PROMOTING CERVICAL CANCER SCREENING IN TRANSGENDER MALES: BARRIERS TO CARE

Introduction: Cervical cancer (CC) screening or Papanicolaou (Pap) testing has successfully decreased mortality amongst women. National recommendations have resulted in published guidelines for CC prevention, including specific age recommendations that facilitate provider compliance with the conduct of these important health care screenings. Despite the availability of resources, access to CC screening (Pap smear) within the female-to-male or Transgender Men (TM) population is much less frequent as compared to non-transgender women. Background: According to the literature, the failure of TM to disclose their sexual orientation (SO) and gender identity (GI) are often caused by factors such as provider discrimination, bias, and neglect. This is turn results in a patient-provider relationship where open communication does not occur, leading to suboptimal care practices. An effective way to address this barrier is to create a welcoming environment by integrating SO and GI into the encounter history, as well as in the Electronic Health Record (EHR), in hopes of promoting self-identification and disclosure. Methods: This project utilized retrospective chart reviews to evaluate the pre- and post- implementation of SO and GI intake forms introduced at a Los Angeles based health care institution between the years 2014 and 2015. A population sampling technique was used to identify TMs who received annual physicals within the Primary Care Department between January 1, 2013 to December 31, 2013 pre-implementation and January 1, 2016 to December 31, 2016 post-implementation of these new forms. iv Discussion: The number of TM patients who were offered and completed CC screening (pap smear) decreased from 62.5% (15 of 24 patients) in 2013 to 52.6% (20 of 38 patients) in 2016, despite the implementation of gender neutral forms and higher selfidentification of TM patients. Results support the need for further training of providers on how to provide gynecologic care to the TM population. Integrating SO and GI forms within a healthcare institution are key first steps in eliminating and overcoming barriers, but are not sufficient as a stand-alone intervention to promote TM equitable care. What may prove to be even more critical may be the presence of an open, trusting and respectful relationship between healthcare providers and their transgender male clients