03.01.06. Gender inclusive care
MRTs should provide person centred care that is gender-inclusive, including the use of gender-inclusive language
Importance of gender-inclusive healthcare
- Sex refers to a set of biological attributes and is primarily associated with physical and physiological features including chromosomes, gene expression, hormone levels and function, and reproductive/sexual anatomy. Sex is typically categorized in the binary terms of female and male.1
- Gender represents the socially constructed roles, behaviours, expressions, and identities of an individual. It can influence how people perceive themselves and each other, how they act and interact, and the distribution of power and resources in society.1
- A cis-gender person is one whose gender identity is aligned with the sex assigned to them at birth.2
- A transgender person identifies their gender as different from the sex assigned at birth or surgical anatomy. 2
- Transgender identifying individuals may use gender-expansive terms to describe their gender identity (e.g., non-binary, two spirit, genderqueer, androgyne).3,4
- Societal acceptance of transgender individuals has increased and given more opportunities for transgender individuals to live authentically and openly. However, transgender individuals in Canada are a medically underserved population as they continue to be discriminated against.
- Evidence suggests that many transgender people either avoid/delay receiving healthcare or engage in selective disclosure about their transgender identity to health providers in order to avoid discrimination.5,6
- Although gender identity in itself does not determine health, it socially stratifies the population into different social determinants of health categories, similar to race or ethnicity.7
- Cis-normative assumptions are pervasive in the healthcare setting, which does not meet cultural sensitivity standards. Failure to appropriately address gender diverse patients may cause alienation and health care barriers.3,6,8
- In a survey of 363 transgender and gender non-binary patients, more than 70% reported having had a negative encounter at an imaging center (e.g., inappropriate pronouns, being misgendered in the radiology report, and complaints of staff making care uncomfortable for the patient).9
- In addition to cultural sensitivity, the use of gender-inclusive language is at the forefront of ensuring respectful communication and provision of healthcare and imaging.9,10
- For individuals, asking for names and pronouns is important, as experiences of gender affirmation are known to be protective against mental health problems.9,11
- At the systems level, terminology such as “women’s imaging” represents a lack of inclusivity to non-binary and transmasculine audiences, yet continues to be used frequently.8
Gender-inclusive workplace
- MRTs must understand the general needs of the transgender patient population to ensure their rights and dignity are upheld, that the tenants of person centred care are provided at all times, and that advocacy efforts to obtain optimal patient care can be made.3,12
- Legislation upholds that MRTs must honor and respect all people’s right to self-determination, and right to receive health care and work in a professional environment that is free from discrimination, transphobia, and prejudice.
- Whether gender identity has been explicitly prohibited and considered discrimination within legislation or not, other legal grounds interpret the concept of sex to include this.13
- MRTs can provide, support, and/or advocate for creating a transgender-inclusive practice, which includes but is not limited to14:
- Ensure waiting rooms and patient spaces are gender neutral or gender inclusive (e.g., art, posters, and posted policies are non-discriminatory and gender diverse).
- Enable transgender patients to have access to gender affirming clothing and belongings whenever possible while in imaging and treatment environments.
- Clearly communicate expectations and processes related to imaging examinations.
- Ask clarifying questions to the patient that are relevant to the imaging visit.
- Be aware of gender identity concerns and approach all patient encounters with sensitivity and empathy.
- Utilize an electronic health record/information system that includes gender identity.
- Educate all members of imaging and treatment teams about existing gender disparities and the steps they can take to address them.
- Include and document transgender patients in research.
- Ensure education and training activities in the professional environment include gender diversity concepts, where appropriate.
Gender-inclusive language practices
- MRTs should maintain an understanding of the evolving gender lexicon to foster inclusive dialogue with gender-diverse patients within their workplace.3
- MRTs should use gender-inclusive and non-discriminatory language
- MRTs should not make assumptions about an individual’s gender (e.g., check medical record, request information from patient)
- There are complex discussions occurring in healthcare as to whether each patient at every appointment should be asked about their gender identity and pronouns.14–16 At this time, a standard for the frequency in asking for gender identification from patients has not been achieved through research.
- At minimum, MRTs should request gender identification from patients when the information:
- is considered imperative to the services provided to the patient,
- is not listed in the medical record, and/or
- builds the therapeutic relationship between the patient and MRT.
- MRTs should document a patient’s preferences for gender identification in the medical record if missing or if the patient identifies a possible change.17
- Collection of patient information must be completed in accordance with the legislation requirements and local policies and procedures. The information should only be used to enable facilities and healthcare professionals to meet equity and evidence-based policy objectives for healthcare services.18
References
- Government of Canada CI of HR. What is gender? What is sex? – CIHR. Published January 10, 2014. Accessed February 1, 2022. https://cihr-irsc.gc.ca/e/48642.html
- Government of Canada SC. Display definitions – Classification of cisgender and transgender – C – Cisgender. Published February 5, 2018. Accessed February 1, 2022. https://www23.statcan.gc.ca/imdb/p3VD.pl?Function=getVD&TVD=469267&CVD=469268&CLV=0&MLV=2&D=1
- Stowell JT, Zavaletta VA. Radiologists’ education in transgender health care must Include sensitivity to language. Am J Roentgenol. 2020;214(3):W69-W69. doi:10.2214/AJR.19.22559
- de Vries E, Kathard H, Müller A. Debate: Why should gender-affirming health care be included in health science curricula? BMC Med Educ. 2020;20(1):51. doi:10.1186/s12909-020-1963-6
- Giblon R, Bauer GR. Health care availability, quality, and unmet need: a comparison of transgender and cisgender residents of Ontario, Canada. BMC Health Serv Res. 2017;17(1):283. doi:10.1186/s12913-017-2226-z
- Kcomt L, Gorey KM, Barrett BJ, McCabe SE. Healthcare avoidance due to anticipated discrimination among transgender people: A call to create trans-affirmative environments. SSM – Popul Health. 2020;11:100608. doi:10.1016/j.ssmph.2020.100608
- Pega F, Veale JF. The case for the World Health Organization’s commission on social determinants of health to address gender identity. Am J Public Health. 2015;105(3):e58-e62. doi:10.2105/AJPH.2014.302373
- Yan TD, Mak LE, Carroll EF, Khosa F, Yong-Hing CJ. Gender-inclusive fellowship naming and equity, diversity, and inclusion in radiology: An analysis of radiology department websites in Canada and the United States. Can Assoc Radiol J. Published online January 12, 2022:08465371211066104. doi:10.1177/08465371211066104
- Grimstad FW, Stowell JT, Gaddis M. Survey of experiences of transgender and gender nonbinary patients during imaging encounters and opportunities for improvement. Am J Roentgenol. 2020;215(5):1136-1142. doi:10.2214/AJR.19.22558
- Doo FX, Khorsandi A, Avanessian B, Bowers M, Somwaru AS. Gender affirmation surgery: A primer on imaging correlates for the radiologist. AJR Am J Roentgenol. 2019;213(6):1194-1203. doi:10.2214/AJR.19.21686
- Hughto JMW, Gunn HA, Rood BA, Pantalone DW. Social and medical gender affirmation experiences are inversely associated with mental health problems in a U.S. non-probability sample of transgender adults. Arch Sex Behav. 2020;49(7):2635-2647. doi:10.1007/s10508-020-01655-5
- Canadian Association of Medical Radiation Technologists. Member code of ethics and professional conduct. CAMRT. Published November 2015. Accessed June 23, 2020. https://www.camrt.ca/mrt-profession/professional-resources/code-of-ethics/
- Forrester v. Peel (Regional Municipality) Police Services Board et Al.(Human Rights Tribunal of Ontario 2006). Accessed February 24, 2022. https://canlii.ca/t/1r78d
- Perry H, Fang AJ, Tsai EM, Slanetz PJ. Imaging health and radiology care of transgender patients: A call to build evidence-based best practices. J Am Coll Radiol. 2021;18(3):475-480. doi:10.1016/j.jacr.2020.10.008
- Pedersen S. Re: Kohli, Shay response to Commentary: Determining pregnancy status. J Med Imaging Radiat Sci. 2021;0(0). doi:10.1016/j.jmir.2021.09.006
- Kohli (He/They) S. Re: Determining pregnancy status. J Med Imaging Radiat Sci. 2021;0(0). doi:10.1016/j.jmir.2021.07.008
- Lau F, Antonio M, Davison K, Queen R, Bryski K. An environmental scan of sex and gender in electronic health records: Analysis of public information sources. J Med Internet Res. 2020;22(11):e20050. doi:10.2196/20050
- Treasury Board of Canada Secretariat. Modernizing the Government of Canada’s sex and gender information practices: Summary report. Published April 8, 2019. Accessed February 2, 2022. https://www.canada.ca/en/treasury-board-secretariat/corporate/reports/summary-modernizing-info-sex-gender.html
Related Posts
-
-
-
01.01.05. Claustrophobia MRTs help to minimize and alleviate patient anxiety due to claustrophobia through education…