Practical guide to implementing patient-reported outcome measures in gender-affirming care: evaluating acceptability, appropriateness and feasibility

Rakhshan Kamran; Liam Jackman; Anna Laws; Melissa Stepney; Conrad Harrison; Abhilash Jain; Jeremy Rodrigues

doi:10.1136/bmjoq-2023-002677

Practical guide to implementing patient-reported outcome measures in gender-affirming care: evaluating acceptability, appropriateness and feasibility

BMJ Open Qual. 2024 May 1;13(2):e002677. doi: 10.1136/bmjoq-2023-002677.

Authors

Rakhshan Kamran¹, Liam Jackman², Anna Laws³, Melissa Stepney⁴, Conrad Harrison⁵, Abhilash Jain⁵, Jeremy Rodrigues^{6

7}

Affiliations

¹ Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK [email protected].
² Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.
³ Northern Region Gender Dysphoria Service, Cumbria Northumberland Tyne and Wear NHS Foundation Trust, Newcastle Upon Tyne, UK.
⁴ Department of Psychiatry, University of Oxford, Oxford, UK.
⁵ Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK.
⁶ Department of Plastic Surgery, Buckinghamshire Healthcare NHS Trust, Amersham, UK.
⁷ Warwick Clinical Trials Unit, University of Warwick, Coventry, UK.

Abstract

Objective: Assess acceptability, appropriateness and feasibility of the Practical Guide to Implementing patient-reported outcome measures (PROMs) in Gender-Affirming Care (PG-PROM-GAC) from a sample of patients and healthcare professionals.

Design: Cross-sectional study conducted August-October 2023.

Setting: Participants were recruited from a National Health Service (NHS) gender clinic.

Participants: Patient participants seeking care and healthcare professionals working at an NHS gender clinic were eligible for participation. The PG-PROM-GAC was sent to participants via email for review.

Outcome measures: Three validated tools to measure acceptability, appropriateness and feasibility were administered: the acceptability of intervention measure (AIM), intervention appropriateness measure (IAM) and feasibility of intervention measure (FIM). The percentage of participants indicating agreement or disagreement with items on the AIM, IAM and FIM was calculated.

Results: A total of 132 transgender and gender diverse (TGD) patients (mean age, SD: 33, 14) and 13 gender-affirming healthcare professionals (mean age, SD: 43, 11) completed the AIM, IAM and FIM, representing a range of gender identities. The cumulative percentage of patients indicating agree or strongly agree on the AIM, IAM and FIM for the patient-relevant strategies in the PG-PROM-GAC was over 50% for each item. The cumulative percentage of patients indicating disagree or strongly disagree on the AIM, IAM and FIM for the PG-PROM-GAC was less than 20% for each item. The cumulative percentage of healthcare professionals indicating agree or strongly agree on the AIM, IAM and FIM for the healthcare professional-relevant strategies in the PG-PROM-GAC was over 38% for each item. The cumulative percentage of healthcare professionals indicating disagree or strongly disagree on the AIM, IAM and FIM for the PG-PROM-GAC was less than 15% for each item.

Conclusions: Gender-affirming healthcare professionals and TGD patients find the PG-PROM-GAC acceptable, appropriate and feasible. The PG-PROM-GAC is ready-to-use for clinicians, policy-makers and researchers committed to service improvement for gender-affirming care.

Keywords: Health Equity; Health services research; Healthcare quality improvement; Implementation science.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Adult
Cross-Sectional Studies
Feasibility Studies
Female
Gender-Affirming Care*
Humans
Male
Middle Aged
Patient Reported Outcome Measures*
State Medicine / statistics & numerical data
Surveys and Questionnaires
Transgender Persons* / psychology
Transgender Persons* / statistics & numerical data