Care of transgender patients by diagnostic radiographers: What can be learnt from the literature

Journal article


Hammond, C and Lockwood, P. 2023. Care of transgender patients by diagnostic radiographers: What can be learnt from the literature. Radiography. 30 (1), pp. 145-150. https://doi.org/10.1016/j.radi.2023.10.020
AuthorsHammond, C and Lockwood, P.
Abstract

Introduction: Transgender patients have described negative healthcare experiences, including discrimination and feeling unwelcome. Additionally, these patients are at risk of inadequate or unsafe care due to healthcare providers being unable to obtain and record transgender patients’ correct gender and assigned birth sex. This literature review aims to review radiology and radiographer articles published since 2018 about transgender healthcare issues and make recommendations that can be applied by diagnostic radiographers, their managers and diagnostic radiography programme providers.

Method: A literature search used multiple databases containing peer-reviewed articles. Boolean operators and key words were utilised. Identified articles were searched to identify any articles not found by searching the databases. Themes and sub-themes from each paper were identified and discussed.

Results: Three key themes were identified: education, systems and environment. Education sub-themes were knowledge and awareness. Systems sub-themes were recording gender correctly and discriminating/stigmatising policies. Environment sub-themes were transgender-friendly symbols and environmental dysphoria.

Conclusion: Transgender patients still face barriers to equitable care. Several recommendations were made based on the thematic discussion that could be applied by diagnostic radiographers, student radiographers, radiology managers, University training providers, and professional body organisations. Diagnostic radiography programmes should include training on both clinical topics and cultural competence. Radiology managers should display transgender-positive symbols in their departments and ensure their policies are non-discriminatory and non-stigmatising. Radiology hardware and software providers should provide the ability to record non-binary genders and birth-assigned sex.

Implications for Practice: Transgender patients have the right to receive equitable care from diagnostic radiographers during their imaging examination and radiology attendance, and that any risks relating to their transgender status should be correctly managed with appropriate sensitivity.

KeywordsTransgender; Gender identity; Non-cisgendered; Radiography; Patient care
Year2023
JournalRadiography
Journal citation30 (1), pp. 145-150
PublisherElsevier
ISSN1078-8174
Digital Object Identifier (DOI)https://doi.org/10.1016/j.radi.2023.10.020
Official URLhttps://www.sciencedirect.com/science/article/pii/S1078817423002158
Publication dates
Online29 Nov 2023
PrintJan 2024
Publication process dates
Accepted25 Oct 2023
Deposited04 Dec 2023
Accepted author manuscript
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All rights reserved
File Access Level
Restricted
Publisher's version
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File Access Level
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References

1. Vincent B. Transgender health: A Practitioner’s Guide to Binary and Non-Binary Trans Patient Care, London: Jessica Kingsley Publishers; 2018.
2. Stonewall. List of LGBTQ+ terms, London; 2022.
3. Mack K. BIPOC, LGBTQ+, and the Power and Limitations of Umbrella Terms. MacArthur Foundation. Available from: https://www.macfound.org/press/perspectives/bipoc-lgbtq-power-limita... [accessed May 30, 2023].
4. Winter S., Diamond M., Green J., Karasic D., Reed T., Whittle S., et al. Transgender people: health at the margins of society. The Lancet 2016;388(10042):390–400. Doi: 10.1016/S0140-6736(16)00683-8.
5. Stowell JT., Grimstad FW., Kirkpatrick DL., Brown LR., Flores EJ. Serving the Needs of Transgender and Gender-Diverse Persons in Radiology. Journal of the American College of Radiology 2019;16(4):533–5. Doi: 10.1016/j.jacr.2018.12.050.
6. Reisner SL., Poteat T., Keatley J., Cabral M., Mothopeng T., Dunham E., et al. Global health burden and needs of transgender populations: a review. The Lancet 2016;388(10042):412–36. Doi: 10.1016/S0140-6736(16)00684-X.
7. NHS England. Equality objectives and information , London; 2021.
8. NHS England. The NHS Constitution for England, London; 2023.
9. Hudson-Sharp N., Metcalf H. Inequality among lesbian, gay bisexual and transgender groups in the UK: a review of evidence, 2016.
10. Bolderston A., Ralph S. Improving the health care experiences of lesbian, gay, bisexual and transgender patients. Radiography 2016;22(3):e207–11. Doi: 10.1016/j.radi.2016.04.011.
11. Watts S., Hirsch B. Connecting Radiography Students to Transgender Patient Care. Radiol Technol 2020;91(4):401–3.
12. Cates BA. Caring for Transgender Patients in the Radiology Department. Radiol Technol 2022;93(6):573–6.
13. Custer T., Sayles H., Michael K. Assessing the Educational Climate: Transgender Content in Medical Imaging Curricula. Journal of Diagnostic Medical Sonography 2020;36(6):536–43. Doi: 10.1177/8756479320944930.
14. UK Government. Ionising Radiation (Medical Exposure) Regulations (IR(ME)R) 2017 (SI 2017/1322), London: HMSO; 2017.
15. Clark K., Vealé B., Zaleski F. Caring for the transgender patient. Radiol Technol 2018;90(1):7–19.
16. Floyd MJ., Martin O., Eckloff KJ. A qualitative study of transgender individuals’ experiences of healthcare including radiology. Radiography 2020;26(2):e38–44. Doi: 10.1016/j.radi.2019.10.008.
17. Health Protection Agency. Protection of Pregnant Patients during Diagnostic Medical Exposures to Ionising Radiation., London; 2009.
18. Aarne Grossman VG. Providing Quality Care to the Transgender Patient in the Radiology Setting. J Radiol Nurs 2016;35(3):218–26. Doi: 10.1016/j.jradnu.2016.06.002.
19. Hammond I., Lentle B., van den Berg L., Vitols-McKay M. Gender Identity and Bone Densitometry. Canadian Association of Radiologists Journal 2017;68(3):267–9. Doi: 10.1016/j.carj.2016.10.006.
20. Neira PM. Caring for the Transgender Patient. J Radiol Nurs 2017;36(2):88–9. Doi: 10.1016/j.jradnu.2017.03.002.
21. Wanta JW., Unger CA. Review of the Transgender Literature: Where Do We Go from Here? Transgend Health 2017;2(1):119–28. Doi: 10.1089/trgh.2017.0004.
22. Canterbury Christ Church University. Research Ethics Policy , Canterbury; 2023.
23. Cooper C., Booth A., Varley-Campbell J., Britten N., Garside R. Defining the process to literature searching in systematic reviews: a literature review of guidance and supporting studies. BMC Med Res Methodol 2018;18(1):85. Doi: 10.1186/s12874-018-0545-3.
24. Page MJ., McKenzie JE., Bossuyt PM., Boutron I., Hoffmann TC., Mulrow CD., et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. Syst Rev 2021;10(1):89. Doi: 10.1186/s13643-021-01626-4.
25. Benton DC., Cormack DFS. ’Reviewing and evaluating the literature. In: Cormack DFS, editor. The research process in nursing . Fourth, Oxford: Blackwell Sciences Ltd; 2000, p. 53–63.
26. Aveyard H. Doing a Literature Review in Health and Social Care: A Practical Guide, Third, Maidenhead: Open University Press; 2014.
27. Clark KR., Vealé BL. Assessing Transgender-Related Content in Radiography Programs in the United States: A Survey of Educators. J Med Imaging Radiat Sci 2018;49(4):414–9. Doi: 10.1016/j.jmir.2018.06.050.
28. Ussher JM., Perz J., Allison K., Power R., Hawkey A., Dowsett GW., et al. Attitudes, knowledge and practice behaviours of oncology health care professionals towards lesbian, gay, bisexual, transgender, queer and intersex (LGBTQI) patients and their carers: A mixed-methods study. Patient Educ Couns 2022;105(7):2512–23. Doi: 10.1016/j.pec.2021.12.008.
29. White Hughto JM., Clark KA., Altice FL., Reisner SL., Kershaw TS., Pachankis JE. Creating, reinforcing, and resisting the gender binary: a qualitative study of transgender women’s healthcare experiences in sex-segregated jails and prisons. Int J Prison Health 2018;14(2):69–88. Doi: 10.1108/IJPH-02-2017-0011.
30. Hendrickson SG., Contreras C V., Schiller E., Walsh D. Exploring health care experiences of transgender people living in Texas. Nurs Outlook 2020;68(4):476–83. Doi: 10.1016/j.outlook.2020.02.002.
31. Tabaac AR., Sutter ME., Wall CSJ., Baker KE. Gender Identity Disparities in Cancer Screening Behaviors. Am J Prev Med 2018;54(3):385–93. Doi: 10.1016/j.amepre.2017.11.009.
32. Perry H., Fang AJ., Tsai EM., Slanetz PJ. Imaging Health and Radiology Care of Transgender Patients: A Call to Build Evidence-Based Best Practices. Journal of the American College of Radiology 2021;18(3):475–80. Doi: 10.1016/j.jacr.2020.10.008.
33. Matoori S., Donners R., Garcia Nuñez D., Nguyen-Duong S., Riopel C., Baumgartner M., et al. Transgender health and medicine – Are radiological devices prepared? Eur J Radiol 2022;151:110320. Doi: 10.1016/j.ejrad.2022.110320.
34. Society and College of Radiographers. Inclusive pregnancy status guidelines for ionising radiation: Diagnostic and therapeutic exposures, London; 2021.
35. Society and College of Radiographers. New version of popular SCoR pregnancy poster. , London; 2020.
36. Society and College of Radiographers. Society defends inclusive pregnancy guidance after media criticism. Society Defends Inclusive Pregnancy Guidance after Media Criticism. Available from: https://www.sor.org/news/obstetrics-and-gynaecology/inclusive-pregna... [accessed May 24, 2023].
37. Macdonald DW., Grossoehme DH., Mazzola A., Pestian T., Schwartz SB. “I just want to be treated like a normal person.” The Journal of the American Dental Association 2019;150(9):748–54. Doi: 10.1016/j.adaj.2019.03.025.
38. Yan TD., Mak LE., Carroll EF., Khosa F., Yong-Hing CJ. Gender-Inclusive Fellowship Naming and Equity, Diversity, and Inclusion in Radiology: An Analysis of Radiology Department Websites in Canada and the United States. Canadian Association of Radiologists Journal 2022;73(3):473–7. Doi: 10.1177/08465371211066104.

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