172 results on '"Almack, Kathryn"'
Search Results
152. Seeking Sperm: Accounts of Lesbian Couples’ Reproductive Decision-Making and Understandings of the Needs of the Child
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Almack, Kathryn, primary
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- 2006
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153. What’s in a Name? The Significance of the Choice of Surnames Given to Children Born within Lesbian-parent Families
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Almack, Kathryn, primary
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- 2005
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154. Questioning the Answer: Choice and Self-determination in Interactions with Young People with Intellectual Disabilities.
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Pilnick, Alison, Clegg, Jennifer, Murphy, Elizabeth, and Almack, Kathryn
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AUTONOMY (Psychology) ,INTERPERSONAL relations ,YOUNG adults with disabilities ,SOCIAL interaction ,CONVERSATION analysis - Abstract
For young people with intellectual disabilities (ID), the transition from children's to adult services has long been recognised as a challenging move. One of the aims of the White Paper 'Valuing People' (2001) was to address some of the problems associated with this transition. This paper reports on data from a project which examines the impact of these service changes, and the ways in which transition is negotiated by carers, professionals and users. It presents a conversation analysis of 8 tape-recorded formal review meetings at which transition to adult services is discussed. It takes as its starting point the existing interactional work on ID and the way in which this demonstrates the effects of the local and contextual specifics of particular kinds of interaction on the eventual outcomes (e.g. Rapley 2004, Antaki 2001, Maynard and Marlaire 1992). We show that an attempt to allow self-determination in the context of transitions can paradoxically result in undermining user choice and control. We also argue that, while a rule-based approach to practice may offer moral clarity for professionals, it can result in interactional and practical difficulties which cannot be easily reconciled. ..PAT.-Unpublished Manuscript [ABSTRACT FROM AUTHOR]
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- 2009
155. Contesting Sexual Prejudice to Support Sexual Minorities: Views of Chinese Social Workers.
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Kwok, Diana K., Fish, Julie, Hafford-Letchfield, Trish, Toze, Michael, and Almack, Kathryn
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- 2021
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156. Women parenting together : motherhood and family life in same sex relationships
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Almack, Kathryn
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This study is based on joint and separate in-depth interviews with twenty (female) same sex couples who planned and had their children together in the context of their relationship. These families are one example of the increasing possibilities to live in non-traditional relationships and family forms, in contemporary Western societies. While lesbian and gay parents have a long history, there is little precedence for same sex couples setting up families 'from scratch' i.e. choosing to have children in the context of their relationship. These possibilities can be placed in the context of wider transformations of intimacy. There is widespread agreement that individualism in personal relationships has substantially increased, although opinions differ about the extent to which this individualism is essentially selfish. Lesbian parents, for example, have been portrayed as selfish individuals (Phillips, 1998) or alternatively as 'prime everyday experimenters' (Giddens, 1992), although the reality may be more nuanced than either of these polarities suggests. Overall, recent sociological research into both heterosexual and 'non-heterosexual' family lives suggests that transformations of intimacy are characterised by negotiated commitments and moral reasoning. However, to date, relatively little attention has been paid to the ways in which these themes may be modified by the presence of dependent children, particularly given the socially constructed nature of children's needs. Respondents in my study are involved in both innovative family practices and the care of dependent children. As such, they can offer new insights to the above debates. They present a radical departure from dominant conventions of heterosexual gendered family norms and the biological imperatives of reproduction. However, while working out new ways of doing family, these practices are located within deeply conventional moralities of motherhood, which leave little space within which to offer up new stories of doing family.
157. 7 Exploring caregivers’ experiences of caring for men with advanced prostate cancer in a resource-poor setting: a qualitative serial interview study
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Salifu, Yakubu, Almack, Kathryn, and Caswell, Glenys
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BackgroundFamily caregivers who assume the responsibility of care for patients living with advanced diseases could have challenges especially in resource-poor settings. The bulk and responsibility for care are predominantly provided by the family caregivers within the informal sector. The family caregivers, therefore, could be described as the ‘general practitioners’ of the patients at home. Using a qualitative study, the experiences of the family caregivers caring for men with advanced prostate cancer were explored.MethodsUsing serial qualitative approach, 23 in-depth individual and dyad interviews were conducted. Patients and their caregivers participated in repeat interviews approximately 2 months apart, across a period of up to 6 months. Transcribed interviews were analysed using thematic analysis.FindingsThis paper focuses on the experiences of family caregivers in the light of inadequate resources for care. Two main themes emerged from the data: Challenges and burden of care, and the support and coping strategies adopted. The family caregivers expressed the overburden nature of the care, ‘feeling of being alone in the middle of a deep sea’, disruption of their lives, and unhappiness and the fear of an unknown future. On the other hand, they rely on the support of the social network of the extended family, their faith in God, and the positive aspect of living helped to mitigate some of the challenges. The belief in reciprocity and ‘giving back’ through caring for their loved ones were highlighted by participants.ConclusionGenerally, the informal social network helped in the care at home. However, the magnitude of the adverse changes in their lives and challenges associated with the caring role was dependent on factors such as the level of care required, financial and other resources available, and the coping mechanisms in place. Efforts to enhance existing social support systems are recommended.
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- 2018
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158. 25 Evaluation of a multi site specialist palliative care at home intervention
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Johnston, Bridget, Patterson, Anne, Wilson, Eleanor, Almack, Kathryn, Bird, Lydia, Mathews, Gillian, and Seymour, Jane
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BackgroundThe Midhurst Macmillan Specialist Palliative Care at Home Service was founded in 2006 to improve community-based palliative care provision. Principal components include; early referral; home-based clinical interventions; close partnership working; and flexible teamwork. Following a successful introduction, the model was implemented in six further sites across England. This article reports a mixed methods evaluation of the implementation across these ‘Innovation Centres’.AimTo assess the process and impact on staff, patients and carers of providing Macmillan Specialist Care at Home services across the six sites.MethodsA longitudinal, mixed methods research design. Data collection over 15 months (2014–2016) included: Quantitative outcome measures:- Palliative Performance Scale [PPS]; Palliative Prognostic Index [PPI] (n=2,711); Integrated Palliative Outcome Scales [IPOS] (n=1,157); Carers Support Needs Assessment Tool [CSNAT] (n=241); Views of Informal Carers – Evaluation of Services [VOICES-SF] (n=102); a custom-designed Service Data Tool [SDT] (n=88). Qualitative data methods:- focus groups with project team and staff (n=32 groups, [n=190 participants]), and, volunteers (n=6 groups, [n=32 participants]). Quantitative data analysis – SPPS vs 21; Qualitative data – thematic analysis.ResultsComparison across the different sites revealed contrasting modes of implementation. PPS, PPI and IPOS data exposed disparity in early referral criteria, complicated by conflicting interpretations of palliative care. The qualitative analysis, CSNAT and VOICES-SF data confirmed the value of the Macmillan model of care but uptake of the specialist home-based clinical intervention component was limited. Significant findings included better co-ordination of palliative care through project management and a single referral point and multi-disciplinary teamwork including leadership from consultants in palliative medicine, the role of health care assistants in rapid referral, and volunteer support.DiscussionSpecialist palliative care teams enhance the quality of palliative and end of life care in the community setting and should form an integral part of future policy in this area.
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- 2018
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159. Book Reviews.
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Dobrowolsky, Alexandra and Almack, Kathryn
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NONFICTION - Abstract
The article reviews the books "Children of the 21st Century: From Birth to Nine Months," edited by Shirley Dex and Heather Joshi and "Feminist Research in Theory and Practice," by Gayle Letherby.
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- 2006
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160. Intersections of Ageing, Gender and Sexualities: Multidisciplinary International Perspectives
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King, Andrew, editor, Almack, Kathryn, editor, and Jones, Rebecca L., editor
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- 2019
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161. Intersections of Ageing, Gender and Sexualities: Multidisciplinary International Perspectives
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King, Andrew, editor, Almack, Kathryn, editor, and Jones, Rebecca L., editor
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- 2019
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162. The queer subject of 'getting on'
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Yvette Taylor, King, Andrew, Almack, Kathryn, and Jones, Rebecca L.
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LB2300 ,HM - Abstract
This chapter hopes to speaks to the theme of Intersections of Ageing, Gender, Sexualities as matched to – or far from – the particular research projects which I have undertaken, often involving ‘intersections’ of class, gender and sexuality. In considering what to present at the related conference, and write-up in this chapter, I wanted to question (myself), and had to resist (my own), urges to pull data from particular aged research participants, as older or, indeed, younger; certainly I could have done this as my research has usually involved participants across diverse age ranges. In my current project on Making Space for Queer Identifying Religious Youth, I am seeing how young people inhabit particular times, places, bodies as age-d subjects, with certain rememberings of the past and projections for the future (Taylor 2015). To think of these intersections, involves a consideration of the ‘queer subject of ‘getting on’’, as a beneficiary of international Equalities Legislation, and new ‘sexual citizen’. In this chapter I want to explore three cases, that of ‘queer families’, ‘queer cares’, and the queer spaces of academia, to inflect ideas of ‘moving on’ and becoming as interrupted and interrupting of linear trajectories of, for example, becoming sexual citizenship, becoming adult, and becoming academic. I interweave these examples to explore interruptions to normative career-caring trajectories, highlighting the work-life balances and the effort of ‘getting on’, as applied in research-researched-researcher exchanges, experiences and biographies.
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- 2020
163. 'Last-minute mothers’:the construction of age and midlife motherhood in Denmark and Israel
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Lahad, Kinneret, Hvidtfeldt, Karen, King, Andrew, Almack, Kathryn, and Jones, Rebecca L.
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- 2019
164. Implementing advance care planning: a qualitative study of community nurses' views and experiences
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Kennedy Sheila, Almack Kathryn, and Seymour Jane
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Special situations and conditions ,RC952-1245 - Abstract
Abstract Background Advance care planning (ACP) is a process of discussion about goals of care and a means of setting on record preferences for care of patients who may lose capacity or communication ability in the future. Implementation of ACP is widely promoted by policy makers. This study examined how community palliative care nurses in England understand ACP and their roles within ACP. It sought to identify factors surrounding community nurses' implementation of ACP and nurses' educational needs. Methods An action research strategy was employed. 23 community nurses from two cancer networks in England were recruited to 6 focus group discussions and three follow up workshops. Data were analysed using a constant comparison approach. Findings Nurses understood ACP to be an important part of practice and to have the potential to be a celebration of good nursing care. Nurses saw their roles in ACP as engaging with patients to elicit care preferences, facilitate family communication and enable a shift of care focus towards palliative care. They perceived challenges to ACP including: timing, how to effect team working in ACP, the policy focus on instructional directives which related poorly to patients' concerns; managing differences in patients' and families' views. Perceived barriers included: lack of resources; lack of public awareness about ACP; difficulties in talking about death. Nurses recommended the following to be included in education programmes: design of realistic scenarios; design of a flow chart; practical advice about communication and documentation; insights into the need for clinical supervision for ACP practice. Conclusions Nurses working in the community are centrally involved with patients with palliative care needs who may wish to set on record their views about future care and treatment. This study reveals some important areas for practice and educational development to enhance nurses' use and understanding of ACP.
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- 2010
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165. Commissioning and co-production in health and care services in the United Kingdom and Ireland: An exploratory literature review.
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Scott RJ, Mathie E, Newman HJH, Almack K, and Brady LM
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- United Kingdom, Ireland, Humans, State Medicine organization & administration, Health Policy, Delivery of Health Care organization & administration
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Introduction: This exploratory literature review seeks to examine the literature around commissioning processes in the co-production of health and care services, focusing on two questions: How do health and care commissioning processes facilitate and/or pose barriers to co-production in service design and delivery? What are the contextual factors that influence these processes?, Method: A systematic search of three databases (Medline, Public Health and Social Policy and Practice) and a search platform (Web of Science) was conducted for the period 2008-2023. A total of 2675 records were retrieved. After deduplication, 1925 were screened at title and abstract level. Forty-seven reports from 42 United Kingdom and Ireland studies were included in the review. A thematic synthesis of included studies was conducted in relation to the research questions., Results: The review identified one overarching theme across the synthesised literature: the complexity of the commissioning landscape. Three interconnected subthemes illuminate the contextual factors that influence this landscape: commissioners as leaders of co-production; navigating relationships and the collective voice., Conclusion: Commissioning processes were commonly a barrier to the co-production of health and care services. Though co-production was an aspiration for many commissioners, the political and economic environment and service pressures meant that it was often not fully realised. More flexible funding models, longer-term pilot projects, an increased emphasis in social value across the health and care system and building capacity for strong leadership in commissioning is needed., Patient and Public Contribution: Patients and the public did not contribute to this review as it was a small piece of work following on from a completed project, with no budget for public involvement., (© 2024 The Authors. Health Expectations published by John Wiley & Sons Ltd.)
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- 2024
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166. Between loss and restoration: The role of liminality in advancing theories of grief and bereavement.
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Bristowe K, Timmins L, Pitman A, Braybrook D, Marshall S, Johnson K, King M, Roach A, Yi D, Almack K, Day E, Clift P, Rose R, and Harding R
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- Humans, Grief, Anger, Loneliness, Language, Bereavement
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A recent national survey of bereaved partners found high levels of complicated grief and psychological distress, with evidence that loneliness and isolation may contribute to these outcomes. However, the mechanisms of action for this have not been explored. To advance grief theory this paper reports analysis of the survey free-text data to examine the relationship between social support and emotional responses to bereavement. Individuals bereaved of a civil partner or spouse 6-10 months previously were identified through death registration data. 569/1945 (29 %) completed surveys were received. Of those, 311 participants (55 %) provided responses to two free-text questions which asked about their 'feelings since the death of their partner or spouse', and 'about the support around' them. Data were analysed using corpus-assisted discourse analysis and the discourse dynamics approach for figurative language. Participants described diverse emotional responses to the bereavement (e.g. sadness, anger, denial, acceptance), and the value of formal and informal bereavement support. Although many of the experiences described are accounted for in existing grief theory, some participants described a liminal experience not recognised within these theories. They felt trapped, unable to engage with loss or restoration, and unable to move forward as their planned future no longer existed. They sought out 'communitas' (solidarity in experiences), but often found support from their social networks had diminished. Metaphors were used to describe this liminality, with partner grief expressed as a dark agentic force, a monster, an abyss, and as water. The findings of this study offer original insights into experiences and trajectories of bereavement, and our understandings of prolonged or complicated grief. A novel model 'Between Loss and Restoration' is presented to include these experiences. Recognition of the place for liminality within the spectrum of grief experiences could enhance grief literacy and improve formal and informal bereavement support provision., Competing Interests: Declaration of competing interest The authors report there are no competing interests to declare., (Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)
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- 2024
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167. Does the impact of bereavement vary between same and different gender partnerships? A representative national, cross-sectional study.
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Timmins L, Pitman A, King M, Gao W, Johnson K, Yu P, Braybrook D, Roach A, Marshall S, Day E, Rose R, Clift P, Almack K, Yi DH, Bristowe K, and Harding R
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- Female, Humans, Cross-Sectional Studies, Grief, Spouses, Bereavement, Sexual and Gender Minorities
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Background: Data suggest poorer bereavement outcomes for lesbian, gay and bisexual people, but this has not been estimated in population-based research. This study compared bereavement outcomes for partners of same-gender and different-gender decedents., Methods: In this population-based, cross-sectional survey of people bereaved of a civil partner or spouse 6-10 months previously, we used adjusted logistic and linear regression to investigate outcomes of interest: (1) positive screen on Inventory of Complicated Grief (ICG), (2) positive screen on General Health Questionnaire (GHQ), (3) grief intensity (ICG) and (4) psychiatric symptoms (GHQ-12)., Results: Among 233 same-gender partners and 329 of different-gender partners, 66.1% [95% confidence interval (CI) 60.0-72.2] and 59.2% [95% CI (53.9-64.6)] respectively screened positive for complicated grief on the ICG, whilst 76.0% [95% CI (70.5-81.5)] and 69.3% [95% CI (64.3-74.3)] respectively screened positive on the GHQ-12. Same-gender bereaved partners were not significantly more likely to screen positive for complicated grief than different-gender partners [adjusted odds ratio (aOR) 1.56, 95% CI (0.98-2.47)], p = 0.059, but same-gender bereaved partners were significantly more likely to screen for psychiatric caseness [aOR 1.67 (1.02, 2.71) p = 0.043]. We similarly found no significant association of partner gender with grief intensity [ B = 1.86, 95% CI (-0.91to 4.63), p = 0.188], but significantly greater psychological distress for same-gender partners [ B = 1.54, 95% CI (-0.69-2.40), p < 0.001]., Conclusions: Same-gender bereaved partners report significantly more psychological distress. In view of their poorer sub-clinical mental health, clinical and bereavement services should refine screening processes to identify those at risk of poor mental health outcomes.
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- 2023
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168. 'Out of the frying pan into the fire': a qualitative study of the impact on masculinity for men living with advanced prostate cancer.
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Salifu Y, Almack K, and Caswell G
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Background: Studies have highlighted how advanced prostate cancer causes biographical disruption and presents challenges to masculine identities for men. This article draws on a wider study that focused on the experiences of men living with advanced prostate cancer and their caregivers. Although men's experience of advanced illness is not overlooked in the literature, only a small body of work has taken an in-depth look at men's experiences with advanced prostate cancer and their caregivers in a non-Westernised cultural and social context., Objective: To explore how advanced prostate cancer impacts on men's masculine identity from the perspective of patients and their caregivers., Methods: A qualitative study of men living with advanced prostate cancer ( n = 23) and family caregivers ( n = 23) in Ghana. We used the Consolidated Criteria for Reporting Qualitative Studies (COREQ) as the reporting guideline., Results: The findings from this study highlight profound challenges for most men to their masculine identities, from both the treatment and the symptoms of advanced prostate cancer within a non-Westernised, patriarchal society. Four main themes were developed. These were the impact on masculinity in terms of: (1) physical changes, (2) sexual ability, (3) socio-economic roles and (4) expressing emotions. Changes in physical appearance, feeling belittled, having no active sexual life and the inability to continue acting as provider and protector of the family made some men describe their situation as one of moving out of the 'frying pan into the fire'., Conclusion: This study revealed the impact of advanced prostate cancer on masculine identity. These narratives add a new dimension to what is already known about the impacts on men's masculine identities when dealing with advanced prostate cancer. This knowledge can help improve the care provided to men with advanced prostate cancer with emphasis on the cultures, beliefs and aspirations of these men and their caregivers., Competing Interests: The authors declared no potential conflicts of interest with respect to the research, authorship and/or publication of this article., (© The Author(s), 2023.)
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- 2023
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169. The impact of Covid-19 pandemic on hospices: A systematic integrated review and synthesis of recommendations for policy and practice.
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van Langen-Datta S, Wesson H, Fleming J, Eccles A, Grimley C, Dale J, Almack K, Mayland C, Mitchell S, Driscoll R, Tatnell L, Roberts L, and MacArtney JI
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Background: The Covid-19 pandemic resulted in the development of numerous recommendations for practice and policy for specialist palliative care provided by hospices in United Kingdom (UK), as hospices were significantly affected by the pandemic and protections put in place.The aim of this review is to identify and synthesise recommendations or implications for policy and practice that have been generated for adult hospice specialist palliative care during the first 24 months of the Covid-19 pandemic., Methods: AMED, BNI, CINAHL, EMBASE, EMCARE, HMIC, Medline, PsycINFO, PubMed databases were searched for peer-reviewed papers, as well as hand searchers for grey literature. Literature relating to hospices and Covid-19 in the UK were included and a thematic synthesis of recommendations for hospice policy and practice was undertaken., Results: 858 articles were identified with 12 meeting the inclusion criteria. Fifty-eight recommendations or implications were identified: 31 for policy, 27 for practice, and 10 covering both. Recommendations were organised under ten themes. There were several recommendations seeking to secure hospice resources to mitigate the short-term impact of the pandemic, as well as those focused on longer-term implications such as core funding. The impact of the pandemic on the quality of hospice care was the focus for numerous recommendations around improving integration of hospice care in the community, provision of bereavement support and better use of Advance Care Plans (ACP). However, there were significant gaps related to carer visitation in hospices, inequities of palliative care, or hospice-at-home services., Conclusion: The Covid-19 pandemic and protections exposed several ongoing policy and practice needs, especially around hospice resources, while generating novel issues for hospices to address. Significant policy gaps remain to be addressed to mitigate the impact of the pandemic on the quality of hospice specialist palliative care., Competing Interests: No competing interests were disclosed., (Copyright: © 2022 van Langen-Datta S et al.)
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- 2022
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170. Older LGBT+ health inequalities in the UK: setting a research agenda.
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Westwood S, Willis P, Fish J, Hafford-Letchfield T, Semlyen J, King A, Beach B, Almack K, Kneale D, Toze M, and Becares L
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- Aged, Aged, 80 and over, Attitude of Health Personnel, Female, Health Services Accessibility, Humans, Male, Mental Health, Minority Health, Research Design, Socioeconomic Factors, United Kingdom, Aging, Bisexuality psychology, Health Equity, Health Promotion, Health Status Disparities, Homosexuality, Female psychology, Homosexuality, Male psychology
- Abstract
Lesbian, gay, bisexual and trans+ (LGBT+) people report poorer health than the general population and worse experiences of healthcare particularly cancer, palliative/end-of-life, dementia and mental health provision. This is attributable to: (a) social inequalities, including 'minority stress'; (b) associated health-risk behaviours (eg, smoking, excessive drug/alcohol use, obesity); (c) loneliness and isolation, affecting physical/mental health and mortality; (d) anticipated/experienced discrimination and (e) inadequate understandings of needs among healthcare providers. Older LGBT+ people are particularly affected, due to the effects of both cumulative disadvantage and ageing. There is a need for greater and more robust research data to support growing international and national government initiatives aimed at addressing these health inequalities. We identify seven key research strategies: (1) Production of large data sets; (2) Comparative data collection; (3) Addressing diversity and intersectionality among LGBT+ older people; (4) Investigation of healthcare services' capacity to deliver LGBT+ affirmative healthcare and associated education and training needs; (5) Identification of effective health promotion and/or treatment interventions for older LGBT+ people, and subgroups within this umbrella category; (6) Development of an (older) LGBT+ health equity model; (7) Utilisation of social justice concepts to ensure meaningful, change-orientated data production which will inform and support government policy, health promotion and healthcare interventions., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2020. No commercial re-use. See rights and permissions. Published by BMJ.)
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- 2020
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171. Developing inclusive residential care for older lesbian, gay, bisexual and trans (LGBT) people: An evaluation of the Care Home Challenge action research project.
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Hafford-Letchfield T, Simpson P, Willis PB, and Almack K
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- Aged, Delivery of Health Care organization & administration, Female, Health Services Research, Humans, Male, Homes for the Aged organization & administration, Nursing Homes organization & administration, Sexual and Gender Minorities
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There have been substantial achievements in legislative and human rights for lesbian, gay, bisexual and transgender (LGBT) older people and their visibility in health and social care has equally increased. These appear to have surpassed the ability of care services to meet their needs given documented concerns about the accessibility, inclusiveness and safety of care services particularly institutionalised care. This requires systemic change not easy to operationalise. This paper describes an action research initiative where six care homes belonging to a national care provider, collaborated to assess and develop their services with the support of local LGBT "Community Advisors" and academic partners. Framed within Rogers' (2003) change management framework and combined with a participatory leadership approach, a programme of intervention was implemented comprising structured activities around seven key areas thought to promote LGBT inclusion. A formal evaluation was conducted involving 35 pre- and post-intervention qualitative interviews with 18 people (community advisors; care home managers and senior managers). The findings are presented across three key themes (1) starting points on the journey; (2) challenges encountered along the journey (organisational and interpersonal); and (3) making change happen; opportunities, initiatives and gains. We make recommendations on the value of a programme approach for achieving tangible outcomes that demonstrate increased inclusion for older LGBT people living in long-term care settings., (© 2017 John Wiley & Sons Ltd.)
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- 2018
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172. Recommendations to reduce inequalities for LGBT people facing advanced illness: ACCESSCare national qualitative interview study.
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Bristowe K, Hodson M, Wee B, Almack K, Johnson K, Daveson BA, Koffman J, McEnhill L, and Harding R
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- Adult, Aged, Aged, 80 and over, Female, Humans, Male, Middle Aged, Qualitative Research, United Kingdom, Young Adult, Health Services Accessibility organization & administration, Health Services Accessibility statistics & numerical data, Healthcare Disparities organization & administration, Healthcare Disparities statistics & numerical data, Sexual and Gender Minorities statistics & numerical data, Terminally Ill statistics & numerical data, Transgender Persons statistics & numerical data
- Abstract
Background: Lesbian, gay, bisexual and/or trans (LGBT) people have higher risk of certain life-limiting illnesses and unmet needs in advanced illness and bereavement. ACCESSCare is the first national study to examine in depth the experiences of LGBT people facing advanced illness., Aim: To explore health-care experiences of LGBT people facing advanced illness to elicit views regarding sharing identity (sexual orientation/gender history), accessing services, discrimination/exclusion and best-practice examples., Design: Semi-structured in-depth qualitative interviews analysed using thematic analysis., Setting/participants: In total, 40 LGBT people from across the United Kingdom facing advanced illness: cancer ( n = 21), non-cancer ( n = 16) and both a cancer and a non-cancer conditions ( n = 3)., Results: In total, five main themes emerged: (1) person-centred care needs that may require additional/different consideration for LGBT people (including different social support structures and additional legal concerns), (2) service level or interactional (created in the consultation) barriers/stressors (including heteronormative assumptions and homophobic/transphobic behaviours), (3) invisible barriers/stressors (including the historical context of pathology/criminalisation, fears and experiences of discrimination) and (4) service level or interactional facilitators (including acknowledging and including partners in critical discussions). These all shape (5) individuals' preferences for disclosing identity. Prior experiences of discrimination or violence, in response to disclosure, were carried into future care interactions and heightened with the frailty of advanced illness., Conclusion: Despite recent legislative change, experiences of discrimination and exclusion in health care persist for LGBT people. Ten recommendations, for health-care professionals and services/institutions, are made from the data. These are simple, low cost and offer potential gains in access to, and outcomes of, care for LGBT people.
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- 2018
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