Lived experiences of transgender and nonbinary people in the perioperative context: a qualitative study.

BACKGROUND: Transgender and nonbinary (TNB) people experience obstacles that create barriers to accessing health care, including stigmatization and health inequities. Our intention was to describe the lived experiences of TNB patients and identify potential gaps in the education of health care professionals. METHODS: We conducted a qualitative descriptive study influenced by phenomenology by interviewing with TNB adults who underwent surgery in Canada within the previous 5 years. We recruited participants using purposeful and snowball sampling via online social networking sites. Audio recordings were transcribed. Two authors coded the transcripts and derived the themes. RESULTS: We interviewed 21 participants, with a median interview duration of 49 minutes. Participants described positive and negative health care encounters that led to stress, confusion, and feelings of vulnerability. Major themes included having to justify their need for health care in the face of structural discrimination; fear and previous traumatic experiences; community as a source of support and information; and the impact of interactions with health care professionals. INTERPRETATION: Participants detailed barriers to accessing care, struggled to participate in shared decision-making, and desired trauma-informed care principles; they described strength in community and positive interactions with health care professionals, although barriers to accessing gender-affirming care often overshadowed other aspects of the perioperative experience. Additional research, increased education for health care professionals, and policy changes are necessary to improve access to competent care for TNB people.

'I don't want to have to teach every medical provider': barriers to care among non-binary people in the Canadian healthcare system.

It is well-known that trans and non-binary individuals experience worse health outcomes due to experiences of violence and discrimination. For this reason, accessible healthcare for trans and non-binary people is crucial. There is a lack of Canadian literature on the experiences of non-binary people within the healthcare system. This study sought to understand barriers to healthcare among non-binary people living in a mid-sized urban/rural region of Canada. Interviews were conducted between November 2019 to March 2020 with 12 non-binary individuals assigned female at birth, living in Waterloo Region, Ontario, Canada, as a part of a larger qualitative study exploring experiences within the community, healthcare and employment. Three broad themes were developed: erasure, barriers to access to healthcare, and assessing whether (or not) to come out. Sub-themes included institutional erasure, informational erasure, general healthcare barriers, medical transition healthcare barriers, anticipated discrimination, and assessing safety. Policy and institutional changes are needed to increase the safety and accessibility of healthcare services to non-binary individuals.

Equity, Diversity, and Inclusion in anesthesiology: a primer.

PURPOSE: This continuing professional development module aims to elucidate the current demographics of anesthesiology in Canada and the experience of anesthesiologists from equity-seeking groups. This module will also identify and describe factors impacting the health care experience of patients from equity-seeking groups who receive perioperative, pain, and obstetric care. PRINCIPAL FINDINGS: In recent years, discrimination based on sex, gender, race, ethnicity, sexual orientation, ability, other demographic factors, and the intersection of these identities have gained greater attention not only in our society at large but also within medicine and anesthesiology. The stark consequences of this discrimination for both anesthesiologists and patients from equity-seeking groups have become clearer in recent years, although the full scope of the problem is not fully understood. Data regarding the demographics of the national anesthesia workforce are lacking. Literature describing patient perspectives of various equity-seeking groups is also sparse, although increasing. Health disparities impacting people who are racialized, women, LGBTQIA+, and/or living with disability are also present in the perioperative context. CONCLUSION: Discrimination and inequity persist in the Canadian health care system. It is incumbent upon us to actively work against these inequities every day to create a kinder and more just health care system in Canada.

RéSUMé: OBJECTIF: Ce module de développement professionnel continu vise à élucider les caractéristiques démographiques actuelles de l'anesthésiologie au Canada et l'expérience des anesthésiologistes issu·es de groupes en quête d'équité. Ce module identifiera et décrira également les facteurs ayant une incidence sur l'expérience des soins de santé de la patientèle issue des groupes en quête d'équité qui reçoit des soins périopératoires, des soins de la douleur et des soins obstétricaux. CONSTATATIONS PRINCIPALES: Au cours des dernières années, la discrimination fondée sur le sexe, le genre, la race, l'ethnicité, l'orientation sexuelle, les capacités, d'autres facteurs démographiques ainsi que sur l'intersection de toutes ces identités a retenu une attention plus soutenue non seulement au sein de notre société en général, mais aussi dans les domaines de la médecine et de l'anesthésiologie. Les graves conséquences de cette discrimination tant pour les anesthésiologistes que pour les patient·es issu·es des groupes en quête d'équité sont devenues plus claires ces dernières années, bien que toute l'ampleur du problème ne soit pas entièrement comprise. Les données démographiques sur la main-d'œuvre nationale en anesthésie font défaut. La documentation décrivant les points de vue des patient·es de divers groupes en quête d'équité est également rare, bien qu'en augmentation. Les disparités en matière de santé touchant les personnes racialisées, les femmes, les personnes de la communauté LGBTQIA+ et/ou celles en situation de handicap existent dans le contexte périopératoire. CONCLUSION : La discrimination et l'iniquité persistent dans le système de soins de santé canadien. Il nous incombe de lutter activement contre ces iniquités chaque jour pour créer un système de soins de santé plus bienveillant et plus juste au Canada.

"It Literally Can Save Lives": How Challenging Structural Inequities in Sexual Orientation and Gender Priorities Can Create Change in the Canadian Dietetic Profession.

Purpose: Our aim was to explore Canadian dietitians' knowledge, beliefs, and values relating to the nutritional care of Two-Spirit, lesbian, gay, bisexual, trans, and other queer groups (2SLGBTQ+).Methods: The research was qualitative and used a poststructural theoretical lens. Interviews were conducted with 16 Canadian dietitians. Data were analyzed using thematic analysis.Results: Three themes were noted: (i) moving away from the binary; (ii) systemic discrimination and 2SLGBTQ+ experiences; and (iii) professional organizations and advocacy. The participants discussed structural, professional, and cultural barriers that affect the nutrition and health experiences of sexual and gender diverse groups.Conclusion: Dietetic institutions and regulatory bodies must provide sexual and gender diversity resources and engage in activities that acknowledge the lives and nutritional concerns of sexual and gender diverse people. Such advocacy is a means to provide more inclusive and equitable care. Key recommendations for structural changes within the profession include using an intersectional lens and a critical dietetic approach to nutritional care.

Not Just Checklists and Rainbows: Exploring Canadian Dietitians' Beliefs, Values, and Knowledge of Transgender Nutritional Care.

Purpose: Many transgender (short form: trans) people are experiencing disparities within Canadian health care systems, including nutritional and dietetic health care systems. This research explores the views, beliefs, and experiences of Canadian dietitians about trans nutritional care and seeks to understand how dietitians can better address the nutritional needs of trans individuals. Methods: Semistructured online interviews were conducted with 16 Canadian dietitians. Interviews were transcribed and the data were analyzed thematically. Results: Three main themes were created; (1) There's an Unjust System, (2) We've Come a Long Way, and (3) Not Just Checklists and Rainbows. The participants explored the historic nature of the Canadian dietetic profession and noted the connection between cis-normativity and the erasure of trans identities. They also explored how dietitians could better address the health needs of trans people, including moving beyond the acknowledgement of trans identities to changing the way gender is viewed in the profession. Conclusion: The dietetic profession must move beyond surface-level activities and rethink gender. Recommendations include adding trans-focused care training into the profession, creating safer spaces for trans individuals, advocacy and allyship, and recruiting trans people to the profession.