Dr Richard Green

This article explores men’s experiences following treatment for prostate cancer through the lens of chronic illness. Recent empirical work suggests prostate cancer may be better understood as a chronic illness. Prostate cancer offers a case study to examine how older men’s masculinities are disrupted by chronic illness experience. Qualitative interviews with 29 men, recruited from two prostate cancer support groups, explored prostate cancer and post-treatment experiences. Men’s experiences are examined by drawing on the works of Steve Robertson and Kathy Charmaz for understanding masculinities in relation to health and illness. Aspects of chronic illness experience are identified in men’s accounts, particularly concerns with loss of moral status resulting from ongoing and potentially stigmatising treatment side effects. Four forms of moral positioning are identified that align with Steve Robertson’s empirically derived model theorising the relationship between health and hegemonic masculinity. These findings facilitate discussion of the interaction between chronic illness experience, morality and masculinities, providing insight into how older men maintain their masculinity in the wake of illness.

This article examines men’s prostate cancer experiences through the lens of patient expertise. Qualitative interviews were conducted with 29 men treated for prostate cancer, recruited from two prostate cancer support groups (PCSGs) in the South-East of England. Different forms of expertise, as classified by Collins, were found to be possessed by these men. How these different forms of expertise were acquired, used, and shared with others are explored, and a concept of communal licensing is posited to better understand these activities. The acquisition and usage of these different forms of expertise, through the employment of moral discourses that emphasise responsibility for one’s own health, are found to serve to blur the boundaries between lay person and expert.

Background:

Older people living with multimorbidity are projected to become the main recipients of palliative care in the coming decades, yet there is limited evidence regarding their expressed palliative care needs to inform person-centred care.

Aim:

To understand the palliative care needs of community-dwelling people aged ⩾60 living with multimorbidity in the last 2 years of life.

Design:

A scoping review following Arksey and O’Malley.

Data sources:

Three international electronic databases (CINAHL, Ovid Medline, PsycINFO) were searched from March 2018 to December 2021. Reference lists were hand searched. Eligible papers were those reporting empirical data on older people’s needs.

Results:

From 985 potential papers, 28 studies were included, published between 2002 and 2020; sixteen quantitative, nine qualitative and three mixed methods. Data were extracted and presented under the holistic palliative care domains of need: physical, psychological, social, spiritual, and additionally practical needs. Different measurement tools (n = 29) were used, of which 20 were multidimensional. Primacy in reporting was given to physical needs, most commonly pain and function. Social and practical needs were often prioritised by older people themselves, including maintaining social connections and accessing and receiving individualised care.

Conclusion:

Identifying the palliative care needs that matter most to older people with multimorbidity requires the recognition of their concerns, as well as their symptoms, across a continuum of living and dying. Available evidence is superficial. Supporting end of life provision for this growing and underserved population necessitates a shift to tailored multidimensional tools and community focussed integrated care services.

As mediated death has become a staple of contemporary society, debates about the treatment of death in the public domain abound. This article examines the true crime comedy podcast My Favorite Murder, arguing that it functions to produce a collaboratively ‘provocative morbid space’ in which its hosts and audiences can engage in contemplating, discussing, and negotiating the politics of murder, victimhood, and their surrounding inequalities. My Favorite Murder explicitly positions itself as provocative and morally ambiguous, raising questions about who has ownership, legitimacy, and moral standing when it comes to discussing death. We argue that the podcast both reflects public fascination with death and functions to enact a socially progressive agenda through controversial and entertaining popular cultural engagement with the sensitive subject of murder. With the hosts acting as what we term ‘(im)moral entrepreneurs’ collaboratively producing with audiences ‘counter cultural (im)moral discourses’, the commercially successful podcast offers a version of the ‘cautionary tale’ that foregrounds the sociocultural inequalities that have contributed to the vast array of murders discussed across its 300+ existing episodes.

This article explores men’s experiences of and management strategies for urinary incontinence (UI) following treatment for prostate cancer. Qualitative interviews with 29 men, recruited from two prostate cancer support groups, explored their post-treatment experiences. Drawing on a conceptual toolkit connecting theories of masculinities, embodiment, and chronic illness, this paper identifies older men’s experiences and strategies for managing UI and explores how these are shaped by their masculinities. This article identifies interdependence between managing stigma for UI and maintaining masculinity. Men’s embodied practices for engaging in activities in public, crucial to masculine identity, were disrupted. In response, they adopted new reflexive body techniques to manage and resolve their UI, and thereby address the threat to their masculine identities, characterised in three strategies: monitoring, planning, and disciplining. The new embodied practices men described suggest three factors as important components for adopting new reflexive body techniques: routine, desire, and unruliness.

Background:

Older people with severe frailty are nearing the end of life but their needs are often unknown and unmet. Systematic ways to capture and measure the needs of this group are required. Patient reported Outcome Measures (PROMs) & Patient reported Experience Measures (PREMs) are possible tools to assist this.

Aim:

To establish whether, and in what ways, the needs of older people living with severe frailty are represented within existing PROMs and PREMs and to examine the extent to which the measures have been validated with this patient group.

Design:

The scoping review follows the method of Arksey and O’Malley.

Results:

Seventeen papers from 9 countries meeting the inclusion criteria and 18 multi-dimensional measures were identified: 17 PROMs, and 1 PROM with PREM elements. Seven out of the 18 measures had evidence of being tested for validity with those with frailty. No measure was developed specifically for a frail population. Using the adapted framework of palliative need, five measures covered all five domains of palliative need (IPOS, ICECAP-SCM, PDI, WHOQOL-BREF, WHOQOL-OLD). The coverage of items within the domains varied between the measures.

Conclusion:

Existing PROMs and PREMs are not well designed for what we know about the needs of older people with severe frailty. Future research should firstly focus on adapting and validating the existing measures to ensure they are fit for purpose, and secondly on developing a better understanding of how measures are used to deliver/better person-centred care.