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Background: People with mesothelioma and their families have palliative care needs throughout the relatively short trajectory of their illness. Aim: To describe the palliative care needs and experiences of people with mesothelioma and their family carers. Design: Integrative systematic review with narrative synthesis (PROSPERO: CRD42020190115). Data sources: MEDLINE, CINAHL, PsycINFO and the Cochrane Library were searched for articles published between 01 January 2000 and 10 May 2020. Articles were included if they presented empirical studies or comprehensive reviews including information about the palliative care needs and experiences of people with mesothelioma and their family carers. Results: The search yielded 508 articles, 14 were included in the analysis. A cross cutting theme of ‘uncertainty’ was identified encompassing five themes: (1) organisation and co-ordination of services, (2) communication and information needs, (3) management of care needs and high symptom burden, (4) consideration of the impact of seeking compensation and (5) family carer needs. Our findings demonstrate that people with mesothelioma want a co-ordinated, team-based approach to palliative care with a named point of contact. Whilst carers value and benefit from early referral to specialist palliative care, this does not necessarily reflect the outcomes and views of patients. Conclusion: The evidence base around the palliative care needs and experiences of people with mesothelioma and their carers needs to be strengthened. The results of this review support the need to develop a greater understanding about the role non-specialist palliative care clinicians’ play in providing generalist palliative care for people with mesothelioma and their carers.

To explore the barriers and facilitators to sexual discussions in primary care according to a sample of women aged 50 and older living with Type 2 diabetes.A qualitative, interpretative phenomenological analysis study.Ten women aged 50-83 years living with Type 2 diabetes were interviewed between August 2016 -March 2017. Data were analysed using interpretative phenomenological analysis.The participants reported changes to their sexual health and well-being, which they attributed to diabetes, menopause, ageing and changes in intimate relationships. Not all changes were considered problematic, but those that were, tended not to be discussed with healthcare professionals. The women assumed that the topic of sex was not broached by professionals due to embarrassment (both their own and that of the healthcare professional), ageism and social taboos around older women's sexual pleasure. The place that sexual health and well-being held in the women's lives also influenced primary care discussions.These findings demonstrate that social taboos around gender, ageing and sex influenced the barriers to sexual health and well-being discussions in primary care. Facilitators to overcoming these barriers were professional-patient rapport, consulting with a female healthcare professional and instigation of the conversation by healthcare professionals.Type 2 diabetes can have a negative impact on women's sexual health and well-being. Prior to this study, little evidence existed of the barriers that older women with Type 2 diabetes faced with regard to sexual health care. This study shows that midlife-older women with Type 2 diabetes can experience sexual health and well-being problems which are neglected in primary care. It also shows that women want their healthcare professionals to explore these problems. Raising awareness and giving training for healthcare professionals may lead to better provision of sexual health support for midlife-older women with Type 2 diabetes.目的: 以50岁及以上患有2型糖尿病的妇女为样本, 探讨初级保健中性讨论的障碍和促进因素。 设计: 一项定性的、解释性的现象学分析研究。 方法: 在2016年8月至2017年3月期间, 对10名年龄在50至83岁且患有2型糖尿病的女性进行了访谈。采用解释现象学分析对数据进行了分析。 结果: 参与者报告了其性健康和幸福的变化, 将其归因于糖尿病、更年期、衰老和亲密关系的变化。并非所有的改变都认为是有问题的, 而实际上那些有问题的改变, 往往不会与医疗保健专业人员讨论。这些女性认为, 因为感到尴尬 (她们自己以及医疗保健专业人员都会感到尴尬) 、存在年龄歧视以及谈论老年女性性快感等社会禁忌, 专业人员不会提起性话题。性健康和幸福在女性生活中的地位也对初级保健的讨论造成了阻碍。 结论: 这些调查结果表明, 性别、老龄化和性等社会禁忌对初级保健中性健康和幸福的讨论造成了障碍。要想克服这些障碍, 需要专业人员与患者建立融洽关系, 提供女性医疗保健专业人员以便患者咨询以及医疗保健专业人员不断进行沟通。 影响: 2型糖尿病会对妇女的性健康和幸福产生负面影响。在进行本研究之前, 很少有证据表明患有2型糖尿病的中老年妇女在性保健方面面临障碍。本研究表明, 患有2型糖尿病的中老年妇女可能会遇到在初级保健中被忽视的性健康和幸福问题。此外,还表明妇女希望相关医疗保健专业人员能够对此类问题进行探讨。提高对保健专业人员的认识和培训, 可以更好地为患有2型糖尿病的中年老年妇女提供性健康支持。.

Purpose\ud \ud Mesothelioma is a terminal cancer caused by exposure to asbestos. As a cancer with a higher rate in men than women, women's experiences of living with mesothelioma are often underexplored. Furthermore, men's experiences are often taken for granted and therefore have remained underexplored. This paper considers men's and women's experiences across the mesothelioma pathway.\ud \ud \ud Methods\ud \ud This qualitative study incorporated semi-structured interviews with 13 men and 11 women living with mesothelioma. Telephone interviews took place between July and December 2019, and were audio recorded, transcribed and anonymised. Thematic analysis was used to analyse the data.\ud \ud \ud Results\ud \ud Three themes were developed in relation to the gendered experience of mesothelioma: familial responsibility and social perceptions; support preferences; and treatment and trials. Analysis suggests that men and women's sense of familial responsibility varied. Differences in priorities and motivations influenced approaches to seeking support, compensation and, making decisions around treatments and clinical trials.\ud \ud \ud Conclusions\ud \ud The current study reports on how gender can influence the experience of living with mesothelioma. The findings indicate how the patients' role in their families and society can more broadly influence their experiences, choices and preferences. Nurses caring for mesothelioma patients need high quality research on which to base their practice. Recognition and an understanding of the underlying factors influencing patients’ decision-making will enable nurses and other professionals to support their patients better.