Journal of Clinical Nursing

Transgender Men's and Non‐Binary People's Experiences of Cervical Cancer Screening—A Journey Mapping Approach

ABSTRACT Background Research indicates various barriers to cervical cancer screening for transgender people, contributing to cancer inequities. Further research is required to better understand how these barriers affect experiences along the screening trajectory, from engaging with information, through invitation and testing, to receiving test results. Research exploring how transgender people navigate these barriers is also required. Aim To explore the experiences of cervical cancer screening in Sweden among transgender people who were assigned female at birth, and to identify touchpoints in need of improvement along the cervical cancer screening trajectory. Design Qualitative interview study inspired by journey mapping. Methods Semi‐structured interviews ( n  = 18) and interpretive description analysis. Results Five phases were identified comprising participants' cervical cancer screening journey, with touchpoints in each phase indicating key experiences, barriers, and strategies to navigate barriers. Experiences of touchpoints were affected by four interrelated dimensions: The embodied person—personal gender identity, relationship with own body, and transition process; System factors—policies, routines, and practices; Gender norms and transphobia; and Prior healthcare experiences. Significant barriers included a lack of trans‐specific screening information; an invitation system that does not automatically invite male‐registered individuals with a cervix; lack of trans competency among clinics and staff; female‐centred clinics; gender dysphoria; anticipation or fear of being mistreated; distrust of healthcare authorities; and participant‐staff power dynamics. Conclusion To make cervical cancer screening more equitable for transgender people, barriers need to be addressed by considering the four dimensions that affect these barriers. Implications for the Profession and/or Patient Care Findings show that staff involved in policy and clinical practice can improve transgender people's experiences of cervical cancer screening by promoting agency and self‐determination in each screening phase. This involves providing inclusive information, continuing invitations for male‐registered individuals with a cervix, enhancing trans‐competency, and addressing power dynamics in staff‐participant interactions. Reporting Method The Standards of Reporting Qualitative Research (SRQR). Patient or Public Contribution Representatives from the Regional Cancer Centre Stockholm–Gotland were involved in the conceptualisation of this study. Representatives from trans and LGBTQI+ organisations, Regional Cancer Centres, and the National Board of Health and Welfare have provided feedback during the analysis and writing phases.

Education, income and occupation and their influence on the uptake of cervical cancer prevention strategies: A systematic review

AbstractAimsTo report a systematic review of the literature exploring how education, income and occupation influence the uptake of cervical screening and HPV vaccination among eligible women in developed countries, including the United Kingdom, United States, Spain, Germany and Norway.BackgroundCervical cancer remains a highly prevalent disease despite it being largely preventable through cervical screening and HPV vaccination. Incidence and mortality of cervical cancer are unequally distributed among socioeconomic groups, warranting research into how individual socioeconomic factors contribute to this unbalanced uptake of prevention strategies.DesignSystematic review and narrative synthesis.MethodsThe PRISMA guidelines (PLoS Medicine, 6, 2009, e1000097) guided the selection of papers. MEDLINE, CINHAL, PsychINFO, Science Citation Index and HMIC were searched. Ten articles were suitable. Key findings were then extracted, and a narrative synthesis was completed, using suitable guidance and the AXIS tool.ResultsObtaining high school or college education is associated with uptake of both cervical screening and HPV vaccination. Total household income and income in respect of the countries' poverty line was measured less frequently than education, but associated with screening and vaccination in some studies. Occupation was infrequently measured in comparison to education and income, limiting conclusions of its association to uptake.ConclusionEducation and income have an association with uptake of cervical screening and HPV vaccination among women. However, evidence is insufficient to affirm a relationship between occupation and uptake of screening and vaccination. Further research would be advised to strengthen these findings.Relevance to clinical practiceInterventions to promote cervical cancer prevention strategies should be targeted at women and girls with lower education levels and lower income. However, differences are displayed in the relationships between the individual socioeconomic factors and uptake of preventative strategies between countries and populations and so they should be considered separately. Nurses play a considerable role in people's perceptions and experiences of cervical screening and HPV vaccination. The review findings offer new insight that can inform future policy and nursing practice on targeting interventions to promote uptake among women who are underusing cervical cancer prevention programmes.

What do young women below national screening age in England think about cervical cancer and cervical screening? A qualitative study

AbstractAims and objectivesTo explore what women aged below the national screening age in the UK know and think about cervical cancer and cervical screening.BackgroundThe efficacy of cervical cancer screening is well established. However, cervical screening attendance in the United Kingdom has decreased, with especially low rates at the first screening opportunity at age 25. Research has not yet explored knowledge and beliefs underpinning young women's intention to screen before first screening invitation.DesignQualitative exploratory study.MethodsQualitative email interviews were undertaken with 16 participants, using questions derived from the Health Belief Model. Data were analysed using template analysis. The COREQ were followed.ResultsAnalysis generated three themes; (1) Learning about cervical cancer and cervical screening: sources of information and (missed) opportunities; (2) Young women know screening is important – but they don't always know why; (3) Screening intentions: a cost/benefit analysis of the available information.ConclusionsYoung women had varied knowledge and beliefs about cervical cancer and screening which were underpinned by several sources of information available to them. Most women expressed an intention to attend screening when invited; however, some participants were unsure, with low screening‐based knowledge and low perceived susceptibility of cervical cancer identified as key barriers. Social media, familial interactions and interventions within education were highlighted as being suited to interventions aimed at increasing cervical cancer‐ and screening‐based knowledge in young women.Relevance to clinical practiceFindings suggest that women below screening age could be better informed about cervical cancer and screening. Tailored interventions addressing common concerns and misconceptions around screening may be acceptable to young women and could help to promote screening attendance at first invitation.

Women’s knowledge and attitudes towards cervical cancer prevention: A qualitative study in the Spanish context

AbstractAims and objectivesTo explore the knowledge, attitudes and practices related to cervical cancer and its prevention in Spain.BackgroundWorldwide, women's knowledge about cervical cancer is low, and their attitudes towards its prevention are good, but they do not correlate with the screening uptake. Although the rates of Spanish women performing cervical cancer screening are mostly acceptable, their knowledge and attitudes about it have not been explored.DesignQualitative descriptive study.MethodsThree focus groups were conducted, with 21 women aged 25 to 65 years. Participants were recruited through convenience sampling. For intragroup homogeneity, women participated in age groups. The COREQ reporting guidelines were used.ResultsWomen expressed their knowledge about cervical cancer was low. None of the participants identified the human papillomavirus as a cause of cervical cancer, nor did they mention the vaccine as a preventive measure. They all knew about the screening existence, but not about its frequency nor target population. About the attitudes and practice, 18 women had an appropriate screening, and they were favourable to this health check, claiming an increase in its frequency. Nineteen women claimed they had not received enough information from the healthcare system and a lack of social awareness in comparison with breast cancer. They demanded from the professionals more health education, a reminder of their appointments and a report of the Pap test results.ConclusionsThere was a self‐perceived low level of knowledge about cervical cancer risk factors and its prevention in the participants. However, they expressed favourable attitudes towards screening, and they demanded more information about cervical cancer and its prevention measures, and they regretted its low social awareness.Relevance to clinical practiceMidwives, general nurses and other nurse specialists may have a leading position in health education for cervical cancer prevention in different population levels.

Healthy life styles, sleep and fatigue in endometrial cancer survivors: A cross‐sectional study

AbstractAims and objectivesThe primary aim of this study is to explore the influence of obesity, healthy lifestyle and sleep quality of endometrial cancer survivors on their fatigue level.BackgroundAs many as 30% of endometrial cancer survivors still suffer from fatigue 5 years after completing therapy. Fatigue may hinder cancer survivors from participating in daily activities or returning to their original roles and functions, thus affecting their health‐related quality of life.DesignThis study adopted a cross‐sectional correlational research design. The STROBE checklist for cross‐sectional studies was used as a reference for reporting the study.MethodsA consecutive sample of 134 endometrial cancer survivors was recruited from the outpatient clinics of a medical centre in Taipei, Taiwan. Data were collected using structured questionnaires.ResultsStudy subjects scored 44 points (SD = 7.09) on average for the fatigue levels. Results of linear regression showed that sleep quality (ß = −0.38), comorbidity index (ß = −0.024) and age (ß = 0.20) were important predictors of fatigue. However, differences in obesity, vegetable and fruit intake, physical activity did not lead to significant differences in fatigue level.ConclusionsSurvivors who had poorer sleep quality, higher comorbidity index and younger age reported higher fatigue.Relevance to clinical practiceThe study findings are relevant for assessing and preventing fatigue in endometrial cancer survivors. Those with poorer sleep quality, higher comorbidity index and younger age are at a greater risk for fatigue and deserve further attention. Although the study results failed to support the link between obesity, vegetable and fruit intake, physical activity and fatigue, the ratio of survivors who comply with recommended healthy lifestyles was low. Hence, it is of urgent necessity that this population receives the help to maintain a healthy lifestyle.

Women's experiences with opting out of cervical cancer screening and the role of the nurse in the women's decision‐making process

AbstractAimTo explore Danish women's experiences with opting out of cervical cancer screening and the role of the nurse in the women's decision‐making process.DesignA qualitative study using semi‐structured, individual interviews with a phenomenological‐hermeneutic approach.MethodsInterviews were conducted with 13 women with experience in opting out of cervical cancer screening. Women were recruited through a public flyer and interviewed virtually or by phone. The interviews were analysed using the theory of interpretation from Paul Ricoeur and consisted of three levels: naïve reading, structural analysis, and critical discussion and analysis. The present study adheres to the COREQ guidelines.ResultsThe women experience various personal causes for opting out of cervical cancer screening, such as low accessibility of screening appointments, discomfort during the smear test, fear of being sick, and insufficient information about the relevance of screening to the individual woman. The perceived disadvantages of screening outweighed their perceived advantages. The women's experiences did not include the role of the nurse in the procedures and knowledge sharing related to cervical cancer screening. However, nurses were described as having good communicative and relational qualifications relevant to being involved in cervical cancer screening.ConclusionIt was challenging for the women to weigh the advantages and disadvantages of cervical cancer screening and thus to make an informed decision about participation. They expressed a need for more information on which to base their decision. This places nurses in a much needed, yet unexplored, role of identifying and lowering potential personal barriers that may outweigh the women's perceived benefits of participating in screening.Implication for the profession and/or patient careNurses should play a more active role in cervical cancer screening such as improving general knowledge and facilitating two‐way communication about its relevance.Reporting MethodThe present study adheres to the Consolidated Criteria for Reporting Qualitative Research (COREQ) guidelines.Patient or Public ContributionNo patient or public contribution.

Effects of Cancer Rehabilitation Interventions for Women Treated for Gynaecological Cancers: A Meta‐Analysis of Randomised Controlled Trials

ABSTRACTAimTo analyse and synthesise current evidence on the effectiveness of cancer rehabilitation interventions in increasing physical activity, increasing healthy dietary habits, alleviating psychological distress, and increasing health‐related quality of life (HRQoL) in women treated for gynaecological cancers (GCs).DesignA meta‐analysis of randomised controlled trials (RCTs).Data SourcesA systematic search was conducted in 12 databases from inception to 31 May 2024.Review MethodsThe quantitative results from comparable RCTs were pooled and meta‐analysed using Review Manager 5.4 software. The results from non‐comparable (i.e., clinically heterogeneous) RCTs were narratively summarised. The methodological quality of all RCTs was assessed using Version 2 of the Cochrane risk of bias tool for randomised trials.ResultsNine RCTs reported in a total of 12 articles met the inclusion criteria and comprised a total of 418 patients. The interventions had significant effects on total physical activity levels at post‐intervention, 6‐month follow‐up, and 12‐month follow‐up, and on self‐efficacy in physical activity at post‐intervention and 3‐month follow‐up. However, the interventions did not significantly improve overall HRQoL or healthy dietary habits and did not significantly alleviate anxiety and depression. The key intervention components were information provision on health‐promoting behaviours; adoption of behavioural change techniques (goal setting, action planning, relapse prevention, problem‐solving, self‐monitoring, and social support); and stress and emotion management.ConclusionRehabilitation interventions effectively increase physical activity in women treated for GCs, leading to sustainable effects. However, there is limited evidence on the effectiveness of such interventions in improving overall HRQoL, encouraging healthy eating, and alleviating psychological distress in women treated for GCs.Relevance to Clinical PracticeThis review found that rehabilitation interventions can increase physical activity levels among women treated for GCs. It also identified the key effective components of such interventions.Reporting MethodThis review is reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta‐Analyses Statement.Patient or Public ContributionNone.Trial Registration: International Prospective Register of Systematic Reviews registration number: CRD42023442877

Comment on ‘Impaired sexual health among women treated for vulvar cancer: An integrated review’

Transgender and non‐binary peoples experiences of cervical cancer screening: A scoping review

AbstractAim(s)To synthesise the literature about transgender and non‐binary people's experiences of cervical cancer screening and identify ways to improve screening.BackgroundTransgender people often face barriers to accessing health services including cervical screening, where transgender people have a lower uptake than cisgender women.DesignA scoping review was undertaken following the Arksey and O’Malley (2005) framework and the PRISMA‐ScR checklist. Following database searching of Medline via PubMed, Web of Science, Scopus and CINHAL, 23 papers published between 2008 and 2003 were included. Papers were included if they shared trans and non‐binary people's experiences of cervical screening and were written in English. There were no date or geographical data restrictions due to the paucity of research.ResultsTransgender people experience barriers to cervical screening including gender dysphoria, a history of sexual trauma, and mistrust in health professionals or health services, which can result in having negative experiences of screening or avoiding screening. Health professionals can help to create a positive experience by informing themselves about best practices for trans+ health.ConclusionChanges are required to improve transgender people's experiences and uptake of cervical screening. Improving medical education about trans health and updating health systems would help to combat issues discussed.Implications for the Profession and/or Patient CareHaving an understanding of the reasons why accessing health services can be more difficult for transgender people will help health professionals to provide appropriate care for transgender patients. This paper details this in the context of cervical cancer screening and can be applied to other areas of healthcare.Reporting MethodWe have adhered to relevant EQUATOR guidelines and used the PRISMA‐ScR reporting method. No Patient or Public Contribution.

Building a Delphi‐Informed Transitional Care Programme Guided by the Omaha System for Gynaecologic Oncology Patients

ABSTRACT Objective This study aimed to develop and validate a standardised transitional care programme for postoperative gynaecologic cancer patients utilising the Omaha system framework. Methods A preliminary transitional care programme was constructed through literature review, semi‐structured interviews and multidisciplinary team discussions. The programme was refined via two rounds of Delphi expert consultations involving 17 oncology nursing specialists. Consensus criteria included expert authority coefficient (Cr), Kendall's W test and coefficient of variation (CV). Results The Delphi consultation demonstrated robust expert consensus, with high authority coefficients (Cr: 0.886 in Round 1; 0.906 in Round 2), exceptional participation rates (88.2% and 100% response rates across two rounds) and statistically significant concordance as evidenced by Kendall's W values (0.233–0.358 and 0.326–0.383; all p  < 0.01). All coefficients of variation (CV) metrics fell within acceptable ranges (0.09–0.42 in the initial phase; 0.08–0.27 post‐refinement). Conclusion The Omaha system‐based transitional care programme exhibits strong expert consensus, scientific rigour and clinical applicability, providing a structured approach to improving postoperative recovery in gynaecologic cancer patients. Relevance to Clinical Practice This protocol standardises postoperative care transitions for gynaecologic oncology patients by integrating multidimensional assessments (physiological, psychosocial and health behaviour domains) and family‐centred education. Clinicians can utilise its evidence‐based framework to reduce preventable complications, enhance caregiver preparedness and improve continuity of care between hospital and home settings. Patient or Public Contribution Six postoperative gynaecologic cancer patients and eight family caregivers participated in semi‐structured interviews to identify unmet transitional care needs. Their insights informed the design of intervention components, including self‐management education and psychosocial support strategies. Patients reviewed draft materials for clarity and cultural appropriateness during Delphi Round 2.

Impaired sexual health among women treated for vulvar cancer: An integrated review

AbstractBackgroundAlthough gynaecological cancer's negative effects on sexual function are well known, most studies on the subject have not included vulvar cancer patients or a multidimensional perspective on sexual health. Therefore, this review aimed to address this research gap and explored the impact of vulvar cancer on women's sexual health from a multidimensional perspective.MethodologyAn integrated review was conducted, as described by Whittemore and Knafl. The PubMed, CINAHL, PsycINFO and Embase databases were searched in March 2021 and updated in August 2022 and March 2023. The data were thematically analysed using NVivo, and the PRISMA‐ScR and ENTREQ guidelines were followed.FindingsThe following themes were identified in the 28 reviewed articles: impact of a changed female body, impact on women's sexual identity, consequences for women's sexual relationships and unmet needs and loneliness caused by taboos about sexual health.DiscussionWomen's impaired sexual health after vulvar cancer points to a great need to understand and holistically investigate sexual health. In addition, healthcare professionals have an obligation to care for the sexual health issues of patients with vulvar cancer. However, most questionnaires used in the selected studies revealed a narrow understanding of sexual health and focused on sexuality as a genital activity.ConclusionThe sexual health of women with vulvar cancer was tabooed and stigmatised for patients and healthcare professionals. Consequently, women received sparse sexual guidance, felt isolated and had unmet needs.Implications for clinical practiceHealthcare professionals need knowledge and training on how to break taboos and address the sexual needs of vulvar cancer patients. Systematic screenings for sexual health needs should be conducted using a multidimensional perspective.Trial and protocol registrationThe protocol was preregistered at the Open Science Framework (www.osf.io), registration DOI: https://doi.org/10.17605/OSF.IO/YDA2QPatient or public contributionNo patient or public contribution.