A meta-ethnography of cultural and relational influences on cancer-related psychological interventions


Year:

Session type:

Damien Ridge1, Karen Pilkington2, Sheila Donovan3, Elisavet Moschopoulou3, Dipesh Gopal3, Kamaldeep Bhui4, Trudie Chalder5, Imran Khan3, Stephanie Taylor3, Ania Korszun3
1University of Westminster, 2University of Portsmouth, 3Queen Mary University of London, 4University of Oxford, 5King’s College London (KCL)

Abstract

Background

Two million people in the UK are living with or beyond cancer, and one in three report poor quality of life (QoL). Our trial, Survivors’ Rehabilitation Evaluation after CANcer (SURECAN), involved developing 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 meta-ethnographic synthesis of qualitative research related to cultural influences (with specific reference to British racially minoritised populations) on cancer-related psychological interventions to inform the design of SURECAN.

Method

Nine databases were searched for studies of minority ethnic groups (as specified in the UK census) describing their experiences of using UK oncological or mental health services/interventions. 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) were identified iteratively via individual and group analytical sessions to arrive at a final synthesis. Review protocol: PROSPERO 2018 CRD42018107695.

Results

The search resulted in 11,142 unique citations, 29 papers met the inclusion criteria. Key influences on participant experiences of healthcare included wide-ranging health beliefs, stigma, specifics of the patient-practitioner relationship (e.g. person-centredness), the role of family (including gatekeeping) and spirituality. Our synthesis suggested that a focus on relationships and the ways in which people are shaped by them (including via their emergent affective meanings, ways of internalising knowledge and relating to the self and others, and the “positioning” of practitioners) framed the possibilities of engagement.

Conclusion

By considering that participants are always persons in relation to others, our paper is the first to apply specifically a relational framework to interpret a qualitative synthesis of Black and ethnicity-related experiences of interventions/care relevant to people living with or beyond cancer. Centring affective relationality in this way challenges existing approaches that might discount diverse types of knowledge, culturally shaped preferences, and the primacy of patient experiences in deconstructing hegemonic practices in care.

Impact statement

Our findings provide some initial insights into how 'decolonising' professional approaches and psychological healing in cancer care might look.