Barriers and facilitators to accessing and utilising post-treatment psychosocial support by Black men treated for prostate cancer—a systematic review and qualitative synthesis

Abstract

Purpose To synthesise findings from published studies on barriers and facilitators to Black men accessing and utilising post-treatment psychosocial support after prostate cancer (CaP) treatment. Methods Searches of Medline, Embase, PsycInfo, Cochrane Database of Systematic Reviews and Central, CINAHL plus and Scopus were undertaken from inception to May 2021. English language studies involving Black men aged ≥18 and reporting experiences of, or suggestions for, psychosocial support after CaP treatment were included. Low or moderate quality studies were excluded. Searches identified 4,453 articles and following deduplication, 2,325 were screened for eligibility. Two independent reviewers carried out screening, quality appraisal and data extraction. Data were analysed using thematic synthesis. Results Ten qualitative studies involving 139 Black men were included. Data analysis identified four analytical constructs: experience of psychosocial support for dealing with treatment side effects (including impact on self-esteem and fear of recurrence); barriers to use of psychosocial support (such as perceptions of masculinity and stigma around sexual dysfunction); facilitators to use of psychosocial support (including the influence of others and self-motivation); and practical solutions for designing and delivering post-treatment psychosocial support (the need for trusted healthcare and cultural channels). Conclusions Few intervention studies have focused on behaviours among Black CaP survivors, with existing research predominantly involving Caucasian men. There is a need for a collaborative approach to CaP care that recognises not only medical expertise but also the autonomy of Black men as experts of their illness experience, and the influence of cultural and social networks.

Demographic and Clinical Factors Associated With Health-Related Quality-of-Life Profiles Among Prostate Cancer Survivors

“…40 Our findings that NHB men with PCa were at greater risk for membership in the low HRQOL compared with NHW men may be due to other factors, including inadequate access to high-quality oncology care including supportive care after treatment, and medical mistrust. 41 We found a significantly higher risk of being in the low HRQOL profile among PCa survivors with worse health carerelated financial well-being, which is consistent with the literature regarding the association between financial hardship (or toxicity) and symptom care and HRQOL in other cancer survivors. 42,43 For example, higher out-of-pocket costs for ambulatory care and prescription medications are likely to be significant barriers to obtain high-quality symptom-related care.…”

“…40 Our findings that NHB men with PCa were at greater risk for membership in the low HRQOL compared with NHW men may be due to other factors, including inadequate access to high-quality oncology care including supportive care after treatment, and medical mistrust. 41…”

Effects of stigma, anxiety and depression, and uncertainty in illness on quality of life in patients with prostate cancer: a cross-sectional analysis

“…In general, cancer has been perceived as a highly stigmatized condition, ranging from 13 to 80% [ 15 ], often in that it is associated with death, changes in physical appearance and body image, social isolation, or blame and shame. Body image change by chemotherapy and androgen deprivation therapy (ADT) [ 16 ], feelings of loss of masculinity by sexual difficulties [ 17 ], and lower self-esteem mixed with stigma [ 18 ] are all impacted by a diagnosis of prostate cancer. Particularly, in a culture fraught with competition advocating, the possibility of public exposure persistently lingers in the background of their struggles with sexual impairment.…”