Decision-making in feminizing genital gender-affirming surgery - the effect of the introduction of the GenderAid decision-aid

IntroductionTransgender individuals considering feminizing genital gender-affirming surgery (gGAS) face multiple options and potential decisional conflict (DC). Shared decision-making (SDM) between patients and healthcare professionals (HCPs) can support personalized care and improve outcomes. To aid trans women during the decision-making process for gGAS, a decision aid, the GenderAid (GA), was developed.MethodsThis study aimed to investigate the effect of the GA on SDM and DC levels during the decision-making process for feminizing gGAS. An observational cross-sectional mixed methods study was conducted at the departments of Psychology and Plastic Surgery at the Center of Expertise on Gender Dysphoria of the Amsterdam UMC between 2020 and 2023. Questionnaires administered before and after implementing the GA included the validated translations of the SDM-Q-doc and SDM-Q-9 and the Decisional Conflict Scale. Qualitative data from interviews explored trans women's perceptions of the concepts of SDM and DC when deciding on feminizing gGAS.ResultsSignificantly higher levels of SDM experienced by trans women were observed after the introduction of the GA, while no such difference was observed for HCPs. The GA facilitated more thorough discussions with HCPs, and trans women felt well prepared for consultations by the decision-aid. DC was low before and after introduction of the GA; however, both quantitative as qualitative data revealed trans women experienced uncertainties during the process, due to new information on (non-)surgical options for gGAS.DiscussionThis study suggests that the GA enhanced SDM in individuals seeking feminizing gGAS and had limited impact on DC by offering extensive information on all (non-)surgical options. However, the improved information overview regarding surgical options also resulted in increased decision uncertainty among trans women. Future controlled research should further explore optimizing information provision throughout the care process, managing uncertainties, and implementing the use of decision-aids by HCPs.