A meta-ethnography of cultural influences on cancer-related psychological interventions
Two million people in the UK are living with or beyond cancer and a third of them report poor quality of life (QoL) due to problems such as fatigue, fear of cancer recurrence and concerns about returning to work. Our trial, Survivors’ Rehabilitation Evaluation after CANcer (SURECAN), aims to develop and evaluate a new talking therapy based on Acceptance and Commitment Therapy for people who have completed treatment for cancer, but are experiencing poor QoL. We conducted a systematic review and meta-ethnography of cultural influences on cancer-related psychological interventions in order to inform the design of a culturally sensitive intervention that will better appeal to ethnically diverse populations. The papers included in the study reported here focused on black and minority ethnic (BME) experiences.
Nine major databases were systematically searched for qualitative studies of minority ethnic groups (as specified in the UK census) describing their experiences of using oncological or mental health services. In the first stage of the meta-ethnography, studies focused on experiences of UK services were selected. Two reviewers working independently screened titles and abstracts to identify potentially eligible studies and two reviewers subsequently assessed full-texts for relevance. Recurring concepts were identified and first order (participant) and second order (authors’ interpretations) constructs extracted by three reviewers. Third order constructs (the review team's interpretations) will be identified iteratively and via group analytical sessions. Interpretations will be presented to the wider research team for confirmation of congruence, and a report on the full findings of the synthesis produced.The review protocol was registered at PROSPERO 2018 CRD42018107695.
The search resulted in 11,142 unique citations, and 28 papers met the inclusion criteria. Interim analysis of 20 papers yielded 10 preliminary themes (recurring concepts). Key influences on patients’ experiences of healthcare include health beliefs, aspects of the patient-practitioner relationship (such as power imbalances, degree of person-centredness), the role of family (including guiding access to care), stigma, the role of spirituality and religion, as well as language and communication issues not accommodated by services. Tertiary order constructs will be developed in the final phase of the project.
The results of this study have implications for the development of interventions that are suitable for diverse patient groups in the UK society. Our findings can inform clinicians’, researchers’ and policy makers’ understanding of the kinds of understanding and support required in order to develop services and trials suitable to the needs of BME patients.