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Introduction Women who have been treated for breast cancer identify vasomotor symptoms, such as hot flushes and night sweats (HFNS), as a serious problem. An estimated 550 000 people live in the UK today with a diagnosis of breast cancer and up to 70% experience HFNS. Estrogen replacement remains the most effective treatment for hot flushes. However, this is contraindicated in the majority of women with estrogen‐dependent breast cancer. Fewer than 50% of women with estrogen receptor (ER) ‐positive breast cancer complete the recommended 5 years of endocrine treatment—tamoxifen and aromatase inhibitors (AIs). This lack of adherence leads to a 20% excess breast cancer mortality. This lack of adherence may be due to unacceptable side effects such as HFNS. Objectives Patient members of the National Cancer Research Institute UK Breast Clinical Studies Group identified that there is very little research into the management of symptoms after breast cancer treatment. In response we established a Working Party on Symptom Management. The members all have a particular interest in the management of HFNS, and include patients, as well as clinical and academic partners representing oncology, psychology, gynaecology, complementary therapies and the voluntary sector. Methods We gauged current clinical practice of the management of HFNS by surveying breast cancer patients, general practitioners (GPs) and healthcare professionals (HCPs) and we will present these data. Results Forty percent of patients reported that no HCPs or GPs had asked them about HFNS. Despite >90% of GPs and HCPs reporting that they prescribed drugs to alleviate HFNS, only 26% of the patients had been offered drugs and fewer than 2% said they helped; 31% of the patients said that the HFNS were severe enough for them to consider stopping endocrine therapy. Conclusion If women are to be helped to adhere to their life‐saving treatment, new approaches need to be developed to ameliorate HFNS.

Background Women who have been treated for breast cancer may identify vasomotor symptoms, such as hot flushes and night sweats (HFNS), as a serious problem. HFNS are unpleasant to experience and can have a significant impact on daily life, potentially leading to reduced adherence to life saving adjuvant hormonal therapy. It is known that Cognitive Behavioural Therapy (CBT) is effective for the alleviation of hot flushes in both well women and women who have had breast cancer. Most women with breast cancer will see a breast care nurse and there is evidence that nurses can be trained to deliver psychological treatments to a satisfactory level, whilst also maintaining treatment fidelity. The research team will assess whether breast care nurses can effectively deliver a CBT intervention to alleviate hot flushes in women with breast cancer. Methods This study is a multi-centre phase III individually randomised controlled trial of group CBT versus usual care to reduce the impact of hot flushes in women with breast cancer. 120–160 women with primary breast cancer experiencing seven or more problematic HFNS a week will be randomised to receive either treatment as usual (TAU) or participation in the group CBT intervention plus TAU (CBT Group). A process evaluation using May’s Normalisation Process Theory will be conducted, as well as practical and organisational issues relating to the implementation of the intervention. Fidelity of implementation of the intervention will be conducted by expert assessment. The cost effectiveness of the intervention will also be assessed. Discussion There is a need for studies that enable effective interventions to be implemented in practice. There is good evidence that CBT is helpful for women with breast cancer who experience HFNS, yet it is not widely available. It is not yet known whether the intervention can be effectively delivered by breast care nurses or implemented in practice. This study will provide information on both whether the intervention can effectively help women with hot flushes and whether and how it can be translated into routine clinical practice. Trial registration ISRCTN 12824632. Registered 25–01-2017. Electronic supplementary material The online version of this article (10.1186/s12905-018-0550-z) contains supplementary material, which is available to authorized users.

National surveys show that people from minority ethnic groups tend to be less satisfied with social care services compared with the white population, but do not show why. Research indicates that barriers to accessing services include lack of information, perceptions of cultural inappropriateness and normative expectations of care. Less research has examined the experience of minority ethnic service users after they access services. This study conducted in-depth interviews with 82 South Asian and White British service users and family carers, the majority of whom were older people. Thematic analysis was used. The key theme was understanding the social care system. Participants with a good understanding of the system were more able to adapt and achieve control over their care. Participants with a poor understanding were uncertain about how to access further care, or why a service had been refused. More White British than South Asian participants had a good understanding of the system. There was more in common between the South Asian and White British participants' experiences than might have been expected. Language was an important facilitator of care for South Asian participants, but ethnic matching with staff was less important. Recommendations include better communication throughout the care process to ensure service users and carers have a clear understanding of social care services and hence a better experience.

The ageing of the ethnic minority population in Britain has led to a more ethnically diverse older client group for social care services than has ever been the case. This article focuses on the issue of how social care staff in England experience working across differences of culture, ethnicity, religion, and language. First, the article critically discusses the concept of cultural competence. Then, it reports on the perspectives of social care staff on their attempts to work in a culturally competent way. Individual in-depth qualitative interviews were carried out with 39 social care practitioners, and thematically analysed. Themes related to professional competence, appropriate behaviour, and training needs. Some practitioners felt unable to perform to their accustomed skill level when working across diversity, which has implications for the quality of care provided and job satisfaction. Other practitioners were confident in working across diversity. The key difference between these practitioners was a degree of cultural reflexivity. Recommendations for training are provided.

Satisfaction with social care services is routinely measured with Likert scales, and surveys have consistently found that people from minority ethnic groups are less satisfied than white people in England. These surveys cannot explain the reasons for the differences found. Therefore, qualitative interviews (n=121) with South Asian and White British service users, family carers, and social care staff were carried out to explore reasons for high or low satisfaction. Thematic analysis focused on three areas: (i) the satisfaction measurement itself, (ii) reasons for satisfaction, and (iii) how staff coped with working across diversity. People who gave the same responses to the Likert scale actually had very different experiences, indicating both that the surveys do not capture the full story and also that individuals understand the scale differently. People with a clear understanding of the social care system were better able to work collaboratively with care staff to meet their needs, and thus had a higher satisfaction level. A clear understanding is facilitated by greater opportunities to become familiar with the social care system, and so first-generation migrants are disadvantaged compared to the British-born. Finally, social care staff who adopted a culturally reflexive working style, and were comfortable asking questions about cultural or religious difference, were more confident working with clients who differed from themselves. Recommendations are to include a qualitative component in satisfaction surveys, increase outreach communication about how social care services work, and to encourage staff to recognise and discuss diversity.

This paper presents new findings on the experiences of Indian mothers in the roles they play in their daughters’ higher education (HE) subject choices. Whilst there are existing studies on White British mothers and parents more generally in terms of parental involvement in education, and a growing number of papers presenting results on Bangladeshi and Pakistani parents, evidence on Indian parents (and students) is relatively sparse. In particular, there is a lack of research where Indian parents are given space to voice their own narratives in their own words. In the main, existing studies focus on parents from the viewpoint of their children as students. This qualitative study involved semi-structured interviews with nine Indian mothers from different areas in England. Commonalities and disparities between the experiences of Indian mothers presented here and accounts of White mothers of similar class and educational backgrounds presented in existing literature are analysed using an intersectional lens. Results show that working class Indian mothers could be making up some of their disadvantage in terms of social and cultural capital through family and community networks. Furthermore, mothers regard younger relatives as potential sources of important knowledge and resources that could help them and their daughters navigate the HE landscape. This has not been found in studies on White mothers where the emphasis instead has been on the exchange of knowledge from adults to the younger generation. This article arises out of an ESRC funded doctoral study of choice at university for British South Asian women.

Given the financial implications for studying at a higher education institution, students are faced with many decisions both in terms of the topics they wish to study but also the decision of whether to remain at home or move away. The aim of this article is to compare the experiences of South Asian (Indian, Bangladeshi and Pakistani) female students to White females, to identify similarities and differences between women from the three Asian groups and also compare changes over time. This article is focused on the term-time accommodation status of these students, i.e. the decision to move away or stay residing in the parental/guardian home during their first year of university. Understanding students’ accommodation choices is important as it can limit the other choices they have to make such as which course to choose and students who are limited to their local institutions can only study what is offered by those particular institutions. We examine this issue by using binary logistic regression to analyse...

The measurement of customer satisfaction has become widespread in both healthcare and social care services, and is informative for performance monitoring and service development. Satisfaction with social care services is routinely measured with a single question on overall satisfaction with care, comprising part of the Adult Social Care Survey. The measurement of satisfaction has been problematised, and existing satisfaction measures are known to be under-theorised. In this article, the process of making an evaluation of satisfaction with social care services is first informed by a literature review of the theoretical background, and second examined through qualitative interviews conducted in 2012-2013 with 82 service users and family carers in Hampshire, Portsmouth and Southampton. Participants in this study were from white British and South Asian backgrounds, and the influence of ethnicity in the process of satisfaction evaluation is discussed. The findings show that the majority of participants selected a positive satisfaction rating even though both positive and negative experiences with services were described in their narratives. It is recommended that surveys provide opportunity for service users and family carers to elaborate on their satisfaction ratings. This addition will provide more scope for services to review their strengths and weaknesses.

There is a rise in the number of women living with the long-term consequences of cancer and continuing to suffer unmet need as breast cancer survival improves. This paper includes an introduction to self-management and a discussion of the evidence around the effectiveness of the key intervention types that could help patients to help themselves after treatment. Self-management interventions are particularly beneficial in reducing bother from symptoms, without patients having to take on the additional burden of more unwanted side-effects frequently seen with pharmacological interventions. There is a need to prioritise the funding of these financially viable self-management strategies to ensure equity of access and that these interventions are available for those in need.