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Equity, Diversity, and Inclusion

USPSTF Approach to Addressing Sex and Gender When Making Recommendations for Clinical Preventive Services

Educational Objective
To identify the key insights or developments described in this article
1 Credit CME
JAMA
Published Online: October 25, 2021
US Preventive Services Task Force
Aaron B. Caughey, MD, MPH, PhD1;
Alex H. Krist, MD, MPH2;
Tracy A. Wolff, MD, MPH3;
Michael J. Barry, MD4;
Jillian T. Henderson, PhD, MPH5;
Douglas K. Owens, MD, MS6;
Karina W. Davidson, PhD7;
Melissa A. Simon, MD, MPH8;
Carol M. Mangione, MD, MSPH9
Author Affiliations
  • 1Department of Obstetrics and Gynecology, Oregon Health & Science University, Portland
  • 2Department of Family Medicine and Population Health, Virginia Commonwealth University, Richmond
  • 3Center for Evidence and Practice Improvement (CEPI), Agency for Healthcare Research and Quality, Rockville, Maryland
  • 4Informed Medical Decisions Program, Division of General Internal Medicine, Massachusetts General Hospital, Boston
  • 5Kaiser Permanente, Northwest, Center for Health Research, Kaiser Permanente Evidence-based Practice Center, Portland, Oregon
  • 6Stanford Health Policy, Department of Medicine and Freeman Spogli Institute for International Studies, Stanford University, Stanford, California
  • 7Feinstein Institutes for Medical Research at Northwell Health, New York, New York
  • 8Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
  • 9Departments of Medicine and Health Policy and Management, University of California at Los Angeles
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Abstract

Clinical preventive service recommendations from the US Preventive Services Task Force (USPSTF) are based on transparent, systematic, and rigorous methods that consider the certainty of the evidence and magnitude of net benefit. These guidelines aim to address the needs of diverse populations. Biological sex and gender identity are sources of diversity that are not often considered in studies of clinical preventive services that inform the recommendations, resulting in challenges when evaluating the evidence and communicating recommendations for persons in specific gender identification categories (man/woman/gender nonbinary/gender nonconforming/transgender). To advance its methods, the USPSTF reviewed its past recommendations that included the use of sex and gender terms, reviewed the approaches of other guideline-making bodies, and pilot tested strategies to address sex and gender diversity. Based on the findings, the USPSTF intends to use an inclusive approach to identify issues related to sex and gender at the start of the guideline development process; assess the applicability, variability, and quality of evidence as a function of sex and gender; ensure clarity in the use of language regarding sex and gender; and identify evidence gaps related to sex and gender. Evidence reviews will identify the limitations of applying findings to diverse groups from underlying studies that used unclear terminology regarding sex and gender. The USPSTF will use gender-neutral language when appropriate to communicate that recommendations are inclusive of people of any gender and will clearly state when recommendations apply to individuals with specific anatomy associated with biological sex (male/female) or to specific categories of gender identity. The USPSTF recognizes limited evidence to inform the preventive care of populations based on gender identity.

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CME Disclosure Statement: Unless noted, all individuals in control of content reported no relevant financial relationships. If applicable, all relevant financial relationships have been mitigated.

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Guidelines United States Preventive Services Task Force LGBTQIA Medicine Equity, Diversity, and Inclusion
Article Information

Corresponding Author: Carol M. Mangione, MD, MSPH, Department of Medicine, University of California at Los Angeles, 1100 Glendon Ave, Ste 850, Los Angeles, CA 90024 (cmangione@mednet.ucla.edu).

Accepted for Publication: August 31, 2021.

Published Online: October 25, 2021. doi:10.1001/jama.2021.15731

Correction: This article was corrected on December 21, 2021, to fix an error in Figure 1.

Author Contributions: Dr Caughey had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.

Conflict of Interest Disclosures: None reported.

Funding/Support: The USPSTF is an independent, voluntary body. The US Congress mandates that the Agency for Healthcare Research and Quality (AHRQ) support the operations of the USPSTF.

Role of the Funder/Sponsor: AHRQ staff assisted in the writing and preparation of this report and its submission for publication. AHRQ staff had no role in the approval of the final report or the decision to submit for publication.

Disclaimer: The findings and conclusions in this document are those of the authors, who are responsible for its content, and do not necessarily represent the views of the Agency for Healthcare Research and Quality (AHRQ). No statement in this report should be construed as an official position of AHRQ or the US Department of Health and Human Services.

Additional Information: We would like to acknowledge Madeline Deutsch, MD, MPH (University of California San Francisco), Jennifer Potter, MD (Harvard Medical School), and Howard Libman, MD (Harvard Medical School), who provided valuable feedback on early drafts of the USPSTF approach. Martha Duffy, MD, MPH, provided support in cataloging USPSTF recommendations and reviewing guidelines from other organizations and feedback on draft language for recommendations. Drs Deutsch, Potter, Libman, and Duffy did not receive compensation for their contributions to this paper. Amy Cantor, MD, MPH, and Elizabeth O’Connor, PhD, are members of the review teams that support the USPSTF and were involved in pilot testing the approach during systematic reviews. Drs Cantor and O’Connor received compensation through their work as part of the Evidence-based Practice Centers’ (EPC) (Pacific Northwest Evidence-based Practice Center and Kaiser Permanente Evidence-based Practice Center, respectively) support of the USPSTF.

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