Culturally safe, high‐quality breast cancer screening for transgender people: A scoping review protocol

Abstract

Aim: To develop evidence-based recommendations for provision of culturally safe, high-quality services for breast cancer screening for transgender people. Design:The scoping review will follow the JBI methodological guidance for scoping reviews.Methods: A search using MEDLINE (PubMed), Embase (Ovid), Scopus, the Cochrane Library, including the Cochrane Methodology Register, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews and the World Health Organization, Australia Government Department of Health and Google Scholar will be undertaken. The review will include people of any age and ethnicity defined in the source of evidence as transgender. The review will include individuals who have used gender-affirming interventions or not and sources of evidence that report information relevant to the provision of culturally safe, high-quality breast cancer screening services for transgender people. English language sources of evidence published from database inception with information from any country will be eligible for inclusion.Sources will be screened for inclusion by three independent reviewers. Results will be extracted using a purpose-built tool and presented in relation to the review questions and objective in the final report using tables, figures and corresponding narrative. Project funding was approved by the Australian Government Department of Health in June 2020.Discussion: There are a range of factors that impact on the equity of health access and outcomes for people who are not cisgender. Transgender people are at risk of breast cancer but there is relatively little evidence about how their risks may or may not differ substantially from cis-gendered individuals and little guidance for health providers to ensure inclusive, culturally safe, high-quality breast cancer screening services for both transgender males, transgender females and gender diverse people who may not identify as male or as female.Impact: It is important to provide culturally safe, high-quality services for breast cancer screening for transgender people. K E Y W O R D S breast neoplasms, delivery of health care, early detection of cancer, gender identify, hormones, nurses, quality of health care, transgender persons | 277 PETERS ET al.

Reflexive Practice as an Approach to Improve Healthcare Delivery for Indigenous Peoples: A Systematic Critical Synthesis and Exploration of the Cultural Safety Education Literature

“…A total of 46 documents were analysed, describing 43 different educational interventions. The majority ( n = 35) of documents described university-based educational interventions [ 16 , 18 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 38 , 54 , 55 , 56 , 57 , 58 , 59 , 60 , 62 , 63 , 64 , 66 , 68 , 69 , 70 , 73 , 80 , 81 , 83 , 84 ], with one set of documents describing a short vocational training course [ 85 , 86 , 87 ], and the remainder ( n = 8) describing continuing professional education (CPE) courses for practicing health professionals [ 17 , 19 , 20 , 36 , 69 , 73 , 88 , 89 ]. Just over half of the documents analysed ( n = 28) were from Australia [ 17 , 18 , 20 , 22 …”

“…Where documents described the process of reflexivity, a variety of terms was used. The most common descriptors included ‘reflect on’ [ 21 , 22 , 23 , 27 , 30 , 31 , 32 , 33 , 36 , 56 , 64 , 66 , 67 , 68 , 73 , 80 , 90 ]; ‘examine’ [ 16 , 17 , 25 , 61 , 71 , 72 ]; ‘become aware of’ [ 17 , 18 , 36 , 63 , 68 , 75 , 88 ]; ‘explore’ [ 17 , 18 , 36 , 63 , 68 , 75 , 88 ]; ‘consider’ [ 29 , 56 , 67 , 68 ]; ‘understanding’ [ 36 , 58 , 87 ]; and ‘identify’ [ 21 , 64 , 67 , 72 , 89 ]. What is notable about these descriptors is that most—including all the most commonly used—describe a passive process of identification, observation, and awareness.…”

“…In most of these educational interventions, learners were required to reflect on both self-identity and held beliefs, and these were conceptualised as related. However, eight of the educational interventions only included a requirement to identify, reflect on, and in some cases actively critique held beliefs [ 19 , 25 , 55 , 56 , 68 , 86 , 88 , 89 ].…”

“…While the results of this study are specifically concerned with reflexivity in the context of Indigenous cultural safety, cultural safety is increasingly being adopted in other discipline and population contexts. In particular, there is growing interest in how cultural safety might improve care provision and health outcomes for marginalised and disadvantaged populations, for example the LGBTIQA+ community [ 88 , 89 ], racial and cultural minority groups [ 94 , 95 ], and Indigenous populations globally [ 96 ]. In an increasingly globalized and multicultural society, the importance of cultural safety and the ability to engage reflexively is fundamental to the provision of equitable, non-discriminatory care.…”

Contemporary LGBTQ + content that should be included in allied health professions education

“…On a systemic barrier level, allied health professions also include health administrators, who are responsible for navigating the insurance policies and ensure that patients can access medical care services with affordable costs. Many transgender individuals carry a heavy burden in simply accessing basic healthcare [41]. For instance, if a patient's gender marker is changed from female to male, a healthcare administrator may need to go the extra distance in ensuring that basic checkup services, such as a pap smear, are still provided to the patient.…”