Transgender females historically described difficulty communicating with healthcare providers. There is a perceived fear of being discriminated against or being misgendered during healthcare encounters (Johnson et al., 2019). In 2017, Seelman reported that 6,450 transgender patients have had difficulty communicating their healthcare needs to their medical providers because of fear, being refused care because of their gender identity, verbal abuse, or a violent experience. Concerns were that patients who do not communicate their healthcare needs or disclose healthcare information are at risk of incorrect decisions being made in their medical treatment. To address this issue, a PICOT question was constructed to begin the process of literature searches and reviews necessary for identifying the appropriate resources, relevant to usable evidence significant to producing answers to the problem identified to structure the project. The mnemonic explanation of PICOT was: (P) In transgender females to females (MtF) who are receiving medical intervention for gender affirmation or post-gender affirmation maintenance (I) does use of a standardized prepared communication note (C) compared to no prepared note (O) to improve the patient's self-reported communication with health care providers (T) in 90 days (about 3 months) of implementation. Information was gathered from the search, and the best intervention was selected. The project was implemented at a clinical site that provided care to transgender females. A post-survey tool was used to measure results: 2 (16.66%) of the 12 participants strongly agreed 100% to all questions. Although participation in the project was lower than expected, the benefits of the intervention showed improved communication hesitancy, reduced medical errors, improved self-advocacy, and improved patient participation in their healthcare. Subsequently, the intervention was determined to be sustainable if incorporated into the clinical intake assessment process.

Date of publication

Spring 5-16-2024

Document Type

DNP Scholarly Project (Local Access Only)



Persistent identifier


Committee members

Cheryl D. Parker, Ph.D., RN, Gina M. Nickles-Nelson, DNP, FNP, Lauri D. John, Ph.D., RN


Doctor of Nursing Practice

Available for download on Saturday, May 16, 2026