Long-Term Regret and Satisfaction With Decision Following Gender-Affirming Mastectomy
Importance: There has been increasing legislative interest in regulating gender-affirming surgery, in part due to the concern about decisional regret. The regret rate following gender-affirming surgery is thought to be approximately 1%; however, previous studies relied heavily on ad hoc instruments.
Objective: To evaluate long-term decisional regret and satisfaction with decision using validated instruments following gender-affirming mastectomy.
Design, Setting, and Participants: For this cross-sectional study, a survey of patient-reported outcomes was sent between February 1 and July 31, 2022, to patients who had undergone gender-affirming mastectomy at a US tertiary referral center between January 1, 1990, and February 29, 2020.
Exposure: Decisional regret and satisfaction with decision to undergo gender-affirming mastectomy.
Main Outcomes and Measures: Long-term patient-reported outcomes, including the Holmes-Rovner Satisfaction With Decision scale, the Decision Regret Scale, and demographic characteristics, were collected. Additional information was collected via medical record review. Descriptive statistics and univariable analysis using Fisher exact and Wilcoxon rank sum tests were performed to compare responders and nonresponders.
Results: A total of 235 patients were deemed eligible for the study, and 139 responded (59.1% response rate). Median age at the time of surgery was 27.1 (IQR, 23.0-33.4) years for responders and 26.4 (IQR, 23.1-32.7) years for nonresponders. Nonresponders (n = 96) had a longer postoperative follow-up period than responders (median follow-up, 4.6 [IQR, 3.1-8.6] vs 3.6 [IQR, 2.7-5.3] years, respectively; P = .002). Nonresponders vs responders also had lower rates of depression (42 [44%] vs 94 [68%]; P < .001) and anxiety (42 [44%] vs 97 [70%]; P < .001). No responders or nonresponders requested or underwent a reversal procedure. The median Satisfaction With Decision Scale score was 5.0 (IQR, 5.0-5.0) on a 5-point scale, with higher scores noting higher satisfaction. The median Decision Regret Scale score was 0.0 (IQR, 0.0-0.0) on a 100-point scale, with lower scores noting lower levels of regret. A univariable regression analysis could not be performed to identify characteristics associated with low satisfaction with decision or high decisional regret due to the lack of variation in these responses.
Conclusions and Relevance: In this cross-sectional survey study, the results of validated survey instruments indicated low rates of decisional regret and high levels of satisfaction with decision following gender-affirming mastectomy. The lack of dissatisfaction and regret impeded the ability to perform a more complex statistical analysis, highlighting the need for condition-specific instruments to assess decisional regret and satisfaction with decision following gender-affirming surgery.
| Errataetall: |
CommentIn: JAMA Surg. 2023 Oct 1;158(10):1077. - PMID 37556133 |
|---|---|
| Medienart: |
E-Artikel |
| Erscheinungsjahr: |
2023 |
|---|---|
| Erschienen: |
2023 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:158 |
|---|---|
| Enthalten in: |
JAMA surgery - 158(2023), 10 vom: 01. Okt., Seite 1070-1077 |
| Sprache: |
Englisch |
|---|
| Beteiligte Personen: |
Bruce, Lauren [VerfasserIn] |
|---|
| Links: |
|---|
| Themen: |
Journal Article |
|---|
| Anmerkungen: |
Date Completed 27.10.2023 Date Revised 13.12.2023 published: Print CommentIn: JAMA Surg. 2023 Oct 1;158(10):1077. - PMID 37556133 Citation Status MEDLINE |
|---|
| doi: |
10.1001/jamasurg.2023.3352 |
|---|
| funding: |
|
|---|---|
| Förderinstitution / Projekttitel: |
|
| PPN (Katalog-ID): |
NLM360557600 |
|---|
| LEADER | 01000caa a22002652 4500 | ||
|---|---|---|---|
| 001 | NLM360557600 | ||
| 003 | DE-627 | ||
| 005 | 20231227131444.0 | ||
| 007 | cr uuu---uuuuu | ||
| 008 | 231226s2023 xx |||||o 00| ||eng c | ||
| 024 | 7 | |a 10.1001/jamasurg.2023.3352 |2 doi | |
| 028 | 5 | 2 | |a pubmed24n1225.xml |
| 035 | |a (DE-627)NLM360557600 | ||
| 035 | |a (NLM)37556147 | ||
| 040 | |a DE-627 |b ger |c DE-627 |e rakwb | ||
| 041 | |a eng | ||
| 100 | 1 | |a Bruce, Lauren |e verfasserin |4 aut | |
| 245 | 1 | 0 | |a Long-Term Regret and Satisfaction With Decision Following Gender-Affirming Mastectomy |
| 264 | 1 | |c 2023 | |
| 336 | |a Text |b txt |2 rdacontent | ||
| 337 | |a ƒaComputermedien |b c |2 rdamedia | ||
| 338 | |a ƒa Online-Ressource |b cr |2 rdacarrier | ||
| 500 | |a Date Completed 27.10.2023 | ||
| 500 | |a Date Revised 13.12.2023 | ||
| 500 | |a published: Print | ||
| 500 | |a CommentIn: JAMA Surg. 2023 Oct 1;158(10):1077. - PMID 37556133 | ||
| 500 | |a Citation Status MEDLINE | ||
| 520 | |a Importance: There has been increasing legislative interest in regulating gender-affirming surgery, in part due to the concern about decisional regret. The regret rate following gender-affirming surgery is thought to be approximately 1%; however, previous studies relied heavily on ad hoc instruments | ||
| 520 | |a Objective: To evaluate long-term decisional regret and satisfaction with decision using validated instruments following gender-affirming mastectomy | ||
| 520 | |a Design, Setting, and Participants: For this cross-sectional study, a survey of patient-reported outcomes was sent between February 1 and July 31, 2022, to patients who had undergone gender-affirming mastectomy at a US tertiary referral center between January 1, 1990, and February 29, 2020 | ||
| 520 | |a Exposure: Decisional regret and satisfaction with decision to undergo gender-affirming mastectomy | ||
| 520 | |a Main Outcomes and Measures: Long-term patient-reported outcomes, including the Holmes-Rovner Satisfaction With Decision scale, the Decision Regret Scale, and demographic characteristics, were collected. Additional information was collected via medical record review. Descriptive statistics and univariable analysis using Fisher exact and Wilcoxon rank sum tests were performed to compare responders and nonresponders | ||
| 520 | |a Results: A total of 235 patients were deemed eligible for the study, and 139 responded (59.1% response rate). Median age at the time of surgery was 27.1 (IQR, 23.0-33.4) years for responders and 26.4 (IQR, 23.1-32.7) years for nonresponders. Nonresponders (n = 96) had a longer postoperative follow-up period than responders (median follow-up, 4.6 [IQR, 3.1-8.6] vs 3.6 [IQR, 2.7-5.3] years, respectively; P = .002). Nonresponders vs responders also had lower rates of depression (42 [44%] vs 94 [68%]; P < .001) and anxiety (42 [44%] vs 97 [70%]; P < .001). No responders or nonresponders requested or underwent a reversal procedure. The median Satisfaction With Decision Scale score was 5.0 (IQR, 5.0-5.0) on a 5-point scale, with higher scores noting higher satisfaction. The median Decision Regret Scale score was 0.0 (IQR, 0.0-0.0) on a 100-point scale, with lower scores noting lower levels of regret. A univariable regression analysis could not be performed to identify characteristics associated with low satisfaction with decision or high decisional regret due to the lack of variation in these responses | ||
| 520 | |a Conclusions and Relevance: In this cross-sectional survey study, the results of validated survey instruments indicated low rates of decisional regret and high levels of satisfaction with decision following gender-affirming mastectomy. The lack of dissatisfaction and regret impeded the ability to perform a more complex statistical analysis, highlighting the need for condition-specific instruments to assess decisional regret and satisfaction with decision following gender-affirming surgery | ||
| 650 | 4 | |a Journal Article | |
| 650 | 4 | |a Research Support, N.I.H., Extramural | |
| 650 | 4 | |a Research Support, Non-U.S. Gov't | |
| 700 | 1 | |a Khouri, Alexander N |e verfasserin |4 aut | |
| 700 | 1 | |a Bolze, Andrew |e verfasserin |4 aut | |
| 700 | 1 | |a Ibarra, Maria |e verfasserin |4 aut | |
| 700 | 1 | |a Richards, Blair |e verfasserin |4 aut | |
| 700 | 1 | |a Khalatbari, Shokoufeh |e verfasserin |4 aut | |
| 700 | 1 | |a Blasdel, Gaines |e verfasserin |4 aut | |
| 700 | 1 | |a Hamill, Jennifer B |e verfasserin |4 aut | |
| 700 | 1 | |a Hsu, Jessica J |e verfasserin |4 aut | |
| 700 | 1 | |a Wilkins, Edwin G |e verfasserin |4 aut | |
| 700 | 1 | |a Morrison, Shane D |e verfasserin |4 aut | |
| 700 | 1 | |a Lane, Megan |e verfasserin |4 aut | |
| 773 | 0 | 8 | |i Enthalten in |t JAMA surgery |d 2013 |g 158(2023), 10 vom: 01. Okt., Seite 1070-1077 |w (DE-627)NLM221106529 |x 2168-6262 |7 nnns |
| 773 | 1 | 8 | |g volume:158 |g year:2023 |g number:10 |g day:01 |g month:10 |g pages:1070-1077 |
| 856 | 4 | 0 | |u http://dx.doi.org/10.1001/jamasurg.2023.3352 |3 Volltext |
| 912 | |a GBV_USEFLAG_A | ||
| 912 | |a GBV_NLM | ||
| 951 | |a AR | ||
| 952 | |d 158 |j 2023 |e 10 |b 01 |c 10 |h 1070-1077 | ||