Ethnicity and the prostate cancer experience: a qualitative metasynthesis

Objectives: To summarise black and minority ethnic (BME) patients' and partners<br/>experiences of prostate cancer (PCa) by examining the findings of existing qualitative studies<br/>Methods:<br/>We undertook a systematic metasynthesis of qualitative studies using a modified version of<br/>Noblit and Hare's 'meta-ethnography' approach, with a 2000-2015 search of seven databases.<br/>Results: Thirteen studies of men from US and UK BME groups were included. We explored<br/>constructs with BME-specific features. Healthcare provider relationships, formation of a<br/>spiritual alliance with God (which enhanced the participants’ feeling of empowerment and<br/>ability to cope with the cancer) and living on for others (generally to increase cancer<br/>awareness), often connected to spiritual regrowth, were the three constructs most commonly<br/>reported. A magnified effect from erectile dysfunction was also common. Initially this<br/>affected men’s disclosure to others about their cancer and their sexual problems, but<br/>eventually men responded by shifting their conceptualisations of masculinity to sustain self<br/>and social identities. There was also evidence of inequality resulting from financial<br/>constraints and adversity that necessitated resilience in coping.<br/>Conclusions: The prostate cancer experience of BME men and their partners is affected by a<br/>complex intersection of ethnicity with other factors. Healthcare services should acknowledge<br/>this. If providers recognise the men’s felt masculinities, social identities and spiritual beliefs<br/>and their shifting nature, services could be improved, with community as well as individual<br/>benefits. More studies are needed in diverse ethnic groups