] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2019] [Accepted: 06/27/2019] [Indexed: 11/19/2022]
Abstract
SHORT INTRODUCTION/BACKGROUND Children affected by differences/disorders of sex development (DSDs) and their families are vulnerable to significant risks across developmental stages that threaten quality of life and psychosocial functioning. Accordingly, both experts in DSD treatment and patient advocacy groups have endorsed the incorporation of psychosocial care into interdisciplinary management of DSD conditions. OBJECTIVE This study assessed psychosocial needs and received services reported by parents of children with DSD treated at two large US academic medical centers. Specifically, differences in parents' perceptions of psychosocial service needs were compared between those who received or did not receive interdisciplinary care that included psychology/social work professionals. STUDY DESIGN In a cross-sectional study, sixty-four parents of children with DSD aged 0-19 years attending two major academic centers with interdisciplinary teams completed a questionnaire about their receipt and perception of 12 individual psychosocial services throughout their child's DSD treatment. RESULTS Receipt of individual psychosocial services ranged from 27 to 81%. Most commonly, parents reported having a psychosocial provider explain medical terms and answer questions after talking with a doctor (81%), assist with words and terms to describe the condition and treatment (69%), and help navigate the hospital system (63%). Families positively endorsed psychosocial services, with 91-100% of services received rated as helpful. Parents of children who received care as part of an interdisciplinary team were significantly more likely to receive psychosocial services than those treated by single providers (e.g., urologists). Specific gaps in psychosocial care were noted in regard to access to mental health providers familiar with DSD, fertility counseling, and support with community advocacy (e.g., arranging for accommodations at the school or advocating on patient's behalf with the insurance company). Among families who had not received them, services most desired were assistance with words and terms to describe condition or treatment; explanation of medical terms and answering questions after meeting with a doctor; connection to resources such as books, pamphlets, websites, and support groups; and a central care coordinator for the medical team. DISCUSSION AND CONCLUSION Families value psychosocial services but are far less likely to receive services if they are not seen in an interdisciplinary clinic visit that includes a psychosocial provider. Families desire but often lack mental health, advocacy, and fertility-related support. This study highlights the need for sustained psychosocial follow-up across development, even in the absence of pressing medical concerns, to provide support and anticipatory guidance as needs and issues evolve.
Collapse
Affiliation(s)
- C E Crerand
- Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH 43205, USA; Department of Plastic Surgery, The Ohio State University College of Medicine, 370 W. 9th Avenue, Columbus, OH 43210, USA.
| | - H M Kapa
- Center for Biobehavioral Health, The Research Institute at Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH 43205, USA
| | - J L Litteral
- Center for Biobehavioral Health, The Research Institute at Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH 43205, USA
| | - L Nahata
- Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH 43205, USA; Department of Pediatrics, The Ohio State University College of Medicine, 370 W. 9th Avenue, Columbus, OH 43210, USA
| | - B Combs
- Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH 43205, USA
| | - J A Indyk
- Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH 43205, USA; Department of Pediatrics, The Ohio State University College of Medicine, 370 W. 9th Avenue, Columbus, OH 43210, USA
| | - V R Jayanthi
- Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH 43205, USA; Department of Urology, The Ohio State University College of Medicine, 370 W. 9th Avenue, Columbus, OH 43210, USA
| | - Y-M Chan
- Boston Children's Hospital, 300 Longwood Avenue, Boston, MA 02115, USA; Harvard Medical School, 25 Shattuck Street, Boston, MA 02115, USA
| | - A C Tishelman
- Boston Children's Hospital, 300 Longwood Avenue, Boston, MA 02115, USA; Harvard Medical School, 25 Shattuck Street, Boston, MA 02115, USA
| | - J Hansen-Moore
- Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH 43205, USA; Department of Pediatrics, The Ohio State University College of Medicine, 370 W. 9th Avenue, Columbus, OH 43210, USA
| |
Collapse
|
42
|
Nokoff N, Ariefdjohan M, Travers S, Buchanan C. Parent experience with volunteers and support groups in a multidisciplinary DSD clinic. CLINICAL PRACTICE IN PEDIATRIC PSYCHOLOGY 2019; 8:348-358. [PMID: 33777596 DOI: 10.1037/cpp0000302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Objective Despite recommendations that clinics for children with a difference of sex development (DSD) should include peer support, information on how to provide this support is lacking. We utilized a mixed-methods program evaluation to evaluate family satisfaction with our clinic-based volunteers (who either have DSD themselves or are a parent of a child with DSD) and to understand the experience of these volunteers. Methods Parents (n=29) of a child with DSD completed an electronic survey. Interviews were conducted with three clinic volunteers. Results Most participants (72%) met with a clinic volunteer and majority (81%) rated their interaction as helpful. Most common topics discussed between parents and volunteers included: connecting to support groups (81%), their child's future (62%), and learning about their child's diagnosis (48%). Half of parents (48%) attended an after-clinic support group lunch, and 43% of these attendees rated the lunch session as helpful. Parents who attended a lunch liked the experience because they met other families with a child with a similar medical condition (100%), met volunteers with a similar medical condition (64%), and it helped them think more positively about their child's future (64%). Those who did not attend a lunch cited logistical reasons for not attending. Conclusions Incorporating clinic volunteers into a multidisciplinary DSD clinic is associated with high reported rates of satisfaction by families and volunteers.
Collapse
Affiliation(s)
- Natalie Nokoff
- University of Colorado Anschutz Medical Campus, Department of Pediatrics
| | - Merlin Ariefdjohan
- University of Colorado Anschutz Medical Campus, Department of Psychiatry
| | - Sharon Travers
- University of Colorado Anschutz Medical Campus, Department of Pediatrics
| | - Cindy Buchanan
- University of Colorado Anschutz Medical Campus, Department of Psychiatry.,University of Colorado Anschutz Medical Campus, Department of Surgery
| |
Collapse
|
43
|
Delozier AM, Gamwell KL, Sharkey C, Bakula DM, Perez MN, Wolfe-Christensen C, Austin P, Baskin L, Bernabé KJ, Chan YM, Cheng EY, Diamond DA, Ellens REH, Fried A, Galan D, Greenfield S, Kolon T, Kropp B, Lakshmanan Y, Meyer S, Meyer T, Nokoff NJ, Reyes KJ, Palmer B, Poppas DP, Paradis A, Tishelman AC, Yerkes EB, Chaney JM, Wisniewski AB, Mullins LL. Uncertainty and Posttraumatic Stress: Differences Between Mothers and Fathers of Infants with Disorders of Sex Development. ARCHIVES OF SEXUAL BEHAVIOR 2019; 48:1617-1624. [PMID: 31144217 PMCID: PMC7265677 DOI: 10.1007/s10508-018-1357-6] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/08/2017] [Revised: 11/13/2018] [Accepted: 11/21/2018] [Indexed: 06/09/2023]
Abstract
Parents of children with disorders of sex development (DSD) report significant psychological distress, including posttraumatic stress symptoms (PTSS), with mothers consistently reporting higher rates of psychological distress than fathers. However, psychological factors contributing to PTSS in both parents are not well understood. The present study sought to fill this gap in knowledge by examining PTSS and illness uncertainty, a known predictor of psychological distress, in parents of children recently diagnosed with DSD. Participants were 52 mothers (Mage = 32.55 years, SD = 5.08) and 41 fathers (Mage = 35.53 years, SD = 6.78) of 53 infants (Mage = 9.09 months, SD = 6.19) with DSD and associated atypical genital development. Participants were recruited as part of a larger, multisite study assessing parents' psychosocial response to their child's diagnosis of DSD. Parents completed measures of illness uncertainty and PTSS. Mothers reported significantly greater levels of PTSS, but not illness uncertainty, than fathers, and were more likely than fathers to report clinical levels of PTSS (21.2% compared to 7.3%). Hierarchical regression revealed that parent sex, undiagnosed or unclassified DSD status, and illness uncertainty were each associated with PTSS. The overall model accounted for 23.5% of the variance associated with PTSS. Interventions targeting illness uncertainty may be beneficial for parents of children with newly diagnosed DSD.
Collapse
Affiliation(s)
| | - Kaitlyn L Gamwell
- Department of Psychology, Oklahoma State University, Stillwater, OK, 74078, USA
| | - Christina Sharkey
- Department of Psychology, Oklahoma State University, Stillwater, OK, 74078, USA
| | - Dana M Bakula
- Department of Psychology, Oklahoma State University, Stillwater, OK, 74078, USA
| | - Megan N Perez
- Department of Psychology, Oklahoma State University, Stillwater, OK, 74078, USA
| | - Cortney Wolfe-Christensen
- Department of Pediatric Urology, Cook Children's Medical Center, Fort Worth, TX, USA
- Department of Pediatric Urology, Children's Hospital of Michigan, Detroit, MI, USA
| | - Paul Austin
- Department of Urology, Texas Children's Hospital, Houston, TX, USA
| | - Laurence Baskin
- Department of Urology, University of California San Francisco Medical Center, San Francisco, CA, USA
| | - Kerlly J Bernabé
- Department of Urology, Komansky Children's Hospital, New York Presbyterian Weill Cornell Medicine, New York, NY, USA
| | - Yee-Ming Chan
- Department of Pediatrics, Boston Children's Hospital, Boston, MA, USA
| | - Earl Y Cheng
- Division of Urology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
| | - David A Diamond
- Department of Urology, Boston Children's Hospital, Boston, MA, USA
| | - Rebecca E H Ellens
- Department of Pediatric Urology, Children's Hospital of Michigan, Detroit, MI, USA
| | - Allyson Fried
- Department of Pediatric Urology, Oishei Children's Hospital, Buffalo, NY, USA
| | - Denise Galan
- Department of Urology, Komansky Children's Hospital, New York Presbyterian Weill Cornell Medicine, New York, NY, USA
| | - Saul Greenfield
- Department of Pediatric Urology, Oishei Children's Hospital, Buffalo, NY, USA
| | - Thomas Kolon
- Division of Urology, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Bradley Kropp
- Department of Pediatric Urology, Cook Children's Medical Center, Fort Worth, TX, USA
| | - Yegappan Lakshmanan
- Department of Pediatric Urology, Children's Hospital of Michigan, Detroit, MI, USA
| | - Sabrina Meyer
- Department of Pediatric Urology, Oishei Children's Hospital, Buffalo, NY, USA
| | - Theresa Meyer
- Division of Urology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
| | - Natalie J Nokoff
- Department of Pediatrics, University of Colorado Anschutz Medical Campus, Section of Endocrinology, Aurora, CO, USA
| | - Kristy J Reyes
- Department of Pediatric Urology, Cook Children's Medical Center, Fort Worth, TX, USA
| | - Blake Palmer
- Department of Pediatric Urology, Cook Children's Medical Center, Fort Worth, TX, USA
| | - Dix P Poppas
- Department of Urology, Komansky Children's Hospital, New York Presbyterian Weill Cornell Medicine, New York, NY, USA
| | - Alethea Paradis
- Division of Urologic Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, MO, USA
| | - Amy C Tishelman
- Department of Endocrinology, Department of Psychiatry, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Elizabeth B Yerkes
- Division of Urology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
| | - John M Chaney
- Department of Psychology, Oklahoma State University, Stillwater, OK, 74078, USA
| | - Amy B Wisniewski
- Department of Pediatric Urology, Cook Children's Medical Center, Fort Worth, TX, USA
| | - Larry L Mullins
- Department of Psychology, Oklahoma State University, Stillwater, OK, 74078, USA
| |
Collapse
|
44
|
Chawla R, Weidler EM, Hernandez J, Grimbsy G, van Leeuwen K. Utilization of a shared decision-making tool in a female infant with congenital adrenal hyperplasia and genital ambiguity. J Pediatr Endocrinol Metab 2019; 32:643-646. [PMID: 31145695 DOI: 10.1515/jpem-2018-0567] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2018] [Accepted: 04/08/2019] [Indexed: 12/11/2022]
Abstract
Background Shared decision-making (SDM) is the process by which patients/families and providers make healthcare decisions together. Our team of multidisciplinary disorders of sex development (DSD) has developed an SDM tool for parents and female patients with congenital adrenal hyperplasia (CAH) and associated genital atypia. What is new Elective genital surgery is considered controversial. SDM in a patient with genital atypia will allow patient/family to make an informed decision regarding surgical intervention. Case presentation Our patient is a 2.5-year-old female with CAH and genital atypia. Initially, her parents had intended to proceed with surgery; however, after utilizing the SDM checklist, they made an informed decision to defer urogenital sinus surgery for their daughter. Conclusions We successfully utilized an SDM tool with parents of a female infant with CAH and genital atypia, which allowed them to make an informed decision regarding surgery for their daughter. Future directions include a prospective enrolling study to determine the generalizability and applicability of SDM with families of children diagnosed with CAH.
Collapse
Affiliation(s)
- Reeti Chawla
- Attending Physician, Division of Pediatric Endocrinology, Phoenix Children's Hospital, Clinical Assistant Professor - Child Health, UA College of Medicine - Phoenix, 1920 East Cambridge Ave, Suite 301, Phoenix, AZ 85016, USA
| | - Erica M Weidler
- Division of Pediatric Surgery, Phoenix Children's Hospital, Phoenix, AZ, USA
| | - Janett Hernandez
- Division of Pediatric Surgery, Phoenix Children's Hospital, Phoenix, AZ, USA
| | - Gwen Grimbsy
- Division of Pediatric Urology, Phoenix Children's Hospital, Phoenix, AZ, USA
| | | |
Collapse
|
45
|
Liao LM, Hegarty P, Creighton S, Lundberg T, Roen K. Clitoral surgery on minors: an interview study with clinical experts of differences of sex development. BMJ Open 2019; 9:e025821. [PMID: 31171549 PMCID: PMC6561419 DOI: 10.1136/bmjopen-2018-025821] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
OBJECTIVES Clitoral surgery on minors diagnosed with differences of sex development is increasingly positioned as a violation of human rights. This qualitative study identified how health professionals (HPs) navigate the contentious issues as they offer care to affected families. DESIGN Qualitative analysis of audio-recorded semistructured interviews with HPs. All of the interviews were transcribed verbatim for theoretical thematic analysis. SETTING Twelve specialist multidisciplinary care centres for children, adolescents and adults diagnosed with a genetic condition associated with differences of sex development. PARTICIPANTS Thirty-two medical, surgical, psychological and nursing professionals and clinical scientists in 12 specialist centres in Britain and Sweden formed the interview sample. RESULTS All interviewees were aware of the controversial nature of clitoral surgery and perceived themselves and their teams as non-interventionist compared with other teams. Data analyses highlighted four strategies that the interviewees used to navigate their complex tasks: (1) engaging with new thinking, (2) holding on to historical assumptions, (3) reducing the burden of dilemmas and (4) being flexible. In response to recent reports and debates that challenge clitoral surgery on minors, HPs had revised some of their opinions. However, they struggled to reconcile their new knowledge with the incumbent norms in favour of intervention as they counsel care users with variable reactions and expectations. The flexible approach taken may reflect compromise, but the interviewees were often trapped by the contradictory values and assumptions. CONCLUSIONS If the pathology-based vocabularies and narratives about genital diversity could be modified, and normative assumptions are questioned more often, clinicians may be more adept at integrating their new knowledge into a more coherent model of care to address the psychosocial concerns that genital surgery purports to overcome.
Collapse
Affiliation(s)
- Lih-Mei Liao
- Women’s Health Division, University College London Hospitals NHS Foundation Trust, London, UK
| | - Peter Hegarty
- School of Psychology, University of Surrey, Guildford, UK
| | - Sarah Creighton
- Women’s Health Division, University College London Hospitals NHS Foundation Trust, London, UK
| | - Tove Lundberg
- Department of Psychology, Lund University, Lund, Sweden
| | - Katrina Roen
- School of Social Sciences, University of Waikato, Hamilton, New Zealand
- Department of Psychology, University of Oslo, Oslo, Norway
| |
Collapse
|
46
|
Lundberg T, Dønåsen I, Hegarty P, Roen K. Moving intersex/DSD rights and care forward: Lay understandings of common dilemmas. JOURNAL OF SOCIAL AND POLITICAL PSYCHOLOGY 2019. [DOI: 10.5964/jspp.v7i1.1012] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
When sex characteristics develop in ways that do not conform to binary models, dilemmas arise regarding how to understand the situation and what terminology to use to describe it. While current medical nomenclature suggests that it should be understood as a disorder of sex development (DSD) prompting medical responses, many describe intersex as a human variation in sexed embodiment that should be protected under discrimination laws. These opposing perspectives suggest different principles to employ in responding to dilemmas about gender assignment, early genital surgery and full disclosure of medical information. In this discursive psychological study, we explore how lay people, without prior knowledge or experience of intersex/DSD, make sense of these dilemmas and the underpinning discourses giving rise to how they talk about these situations. By using the discursive framework of ideological dilemmas, we analyse how people make sense of sex and gender (as binary or non-binary), how they deal with difference (as problematic or not), and how they understand who is in a position to make decisions in such situations. We conclude that engaging with dilemmas in-depth is more constructive than favouring one principle over others in moving social science research, reflexive clinical practice, and wider political debates on intersex/DSD forward.
Collapse
|
47
|
Roen K. Intersex or Diverse Sex Development: Critical Review of Psychosocial Health Care Research and Indications for Practice. JOURNAL OF SEX RESEARCH 2019; 56:511-528. [PMID: 30907687 DOI: 10.1080/00224499.2019.1578331] [Citation(s) in RCA: 44] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
Intersex or diverse sex development (dsd) can be conceptualized as an aspect of bodily diversity that has particular psychosocial implications. This is a review of psychosocial health care literature, published from 2007 to 2017, focusing on the well-being of people with a diagnosis relating to sex development. The analysis I offer here takes a critical psychological approach, questioning norms and taken-for-granted assumptions. This approach works from the understanding that how we know and how we talk about a phenomenon affects people in material and life-changing ways. This article offers recommendations concerning health care communication, the importance of taking time for emotion, and the process of building supportive relationships. The research reviewed provides clear evidence of psychosocial harm that is done through genital intervention and evidence that parents do not routinely give fully informed consent before their children undergo treatment. Finally, I highlight key points and recommendations for health professionals, indicating how psychosocial professionals can contribute to health care and well-being in the context of dsd when appropriately resourced and trained.
Collapse
Affiliation(s)
- Katrina Roen
- a Department of Sociology , University of Waikato
| |
Collapse
|
48
|
Timmermans S, Yang A, Gardner M, Keegan CE, Yashar BM, Fechner PY, Shnorhavorian M, Vilain E, Siminoff LA, Sandberg DE. Does Patient-centered Care Change Genital Surgery Decisions? The Strategic Use of Clinical Uncertainty in Disorders of Sex Development Clinics. JOURNAL OF HEALTH AND SOCIAL BEHAVIOR 2018; 59:520-535. [PMID: 30303019 DOI: 10.1177/0022146518802460] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
Genital surgery in children with ambiguous or atypical genitalia has been marred by controversies about the appropriateness and timing of surgery, generating clinical uncertainty about decision making. Since 2006, medical experts and patient advocates have argued for putting the child's needs central as patient-centered care. Based on audio recordings of 31 parent-clinician interactions in three clinics of disorders of sex development, we analyze how parents and clinicians decide on genital surgery. We find that clinicians and parents aim for parent-centered rather than infant-centered care. Parents receive ambivalent messages about surgery: while clinicians express caution, they also present the surgery as beneficial. We examine how parents and clinicians reach agreement about surgery-differentiating parents who push strongly for surgery from parents who do not express any preconceived preferences about surgery and parents who resist surgery. We conclude that clinicians use clinical uncertainty about surgery strategically to direct parents toward perceived clinically appropriate decisions.
Collapse
Affiliation(s)
| | - Ashelee Yang
- 1 University of California-Los Angeles, Los Angeles, CA, USA
| | | | | | | | | | | | - Eric Vilain
- 4 Children's National Health System, Washington, DC, USA
| | | | | |
Collapse
|
49
|
Gardner M, Sandberg DE. Navigating Surgical Decision Making in Disorders of Sex Development (DSD). Front Pediatr 2018; 6:339. [PMID: 30510925 PMCID: PMC6252317 DOI: 10.3389/fped.2018.00339] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2018] [Accepted: 10/22/2018] [Indexed: 11/24/2022] Open
Abstract
Surgical management of disorders of sex development (DSD) is associated with contentious debate between and within stakeholder communities. While the intent of surgical management of the genitals and gonads is to benefit the patient physically and psychosocially, these goals have not always been achieved; reports of harm have surfaced. Harm experienced by some patients has resulted in the emergence of an activist platform calling for a moratorium on all surgical procedures during childhood-excepting those forestalling threats to life within the childhood years. This ban is not universally endorsed by patient advocacy groups. Parents, meanwhile, continue to need to make decisions regarding surgical options for their young children. Constructive paths forward include implementation of Consensus Statement recommendations that call for comprehensive and integrated team care, incorporating mental health services, and adopting shared decision making.
Collapse
Affiliation(s)
| | - David E. Sandberg
- Division of Pediatric Psychology and the Child Health Evaluation and Research (CHEAR) Center, Department of Pediatrics and Communicable Diseases, University of Michigan, Ann Arbor, MI, United States
| |
Collapse
|
50
|
Ernst MM, Gardner M, Mara CA, Délot EC, Fechner PY, Fox M, Rutter MM, Speiser PW, Vilain E, Weidler EM, Sandberg DE. Psychosocial Screening in Disorders/Differences of Sex Development: Psychometric Evaluation of the Psychosocial Assessment Tool. Horm Res Paediatr 2018; 90:368-380. [PMID: 30783028 PMCID: PMC6512800 DOI: 10.1159/000496114] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2018] [Accepted: 12/10/2018] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND/AIMS Utilization of a psychosocial screener to identify families affected by a disorder/difference of sex development (DSD) and at risk for adjustment challenges may facilitate efficient use of team resources to optimize care. The Psychosocial Assessment Tool (PAT) has been used in other pediatric conditions. The current study explored the reliability and validity of the PAT (modified for use within the DSD population; PAT-DSD). METHODS Participants were 197 families enrolled in the DSD-Translational Research Network (DSD-TRN) who completed a PAT-DSD during a DSD clinic visit. Psychosocial data were extracted from the DSD-TRN clinical registry. Internal reliability of the PAT-DSD was tested using the Kuder-Richardson-20 coefficient. Validity was examined by exploring the correlation of the PAT-DSD with other measures of caregiver distress and child emotional-behavioral functioning. RESULTS One-third of families demonstrated psychosocial risk (27.9% "Targeted" and 6.1% "Clinical" level of risk). Internal reliability of the PAT-DSD Total score was high (α = 0.86); 4 of 8 subscales met acceptable internal reliability. A priori predicted relationships between the PAT-DSD and other psychosocial measures were supported. The PAT-DSD Total score related to measures of caregiver distress (r = 0.40, p < 0.001) and to both caregiver-reported and patient self-reported behavioral problems (r = 0.61, p < 0.00; r = 0.37, p < 0.05). CONCLUSIONS This study provides evidence for the reliability and validity of the PAT-DSD. Given variability in the internal reliability across subscales, this measure is best used to screen for overall family risk, rather than to assess specific psychosocial concerns.
Collapse
Affiliation(s)
- Michelle M. Ernst
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio and Disorders of Sex Development Center, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
| | - Melissa Gardner
- Department of Pediatrics and Communicable Diseases and the Child Health Evaluation & Research Center, University of Michigan Medical School, Ann Arbor, Michigan
| | - Constance A. Mara
- Department of Pediatrics, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
| | - Emmanuèle C. Délot
- Center for Genetic Medicine Research, Children’s National Medical Center, Washington, DC
| | - Patricia. Y. Fechner
- Department of Pediatrics, University of Washington, Seattle Children’s DSD Program, Seattle, Washington
| | - Michelle Fox
- Department of Pediatrics, UCLA School of Medicine, Los Angeles, California
| | - Meilan. M. Rutter
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio and Disorders of Sex Development Center, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
| | - Phyllis W. Speiser
- Department of Pediatrics, Cohen Children’s Medical Center of New York and Zucker School of Medicine at Hofstra University, New Hyde Park, New York
| | - Eric Vilain
- Center for Genetic Medicine Research, Children’s National Medical Center, Washington, DC
| | - Erica M. Weidler
- Department of Pediatric Surgery, Phoenix Children’s Hospital, Phoenix, Arizona; Accord Alliance, Whitehouse Station, New Jersey
| | | | - David E. Sandberg
- Department of Pediatrics and Communicable Diseases and the Child Health Evaluation & Research Center, University of Michigan Medical School, Ann Arbor, Michigan
| |
Collapse
|