Study set to explore the impact of peer-support for patients undergoing gender-affirming surgery

Investigators at Oregon Health & Science University (OHSU) have been awarded funding from the Patient Centered Outcomes Research Institute (PCORI) to pursue a 5-year study, known as STRIVE, looking at the effect of peer-support on patient outcomes for transgender and nonbinary patients receiving vaginoplasty.^1,2

The national study will include 260 patients aged 18 and older who are set to undergo vaginoplasty.

“We know that peer support can be particularly helpful for those receiving gender-affirming care. Extra support from trusted peers can help make navigating complex health care systems easier for transgender patients, who often have to wait years before receiving gender-affirming genital surgery—while also managing the stress and trauma associated with being part of a society that often doesn’t accept non-conforming gender expression,” said lead author Geolani Dy, MD, FACS, in a news release on the study.¹ Dy is an assistant professor of urology at OHSU School of Medicine in Portland, Oregon.

The national study will include 260 patients aged 18 and older who are set to undergo vaginoplasty. Participants will be randomized 1:1 to participate in a virtual peer support program or to receive educational materials without formal peer support.

Patients in the peer-support cohort will participate in a 3-month virtual program that will be delivered by facilitators from Trans Lifeline, a trans-run nonprofit that offers support to transgender individuals. All patients included in this group will be awaiting vaginoplasty from 5 institutions: OHSU in Portland; New York University Langone Health; University of Utah in Salt Lake City; University of California, San Francisco; and Rush University in Chicago. Participants in the standard care cohort will be given educational materials that cover the same topics as the virtual course through their gender-affirming surgical team.

The goal of the study is to determine whether the peer-support intervention improves patient outcomes and satisfaction. Participants in the study will be followed for up to 3 years, with in-depth interviews taking place at the start of the study and at 6 months. They will also be asked to take a series of surveys over the course of the study.

The primary end point of the study is patients’ ability to cope with stressors, as measured by patient-provided survey responses at 6 months. Secondary outcomes, such as meeting genital gender-affirming surgery presurgical criteria and other important factors such as psychological stress, social support, resilience, quality of life, presurgical knowledge, surgical delays and cancellations, will be assessed at 12 months. At 24 months, the investigators will assess post-surgical outcomes, including surgical satisfaction.

The PCORI website² explains, “In designing this study, the research team worked closely with trans community members and patients, health services and policy researchers, gender-affirming surgeons, advocates, gender program administrators and representatives from social support organizations. Collaboration with and input from the trans community during the conduct of this study will be critical to ensure that the STRIVE study is patient centered.”

References

1. OHSU-led study seeks to better support transgender patients before surgery. News release. Oregon Health & Science University. July 20, 2023. Accessed July 21, 2023. https://news.ohsu.edu/2023/07/20/ohsu-led-study-seeks-to-better-support-transgender-patients-before-surgery-6894045

2. Support for transgender and nonbinary individuals seeking vaginoplasty (STRIVE) study. Patient-Centered Outcomes Research Institute. Accessed July 21, 2023. https://www.pcori.org/research-results/2023/support-transgender-and-nonbinary-individuals-seeking-vaginoplasty-strive-study