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Trial registered on ANZCTR
Registration number
ACTRN12624000835549
Ethics application status
Approved
Date submitted
11/06/2024
Date registered
5/07/2024
Date last updated
19/10/2024
Date data sharing statement initially provided
5/07/2024
Type of registration
Prospectively registered
Titles & IDs
Public title
Evaluating a co-designed shared care model of care on the quality of life of patients accessing gender affirming hormone therapy
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Scientific title
Evaluating a co-designed shared care model of care on the quality of life of patients accessing gender affirming hormone therapy
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Secondary ID [1]
312321
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Nil known
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Universal Trial Number (UTN)
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Trial acronym
COSMAT Study
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Linked study record
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Health condition
Health condition(s) or problem(s) studied:
Gender Dysphoria
334075
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Condition category
Condition code
Mental Health
330750
330750
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0
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Depression
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Intervention/exposure
Study type
Interventional
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Description of intervention(s) / exposure
The shared care model of care co-design process was completed in 2023 with input from trans community members, GPs, practice manager, rural trans community organisations and primary care health networks in rural Victoria.
Current standard of care involves being on a waiting list for 9 months to access specialised gender clinics in Melbourne where initiation and monitoring of hormone therapy is provided by the specialist gender clinic without expectation of the GP to provide significant input. Patients often travel long distances to access care from rural Victoria to metropolitan Melbourne Victoria.
The intervention will be the shared care model of care. The shared care model of care will be available to patients living in rural Victoria (Modified Monash Model Remoteness Areas 2 - 7). It will actively involve their local rural GP alternating consultations with the specialist gender clinic whilst the local rural GP concurrently is supported with an existing training course in gender affirming care (run by Thorne Harbour Health), existing training resources (AusPATH informed consent standards of care, HealthPathways, Transhub website) and the specialist gender clinic endocrinologist. Patients will be supported by a peer navigator and also connected to local rural trans organisations if available in the patient's location of residence. Clinic visits will be one-on-one and occur 3 monthly for 24 months but alternate between the specialist gender clinic endocrinologist via telehealth and the local rural GP face-to-face, The frequency of clinic visits with specialist gender clinic endocrinologist gradually decreases whilst clinic visits with the local rural GP gradually increases over the 24 month period. The shared care model of care will be facilitated by a specialist gender care nurse and adherence by the GP and patient will be supported by session attendance checklists. Both patients and their GPs will provide consent to participate in the shared care model of care.
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Intervention code [1]
328795
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Treatment: Other
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Comparator / control treatment
The comparator will be standard care at existing Austin Health Gender Clinic in Heidelberg, Victoria or Equinox Gender Diverse Health Centre, Abbotsford, Victoria. Current standard of care involves being on a waiting list for 9 months to access specialised gender clinics in Melbourne (face-to-face or telehealth depending on patient preference) where initiation and monitoring of hormone therapy is provided by the specialist gender clinic without expectation of the local GP to provide significant input. Peer support is available to patients if requested. Patients often travel long distances to access care from rural Victoria to metropolitan Melbourne Victoria.
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Control group
Active
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Outcomes
Primary outcome [1]
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Quality of life
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Assessment method [1]
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EQ-VAS
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Timepoint [1]
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0, 3, 6 (primary timepoint), 12, 24 months post-enrolment
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Primary outcome [2]
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Quality of life
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Assessment method [2]
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EQ-5D-5L
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Timepoint [2]
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0, 3, 6 (primary timepoint), 12, 24 months post-enrolment
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Primary outcome [3]
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GP knowledge and GP confidence in transgender health
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Assessment method [3]
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Questionnaire designed specifically for this study
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Timepoint [3]
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0, 12 (primary timepoint), 24 months post-enrolment
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Secondary outcome [1]
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Depression
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Assessment method [1]
436219
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Patient-Health Questionnaire-9
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Timepoint [1]
436219
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0, 3, 6, 12, 24 months post-enrolment
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Secondary outcome [2]
436220
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Suicidal ideation
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Assessment method [2]
436220
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Suicidal ideation attributes scale (SIDAS)
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Timepoint [2]
436220
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0, 3, 6, 12, 24 months post-enrolment
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Secondary outcome [3]
436221
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Gender Dysphoria
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Assessment method [3]
436221
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Gender Preoccupation and Stability Questionnaire
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Timepoint [3]
436221
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0, 3, 6, 12, 24 months post-enrolment
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Secondary outcome [4]
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Patient Satisfaction
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Assessment method [4]
436222
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Short Assessment of Patient Satisfaction (SAPS) questionnaire
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Timepoint [4]
436222
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0, 3, 6, 12, 24 months post-enrolment
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Secondary outcome [5]
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Health service utilisation for cost effectiveness analysis
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Assessment method [5]
436223
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Health service utilisation questionnaire
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Timepoint [5]
436223
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0, 3, 6, 12, 24 months post-enrolment
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Eligibility
Key inclusion criteria
1. Currently residing in rural or remote Victoria (Modified Monash Model Remoteness Areas 2 – 7)
2. Aged 18 years or over
3. Aged 16 – 17 and have both parents provide informed consent for the initiation of gender affirming hormone therapy and participation.
4. Have a gender that is different from what was recorded at birth (i.e. transgender or gender diverse), including binary and non-binary gender identities, or cultural gender identities
5. Have been referred to a Gender Clinic for commencement of gender affirming hormone therapy
6. Have capacity to provide informed consent
7. Able to understand and complete questionnaires
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Minimum age
16
Years
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Maximum age
No limit
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Sex
Both males and females
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Can healthy volunteers participate?
No
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Key exclusion criteria
- aged under 16 years
- have a gender that is congruent with what was presumed for them at birth (i.e. cisgender)
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Study design
Purpose of the study
Treatment
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Allocation to intervention
Non-randomised trial
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Procedure for enrolling a subject and allocating the treatment (allocation concealment procedures)
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Methods used to generate the sequence in which subjects will be randomised (sequence generation)
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Masking / blinding
Open (masking not used)
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Who is / are masked / blinded?
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Intervention assignment
Parallel
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Other design features
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Phase
Not Applicable
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Type of endpoint/s
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Statistical methods / analysis
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Recruitment
Recruitment status
Recruiting
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Date of first participant enrolment
Anticipated
15/11/2024
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Actual
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Date of last participant enrolment
Anticipated
2/09/2027
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Actual
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Date of last data collection
Anticipated
2/09/2029
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Actual
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Sample size
Target
234
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Accrual to date
0
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Final
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Recruitment in Australia
Recruitment state(s)
VIC
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Recruitment hospital [1]
26675
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Austin Health - Heidelberg Repatriation Hospital - Heidelberg West
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Recruitment postcode(s) [1]
42715
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3081 - Heidelberg West
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Funding & Sponsors
Funding source category [1]
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Government body
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Name [1]
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Australian Department of Health and Aged Care, Medical Research Future Fund (MRFF)
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Address [1]
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Country [1]
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Australia
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Primary sponsor type
University
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Name
University of Melbourne
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Address
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Country
Australia
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Secondary sponsor category [1]
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None
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Name [1]
318922
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Address [1]
318922
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Country [1]
318922
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Ethics approval
Ethics application status
Approved
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Ethics committee name [1]
315492
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Austin Health Human Research Ethics Committee
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Ethics committee address [1]
315492
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https://www.austin.org.au/Office-for-Research/
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Ethics committee country [1]
315492
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Australia
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Date submitted for ethics approval [1]
315492
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11/06/2024
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Approval date [1]
315492
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12/08/2024
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Ethics approval number [1]
315492
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HREC/106019/Austin-2024
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Summary
Brief summary
Access to gender affirming healthcare is challenging, especially if a transgender person lives in a rural area. Specialised gender clinics have waiting lists of >12 months. We aim to better support local GPs to deliver gender affirming care in local communities by evaluating a new co-designed shared care model plus tailored training program to start hormone therapy. We will evaluate patient quality of life, mental health and satisfaction with the program over 24 months as well as GP knowledge and confidence in transgender health.
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Trial website
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Trial related presentations / publications
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Public notes
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Contacts
Principal investigator
Name
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A/Prof Ada Cheung
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Address
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Austin Health, 145 Studley Road, Heidelberg VIC 3084
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Country
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Australia
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Phone
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+61 3 94965489
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Fax
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Email
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[email protected]
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Contact person for public queries
Name
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Ada Cheung
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Address
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Austin Health, 145 Studley Road, Heidelberg VIC 3084
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Country
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Australia
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Phone
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+61 3 94965489
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Fax
134867
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Email
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[email protected]
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Contact person for scientific queries
Name
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Ada Cheung
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Address
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Austin Health, 145 Studley Road, Heidelberg VIC 3084
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Country
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Australia
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Phone
134868
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+61 3 94965489
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Fax
134868
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Email
134868
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[email protected]
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Data sharing statement
Will individual participant data (IPD) for this trial be available (including data dictionaries)?
No
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No/undecided IPD sharing reason/comment
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What supporting documents are/will be available?
No Supporting Document Provided
Results publications and other study-related documents
Documents added manually
No documents have been uploaded by study researchers.
Documents added automatically
No additional documents have been identified.
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