Gender affirming and non-affirming language and the healthcare experiences of transgender and gender non-binary individuals: A systematic review.

Abstract

Previous studies have identified the crucial role of provider-client communication in healthcare experiences, but there lacks a comprehensive overview regarding the experiences of transgender and gender non-binary (TGNB) individuals. This review aimed to gain insights into best practices and pitfalls in language and communication with TGNB individuals across various healthcare domains. A systematic literature review was conducted using two databases (PubMed and CINAHL) and following the PRISMA and the Cochrane guidelines, with search terms such as "communication", "patient-provider", "transgender" and "non-binary". The final sample comprised 22 peer-reviewed publications on language and communication with TGNB individuals in various healthcare domains (e.g., primary care, gender/reproductive care, nursing, pharmacy, mental health, genetic counseling, cancer screening). Using a narrative synthesis framework, we thematically analyzed the findings. We identified and categorized recurring patterns of language and communication into three themes: (1) personalized communication, (2) communication about the healthcare provider's (HCP's) knowledge, and (3) assumption-related discriminatory behaviors toward the client. These themes were central in studying provider-client interactions and TGNB clients' healthcare experiences. The literature review and synthesis showed that affirming interactions were characterized by HCPs' ability to express interest and intention in caring for TGNB clients, communicate knowledge and expertise, and most importantly, address clients respectfully. The findings also revealed that TGNB individuals often faced critical shortcomings in healthcare, such as discrimination and HCPs' lack of knowledge and awareness. We argued that a cultural shift toward the person-centered framework is necessary across all healthcare domains to improve TGNB clients' experiences. Within this framework, we highlighted two recommendations: following the client's lead with language and allyship. Additionally, comprehensive and periodic trainings on transgender themes should be accessible to all medical staff. More broadly, the review shed light on what could be the root cause for discrimination in healthcare based on sex and gender.