1.  Creating “Should I Be Screened”: A Transgender Mobile Healthcare Application Lindsey Rehl Temple University

2. Gender Identity: An individual‘s internal sense of being male or female Transgender: An umbrella term for people whose gender identity, expression or behavior is different from those typically associated with their assigned sex at birth. Transgender Man: FTM Transgender Woman: MTF Sex Reassignment Surgery: Surgical procedures that change one’s body to make it conform to a person’s gender identity. (National Center for Transgender Equality, 2009)

3. Transgender Men and Women have lower rates of cancer screening than the general population (Vogel, 2014 & Margolies, 2014 ) Lower rates of screening compounded with higher rates of HIV, HPV, sexual violence, smoking, and the use of exogenous hormones for transition put transgender men and women at higher risk for malignancies that could be detected through early screening and prevention education (Margolies, 2014; Grant et al, 2010)

4. Why???? Reasons  Provider discrimination  Fear of discrimination  Gaps in provider knowledge  Poor community understanding of cancer screenings  Insurance and Financial barriers  Electronic medical record (EMR) systems that utilize a binary gender system (Grant et al, 2010; Lindsey, 2014; Quinn et al, 2014; Roberts & Fantz, 2014)

5. Creating a Solution  Patients and providers need to be educated.  Relevant health history needs to be documented in consistent places within the EMR  Screening and Prevention are vital to better outcomes

6. Creating the Survey  Identify Transgender men and women  Determine use of hormones  Determine use of sexual reassignment surgery (SRS)  Determine family history of cancer  Survey Monkey vs Google Doc Forms  $$$ vs. Free  Question Limit  Linking questions  Identify Mandatory Questions  Collect data (Rehl, L. 2015)

7. Education  Breast cancer  Cervical cancer  Ovarian cancer  Testicular cancer  Prostate cancer

8. Provider Survey  Identify providers who care for transgender patients  How they utilize their EMR to identify quality indicators relevant to individual patients  How is this done for transgender patients (Rehl, L. 2015)

9. Websites  http://www.uspreventiveservicestaskforce.org/BrowseRec/S earch?s=cancer+screening  http://transhealth.ucsf.edu  http://www.cdc.gov/cancer/dcpc/prevention/screening.htm  http://www.cancer.org

10. Impact and Changes  Create conversation  Empower  Early Screening  Effective Treatment  Better Outcomes  Things to Add  HIV history  HPV history  Smoking history  Things to Do  Link survey finding to recommended cancer screenings  Link survey data to EMR

11. References  Grant, J. M., Mottet, L., Tanis, J., Herman, J., Harrison, J., & Keisling, M. (2010). National transgender discrimination survey report on health and health care. National Center for Transgender Equality and National Gay and Lesbian Task Force.  Lindsey, H. (2014b). Overcoming barriers to cancer care for LGBT patients. Oncology Times, (May), 95-96.  Margolies, L. (2014). The same, only scarier -- the LGBT cancer experience. Retrieved from http://www.cancer.org/cancer/news/expertvoices/post/2014/06/05/the-same-only-scarier-the-lgbt-cancer-experience.aspx http://www.cancer.org/cancer/news/expertvoices/post/2014/06/05/the-same-only-scarier-the-lgbt-cancer-experience.aspx  National Center for Transgender Equality. (2014). Transgender terminology. Retrieved from http://transequality.org/sites/default/files/docs/resources/TransTerminology_2014.pdf  Quinn, G. P., Schabath, M. B., Sanchez, J. A., Sutton, S. K., & Green, B. L. (2014). The importance of disclosure: lesbian, gay, bisexual, transgender/transsexual, queer/questioning, and intersex individuals and the cancer continuum. Cancer, 1-4. doi:10.1002/cncr.29203.  Rehl, L. (2015). Should I be screened. (Version 1.0) [Mobile application software]. Retrieved from http://apps.appypie.com/html5/should-i-b-screened http://apps.appypie.com/html5/should-i-b-screened  Roberts, T. K., & Fantz, C. R. (2014). Barriers to quality health care for the transgender population. Clinical Biochemistry, 47, 983-987.  Vogel, L. (2014). Screening programs overlook transgender people. Canadian Medical Association Journal, 186 (11), 823. doi:10.1503/cmaj.109-4839