Perioperative Oncology Health Care Providers and Transgender Health: A Single-Institution Survey to Gauge Attitudes, Knowledge, Behaviors, and Education

Abstract

Purpose:

Patients identifying as transgender report that a lack of access to providers with trans-specific medical knowledge represents one of the largest barriers to equitable health care access. Through an institutional survey, we assessed and analyzed the attitudes, knowledge, behaviors, and education of perioperative clinical staff when caring for transgender patients with cancer.

Methods:

A web-based survey was distributed to 1100 perioperative clinical staff at the National Cancer Institute (NCI)-Designated Comprehensive Cancer Center in New York City between January 14, 2020, and February 28, 2020, and received 276 responses. The survey instrument consisted of 42 nondemographic questions about attitudes, knowledge, behaviors, and education regarding transgender health care and 14 demographic questions. Questions were presented as a mix of Yes/No, free text response, and a 5-point Likert scale.

Results:

Certain demographic groups (younger, lesbian, gay, or bisexual [LGB], fewer years employment at the institution) held more favorable attitudes toward the transgender population and were more knowledgeable regarding their health needs. Respondents underreported the rates of mental illness and risk factors for cancer like HIV and substance use among the transgender population. A greater proportion of respondents identifying as LGB endorsed witnessing an interaction wherein a colleague exhibited attitudes/beliefs about the transgender population that were barriers to care. Only 23.2% of respondents were ever trained on the health needs of transgender patients.

Conclusion:

There is a need for institutions to assess the cultural competency of perioperative clinical staff toward transgender health, especially within certain demographics. This survey may inform quality education initiatives to eliminate biases and knowledge gaps.

Introduction

The transgender population faces socioeconomic barriers that inhibit access to high-quality health care in the United States.^1,2 In 2015, the National Transgender Discrimination Survey reported that transgender patients were less likely to have health insurance compared to the population overall.² Around 28% of respondents reported verbal harassment in a medical setting based on their gender identity and 50% felt the need to teach their provider about some aspect of their health needs.^2,3

Most medical schools, nursing schools, and residency programs lack education curricula centering around transgender patient health.^4–7 Thus, health care providers may lack cultural sensitivity and express stigmatizing attitudes when treating transgender patients.⁸ This gap in education perpetuates socioeconomic marginalization, which has been associated with higher rates of HIV infection, smoking, drugs/alcohol use, and suicide attempts among the transgender population.^2,9–11

Such risk factors may predispose transgender patients to develop certain cancers. Furthermore, transgender patients face barriers in adhering to cancer screenings due to poor provider/patient relationship, gender dysphoria, and lack of knowledge in lesbian, gay, bisexual, transgender, and queer (LGBTQ)-specific cancer screening guidelines.¹²

Recent studies have utilized cross-sectional surveys to identify the attitudes and knowledge held by health care providers when treating transgender patients in outpatient and community-based primary care clinics.^5,13,14 However, few have investigated the attitudes and knowledge of health care providers toward transgender populations in specialized health care settings.¹⁵

As more transgender patients appear for perioperative and oncologic care, health care organizations must become more cognizant of their needs.^12,16,17 For example, in a perioperative setting, not all electronic health records (EHRs) enable health care providers to collect gender identity systematically.¹⁸ A transgender patient who is misgendered can experience stigma and anxiety, preventing future health care visits.^16,19 Providers must also recognize the risk of venous thromboembolism associated with hormone therapy, and changes in anatomy due to gender-confirming surgery that can affect intraoperative airway management or urinary catheter placement.¹⁶

To combat the barriers transgender patients face in receiving perioperative or oncologic health care, it is necessary to provide compassionate and culturally sensitive health care. Health care institutions must understand the biases and knowledge gaps toward transgender health care that may exist in their own environment. With a web-based survey, we aimed to identify existing attitudes, knowledge, behaviors, and education of perioperative health care providers in treating transgender patients at the National Cancer Institute (NCI)-Designated Comprehensive Cancer Center in New York City. As a secondary objective, we investigated how survey responses differed between various demographic groups.

Methods

From January 14, 2020, to February 28, 2020, a web-based survey was distributed to perioperative health care providers at a cancer care center in New York City. IRB exemption was obtained for the survey. Consent was waived because IRB exemption for waiver was obtained. The survey was administered electronically through REDCap, a web application designed to create online surveys and manage survey data. All survey responses were recorded anonymously on REDCap.

Survey instrument

The survey instrument consisted of 42 nondemographic questions related to the attitudes, knowledge, behaviors, and education of perioperative health care providers toward transgender populations and health care. It also included 14 demographic questions regarding age, race, gender, sexual orientation, hometown, role at the institution, and years at the institution. The survey instrument was adapted from various published surveys^5,13,14 The survey included Yes/No questions, free response questions, multiple choice questions, or questions based on a 5-point Likert scale (strongly disagree to strongly agree). Respondents also had the option “prefer not to answer” or “skip the question.”

The 42 nondemographic questions were divided into 6 subsets: general attitudes questions (GAQ), health care-specific attitudes questions (HAQ), knowledge questions (KQ), institution-wide behaviors (IBQ), provider-specific behaviors (PAQ), and education questions (EQ). GAQ focused on perceptions of the transgender population overall, while HAQ focused on the health needs of transgender patients. KQ tested how well respondents knew the perioperative or oncologic care issues transgender populations faced.

IBQ investigated whether respondents had witnessed a colleague's behavior that could be barriers to care. PAQ focused on the respondent's own behaviors toward transgender patients. EQ asked respondents about the level, amount, and benefit of their education with respect to the health needs of transgender patients.

Statistical analysis

Demographic characteristics of respondents were summarized as a frequency (percentage). Each response to a Likert scale question was assigned a score: 1 is strongly disagree, 2 is disagree, 3 is neither agree or disagree, 4 is agree, and 5 is strongly agree. Responses were summarized by calculating a composite score (the mean) and the standard error (SE). In the results section, scores for each question are reported in the format “GAQ1=x (SE),” where GAQ1 is the first GAQ and x represents the composite score, accompanied by the SE.

A greater SE indicates less agreement among survey participants, whereas a lower SE indicates the opposite. As a secondary analysis, the composite scores were recalculated based on individual demographic features to compare across groups. Composite scores were visualized through line plots and stratified by demographics. All results were presented in a descriptive format and no formal statistical test was conducted. The analyses were conducted using R 4.0.1.²⁰

Results

The survey was sent to 1100 providers and received a total of 276 respondents: a 25% response rate. We removed 26 participants who preferred not to disclose their hospital roles, and those not directly involved in the medical management of patients, such as unit assistants, surgical technologists, or patient care techs. The largest proportion of respondents were 25–49 years old (76%), women (76%), straight/heterosexual (88%), and white (71%), as found in Table 1. Most respondents were cisgender, or did not explicitly identify as transgender.

Table 1.

Demographic Characteristics of Survey Respondents

Characteristic	n=2501, n (%)
Age
18–24	1 (0.4)
25–49	189 (76)
50–65	51 (20)
>65	6 (2.4)
Prefer not to answer	3 (1.2)
Gender
Cisgender man	55 (22)
Cisgender woman	190 (76)
Transgender man	0 (0)
Transgender woman	0 (0)
Gender nonconforming/nonbinary/gender queer	3 (1.2)
Other	0 (0)
Prefer not to answer	2 (0.8)
Hometown
Rural	12 (4.8)
Small urban	77 (31)
Urban	54 (22)
Mid-sized metro	33 (13)
Large metro	74 (30)
Prefer not to answer	0 (0)
Race
American Indian or Alaska Native	0 (0)
Asian	39 (16)
Black or African American	12 (4.8)
Native Hawaiian or other Pacific Islander	3 (1.2)
White	177 (71)
Prefer not to answer	19 (7.6)
Role at institution
RN	134 (54)
PA	1 (0.4)
NP	8 (3.2)
CRNA	66 (26)
Resident/fellow (MD)	1 (0.4)
Fellow (APP)	0 (0)
Attending physician	40 (16)
Other	0 (0)
Sexual orientation
Lesbian	3 (1.2)
Gay	12 (4.8)
Bisexual	10 (4.0)
Straight (heterosexual)	221 (88)
Other	0 (0)
Prefer not to answer	4 (1.6)
Years at institution
0–1	39 (16)
2–5	80 (32)
6–10	27 (11)
11–20	58 (23)
>20	44 (18)
Prefer not to answer	2 (0.8)

APP, advanced practice provider; CRNA, certified registered nurse anesthetists; MD, Medical Doctor; NP, nurse practitioner; PA, physician assistant; RN, registered nurse.

General and health care-specific attitudes toward the transgender patient population

GAQ1, 2, 3, 4, 10, 11, and 12 were framed as positive statements; a higher score suggested a more favorable attitude toward the transgender community. GAQ5, 6, 7, 8, and 9 were framed as negative or misinformed statements; a higher score suggested a more negative attitude toward the transgender community.

Around 72.7% of perioperative health care providers strongly agreed that the transgender community should be accepted completely into society (GAQ2=4.6 [0.05]). Approximately75.6% and 80.9% agreed/strongly agreed that they were comfortable interacting with this population in a social (GAQ11=4.1 [0.07]) and work setting (GAQ12=4.3 [0.06]), respectively. Furthermore, 75.6% of respondents agreed/strongly agreed that transgender patients have unique health risks and needs (HAQ1=4.2 [0.06]), and 97.6% agreed/strongly agreed that they should be knowledgeable about the issues unique to transgender patients (HAQ3=4.8 [0.03]).

Around 57.7% of respondents agreed/strongly agreed that when they first meet someone, they assume they are cisgender (GAQ3=3.62 [0.08]) (Table 2).

Table 2.

Summarization of Likert Scale Questions, Responses, and Scores

	Strongly disagree (%)	Disagree (%)	Neutral (%)	Agree (%)	Strongly agree (%)	No. of responses	Composite score	SE
General attitudes
GAQ1. It would be beneficial to society to recognize being transgender as natural	2.9	4.2	15.8	20.4	56.7	240	4.24	0.07
GAQ2. Transgender individuals should be accepted completely into our society	1.7	0.4	6.6	18.6	72.7	242	4.60	0.05
GAQ3. When I first meet someone, I assume they are cisgender (non-transgender)	8.1	6.5	27.6	30.9	26.8	246	3.62	0.08
GAQ4. I believe that the male/female dichotomy is natural	5.5	9.8	37.9	26.0	20.9	235	3.47	0.07
GAQ5. Transgender individuals endanger the institution of the family	80.0	13.5	4.9	0.8	0.8	245	1.29	0.04
GAQ6. I am uncomfortable around people who do not conform to traditional gender roles (e.g., aggressive women or emotional men)	68.3	15.9	5.7	4.5	5.7	246	1.63	0.07
GAQ7. I believe that a person can never change their gender	60.3	22.7	12.4	1.7	2.9	242	1.64	0.06
GAQ8. Most teenagers are still trying to learn about themselves so we should not allow them to label themselves as transgender	31.1	25.7	28.6	9.1	5.4	241	2.32	0.07
GAQ9. I support LGBT people, but I think our society is going too far with transgender issues	41.7	20.4	20.0	10.0	7.9	240	2.22	0.08
GAQ10. I include my pronouns on some correspondence (e.g., emails, ID, and signature lines)	33.8	21.9	28.3	10.1	5.9	237	2.32	0.08
GAQ11. I am comfortable socializing in a group of transgender people in a social setting	3.3	4.1	17.1	29.3	46.3	246	4.11	0.07
GAQ12. I am comfortable interacting with a group of transgender people in a work setting	2.4	1.2	15.4	28.5	52.4	246	4.27	0.06
Health care-specific attitudes
HAQ1. Transgender patients have unique health risks and needs	1.2	4.9	18.3	29.3	46.3	246	4.15	0.06
HAQ2. Transgender patients deserve the same level of quality care from medical institutions as cisgender (non-transgender) patients	0.0	0.0	1.2	4.1	94.7	245	4.93	0.02
HAQ3. Health care professionals should be knowledgeable about issues unique to transgender patients	0.0	0.0	2.4	12.9	84.7	248	4.82	0.03
Knowledge
KQ1. Transgender populations that have undergone medical and surgical interventions (e.g., hormone therapy and gender-confirming surgeries) present with unique health care concerns in the perioperative setting	0.8	0.4	11.8	28.9	58.1	246	4.43	0.05
KQ2. Transgender patients present with psychosocial issues that are different from the general population (e.g., anxiety and depression)	4.9	6.5	19.8	24.7	44.1	247	3.97	0.07
KQ3. The transgender population faces higher rates of HIV infection	14.7	16.0	44.6	12.1	12.6	231	2.92	0.08
KQ4. Transgender women (people born male who identify as women) are at risk for breast cancer	5.2	7.9	45.0	25.8	16.2	229	3.40	0.07
IBQ
IBQ1. At my research institution, I have witnessed a physician or advanced practice provider exhibit behaviors about the transgender population that I feel are barriers to care	59.7	24.0	6.4	3.4	6.4	233	1.73	0.07
IBQ2. At my research institution, I have witnessed a nurse exhibit attitudes/beliefs about the transgender population that I feel are barriers to care	59.3	22.5	7.2	5.1	5.9	236	1.76	0.08
PAQ
PAQ1. It is important for me to know my patient's gender identity (e.g., man, woman, or nonbinary)	4.5	4.5	20.6	25.9	44.5	247	4.02	0.07
PAQ2. I treat every patient the same, so it is not necessary for me to know if a patient is transgender	17.2	22.5	16.0	16.0	28.3	244	3.16	0.09
PAQ3. I am willing to provide care to transgender patients in the perioperative setting	0.0	0.0	2.4	8.9	88.7	248	4.86	0.03
PAQ4. I am comfortable providing care to transgender patients in the perioperative setting	0.8	0.4	6.5	22.0	70.3	246	4.61	0.04
PAQ5. I am comfortable with counseling transgender patients on health concerns specific to them	12.5	23.3	25.8	17.5	20.8	240	3.11	0.09

GAQ, general attitudes questions; HAQ, health care-specific attitudes questions; KQ, knowledge question; IBQ, institution-wide behavior question; PAQ, provider-specific behaviors question; SE, standard error.

Some questions elicited a greater range of responses. Approximately 37.9% of respondents selected neutral with the statement, “I believe that the male/female dichotomy is natural” (GAQ4=3.5 [0.07]). In the query “most teenagers are still trying to learn about themselves so we should not allow them to label themselves as transgender,” 56.8% disagreed/strongly disagreed with this statement. Around 28.6% were neutral and 14.5% agreed/strongly agreed (GAQ8=2.3 [0.07]).

When segmenting by age, the age groups 18–24, 24–49, and >65 had a greater proportion of respondents agree with statements supportive of the transgender community when compared to the 50–65 age group. A similar result was found among respondents identifying as lesbian, gay, or bisexual (LGB) compared to respondents identifying as straight and those with fewer years at their institution compared to those with more years.

Transgender health care knowledge

Eighty-seven percent of perioperative health care providers agreed/strongly agreed that transgender patients who have undergone medical and surgical interventions have unique health concerns in the perioperative setting (KQ1=4.4 [0.05]). Around 68.8% of providers correctly identified that transgender patients presented with psychosocial issues that differ from the general population (KQ2=4.0 [0.07]), although 31.2% were neutral or disagreed. However, many respondents were unaware of the higher risk of HIV (KQ3=2.9 [0.08], 44.6% were neutral) in the transgender population and the risk of breast cancer in transgender women (KQ4=3.4 [0.07]).

All survey statements were written to be true according to current, peer-reviewed literature and research. Thus, high scores (4 or 5) suggested that respondents are more knowledgeable regarding transgender health care. When stratified by age, respondents in the age range 18–24 (average composite score=4.86), 25–49 (3.49), and >65 (4.06) scored higher than those in the age range 50–65 (3.39). However, it is important to note there was only 1 respondent in the 18–24 age range, and 6 respondents in the >65 age range.

When segmented by number of years at the institution, we observed that 0–1 years had the highest average composite score. When stratified by sexual orientation, those identifying as lesbian (average composite score=3.71), gay (3.84), or bisexual (3.72) scored higher on the average composite score than those identifying as straight (3.46).

Institution-wide behaviors

Approximately 83.7% of health care providers disagreed/strongly disagreed that they had witnessed a physician or advanced practice provider at their institution exhibit attitudes/beliefs about the transgender population that were barriers to care (IBQ1=1.7 [0.07]) (Fig. 1). However, when IBQ1 was stratified by sexual orientation, more respondents identifying as lesbian (50.0%) or gay (54.6%) agreed or strongly agreed that they had witnessed such occurrences compared to those who identified as straight (6.8%) (Fig. 2).

FIG. 1.

Individual and average composite scores for all IBQ questions among all survey participants. IBQ1–2 represents IBQ questions 1–2. IBQ, institution-wide behaviors.

FIG. 2.

Individual and average composite scores for all IBQ questions among all survey participants, segmented by sexual orientation. IBQ1–2 represents IBQ questions 1–2.

There was a similar result when asked whether they had witnessed a nurse exhibit attitudes/beliefs that were barriers to care (IBQ2=1.8 [0.08]) (Fig. 1). When IBQ2 was stratified by sexual orientation, respondents identifying as lesbian (66.6%) or gay (58.4%) agreed/strongly agreed that they had witnessed such occurrences compared to those who identified as straight (8.1%) (Fig. 2).

Provider-specific behaviors

Around 70.4% of providers agreed/strongly agreed that it is important to know their patient's gender identity (PAQ1=4.0 [0.07]). Approximately 97.6% of providers overwhelmingly agreed that they are willing to provide care to transgender patients (PAQ3=4.9 [0.03]) and 92.3% felt comfortable doing so in the perioperative setting (PAQ4=4.6 [0.04]). However, only 38.3% of providers agreed or strongly that they were comfortable counseling transgender patients on health concerns specific to them (PAQ5=3.1 [0.09]).

Training and education

Around 76.8% (EQ1) of respondents have never received training in the health needs of transgender patients in the perioperative period, but 93.4% (EQ3) agree they would benefit from this form of training. For those who were trained (67 participants), 80.6% felt the education was beneficial (EQ2) (Table 3).

Table 3.

Summarization of Education Question Responses

	Yes (%)	No (%)	No. of responses	Composite score	SE
Education
EQ1. I have been trained and educated on the health needs of transgender patients in the perioperative period	23.2	76.8	241	1.81	0.03
EQ2. If you received education, was the education beneficial to your understanding of the transgender issue(s)?	80.6	19.4	67	1.30	0.07
EQ3. I feel I would benefit from more education on transgender health needs and care	93.4	6.6	241	1.13	0.03

EQ, education questions.

Concluding and free response questions

Many free response comments stated the need for more education (e.g., lectures and courses) on transgender health and how to properly use pronouns to address transgender patients. Other respondents suggested adding EHR capabilities to delineate the patients' pronouns before meeting them. Our survey culminated in whether respondents were aware of the institutional resources available to learn about transgender health care. Fifty-nine percent were not aware that this institution had available educational resources, and 72.8% did not know where to look for available resources (Supplementary Data).

Discussion

While many participants were supportive of the transgender population, several respondents lacked knowledge regarding several components of transgender health and/or held inappropriate attitudes and behaviors. A clinician who holds negative attitudes and biases toward the transgender community may be unable to provide adequate psychosocial support to transgender populations, especially in the sensitive setting of discussing cancer or surgery.²¹ Rodriguez et al. showcased that being recognized as transgender had a significant association with discrimination in a health care setting (odds ratio [OR] 1.48), mental health settings (OR 1.87), and social service settings (OR 5.22).²²

Our health care system should strive toward completely eliminating these biases. Every patient-provider interaction has a chance to either build a trusting relationship or create a hostile environment to which a patient will not return.^2,23 Our discussion section describes several avenues for improvement based on our survey results.

Overall, practitioners who were younger, identified as LGB, and reported fewer years of employment at the institution reported more favorable attitudes toward the transgender population and higher scores on the KQ. This could be attributed to the propensity of younger generations to be more open-minded and accepting of the LGBTQ community. Younger generations are also more likely to identify as LGBTQ than older generations.²⁴ By segmenting results based on different demographics, we can develop educational interventions targeted toward specific groups.

Another interesting finding was that a majority of providers (57.7%) assumed that their patient was cisgender. Only 14.6% of providers did not assume their patient was cisgender. This assumption can be detrimental to patient care, as transgender patients are at a higher risk of HIV infection, substance abuse, and mental health issues, which are important to screen for.

Transgender patients may also take medications or have altered anatomy that anesthesiologists must be aware of to ensure safe administration of anesthesia.^2,16,17,25 Similar findings have been reported by Rowan et al. within a rural tertiary care center, in which 76.5% of providers assumed that their patient was cisgender.⁵ This points to the need for unconscious bias training programs among perioperative staff. A systematic review on LGBTQ-related bias reduction training programs for medical/nursing/dental students and providers demonstrated their effectiveness in reducing bias and increasing knowledge regarding LGBTQ health care issues.²⁶

Only 23.2% of respondents report having been trained/educated on the health needs of transgender patients, despite an overwhelming majority of participants agreeing they would benefit from such education. Most respondents (62%) were neutral or disagreed with being comfortable counseling transgender patients regarding their health concerns. Of all LGBTQ topics, transgender health may be the least well understood.

In a study investigating LGBT-related medical curricula in 132 Canadian and U.S. medical schools, only a minority of schools reported covering topics regarding transgender-specific care.²⁷ Another study involving 9522 medical students in Canada and the United States showed that students had concerns in addressing certain aspects of LGBT health, specifically with transgender patients.²⁸ Furthermore, a 2015 survey of 1000 U.S. baccalaureate nursing faculty found that only a median of 2.12 hours is devoted to LGBT-curricular content.²⁹

Similarly, a survey of 450 oncologists from 45 cancer centers demonstrated that only 36.9% felt confident in their knowledge of the health needs of transgender patients.³⁰ These findings suggest that institutions should develop meaningful ways to deliver transgender health education to perioperative health care staff. While educational interventions are an important starting point, we recognize this alone may not be enough. Studies show that transphobia may be a barrier to effective education on transgender health care, and that addressing transgender prejudice and bias is a necessary component to interventions.³¹

This survey showcases several topics that education can immediately address. Many survey respondents were unaware of the high rates of mental illness, HIV, and smoking/drug/alcohol use among the transgender population. Existing research shows that gender-related discrimination and societal stigma can cause transgender populations to be disproportionately affected by anxiety, depression, and suicidal ideation.^32,33

As a coping mechanism, transgender populations may engage in behavioral risk factors for cancer like smoking, drug, and alcohol use.¹ Furthermore, one meta-analysis estimates the prevalence of HIV infection among transgender populations in the United States at 9.2%, higher than the estimated HIV prevalence for U.S. cisgender adults (0.5%).^34,35

This training should also address the uncertainties participants had regarding the age at which a patient can label themselves transgender or whether the male/female dichotomy is natural. According to the TransNet working group on Gender Nonconforming/Transgender Youth, an individual can come out as transgender at any age, and gender identity can convey a wider, more flexible range than the binary gender system.³⁶

Our survey noted that a greater proportion of health care providers identifying as lesbian, gay, or bisexual, compared to those identifying as straight, reported witnessing a colleague who exhibited attitudes/beliefs about the transgender population that were barriers to care. This signifies that providers identifying as straight may not be as cognizant of their unconscious biases. Health care providers who identify as LGB may have greater empathy, awareness, and understanding of discriminatory experiences faced by transgender patients because of their own experiences dealing with discrimination and microaggressions. Follow-up surveys should explore these specific negative attitudes/beliefs.

Our study had several limitations. The first is selection bias. Responding to our survey was optional, and it is possible that those who chose to participate were more interested in transgender health care rights than nonparticipants. Second, we did not ask providers if they were transgender; comparing cisgender and transgender providers' attitudes would have been valuable insight. Furthermore, there was an uneven distribution of demographic characteristics of our respondents, such as age, sex, race, and sexual orientation.

In addition, this was a single-institution study, limiting the generalizability of our survey. Finally, there are no current established scales in analyzing behaviors and attitudes of perioperative health care providers toward transgender health care. This survey was adapted from previously published and validated survey instruments, but the survey itself has not been validated. Indeed, these limitations are common to most research centering on surveys. Future studies must address these shortcomings.

Conclusion

Our survey paints an encouraging picture of the willingness and open-mindedness of perioperative care staff in treating transgender patients. However, acceptance may not necessarily equate to competence and high-quality care, as we have identified a significant number of clinicians not properly educated on transgender health care needs. Ideally, institutions should strive for the elimination of all misconceptions and biases toward transgender health care.

The knowledge gaps revealed through our study will guide establishment of institutional cultural competency training programs as well as education sessions on transgender health to improve their quality of care. Follow-up studies at our institution will reassess the attitudes and behaviors of perioperative staff on transgender health care after implementation of this educational curriculum.

Abbreviations Used

APP

advanced practice provider

ASA

American Society of Anesthesiologists

CRNA

certified registered nurse anesthetists

EHRs

electronic health records

EQ

education questions

GAQ

general attitudes questions

HAQ

health care-specific attitudes questions

IBQ

institution-wide behaviors

KQ

knowledge questions

LGB

lesbian, gay, or bisexual

LGBTQ

lesbian, gay, bisexual, transgender, and queer

MD

Medical Doctor

MISP

Merck Investigator Studies Program

NP

nurse practitioner

PA

physician assistant

PAQ

provider-specific behaviors

PCT

patient care techs

RN

registered nurse

SE

standard error

ST

surgical technologists

UA

unit assistants

Authors' Contributions

R.S. helped with data collection, analysis and interpretation, article writing, and submission of article. C.Y. helped with project conception, data collection, data analysis and interpretation, article editing, and submission of article. J.L. helped with data analysis and interpretation, article editing, and writing of methods. K.S.T. helped with data analysis and interpretation of data, article editing, and writing of methods. G.Y. helped with data collection, oversight of project, and article editing. K.H. helped with interpretation of data and article editing. C.W. helped with interpretation of data and article editing. L.T. helped with project conception, data collection, data analysis and interpretation, article editing, and submission of article.

All authors had substantial contribution to acquisition, analysis, or interpretation of data and participated in drafting or revising it critically and approve of final version and agree to be accountable for all aspects of work.

Author Disclosure Statement

R.S., C.Y., J.L., K.S.T., G.Y., K.H., and C.W.: no conflicts to disclose. L.T. serves as a paid consultant and has an advisory role for Merck. He is a grant recipient through Merck Investigator Studies Program (MISP) to fund a clinical trial at MSKCC (NCT03808077).

Funding Information

The authors' (all authors) work was supported and funded, in part, by National Institutes of Health (NIH)/NCI Cancer Center Support Grant P30 CA008748. The authors' (all authors) work was also supported and funded, in part, by the American Society of Anesthesiologists (ASA) Mentoring Grant—awarded by the Committee on Professional Diversity.

Supplementary Material

Supplementary Data

Cite this article as: Shi R, Yeoh C, Lee J, Tan KS, Yang G, Haviland K, Walters C, Tollinche L (2023) Perioperative oncology health care providers and transgender health: a single-institution survey to gauge attitudes, knowledge, behaviors, and education, Transgender Health 8:3, 254–263, DOI: 10.1089/trgh.2021.0001.