Publications

  • Coming out in cancer care: Is disclosure of sexual orientation beneficial?
    Coming out in cancer care: Is disclosure of sexual orientation beneficial? Fish, Julie; Brown, Jayne; Williamson, I. Nurses and other health professionals are to ask about sexual orientation at every face-to-face contact across the NHS from 2019. However, there are concerns about the need for, and relevance of, sexual orientation disclosure and of the potential for discomfort and embarrassment. We conducted qualitative interviews with fifteen lesbian, gay and bisexual patients to investigate how experiences of cancer care are mediated by disclosure. Using thematic analysis, three themes emerged: identifying the barriers to disclosure, approaches to, and facilitators of, coming out, and small actions/big impact: nurses’ responses to disclosure. In conclusion, we situate disclosure within a model of holistic care recognising that patients’ individual needs constitute one of the eight principles of quality nursing. Treating the whole person means that patients are more likely to engage in positive health behaviours, have more knowledge, skills and confidence to manage their health and be more satisfied with their care. The file attached to this record is the author's final peer reviewed version.
  • Coming out in cancer care: Is disclosure of sexual orientation beneficial?
    Coming out in cancer care: Is disclosure of sexual orientation beneficial? Fish, Julie; Brown, Jayne; Williamson, I. Nurses and other health professionals are to ask about sexual orientation at every face-to-face contact across the NHS from 2019. However, there are concerns about the need for, and relevance of, sexual orientation disclosure and of the potential for discomfort and embarrassment. We conducted qualitative interviews with fifteen lesbian, gay and bisexual patients to investigate how experiences of cancer care are mediated by disclosure. Using thematic analysis, three themes emerged: identifying the barriers to disclosure, approaches to, and facilitators of, coming out, and small actions/big impact: nurses’ responses to disclosure. In conclusion, we situate disclosure within a model of holistic care recognising that patients’ individual needs constitute one of the eight principles of quality nursing. Treating the whole person means that patients are more likely to engage in positive health behaviours, have more knowledge, skills and confidence to manage their health and be more satisfied with their care. The file attached to this record is the author's final peer reviewed version. The Publisher's final version can be found by following the DOI link.
  • Social Work with Transgender People
    Social Work with Transgender People Fish, Julie; Donaldson, M.; Hardy, R. This is summary of the podcast recording : Julie Fish •The starting point is inclusive social work education, that case studies include the lives of trans people, that there are inclusive environments in social care settings, that the representation, the approaches, recognise trans people. •When we’re thinking about models of social work practice or models of assessing parenting or children in need, that we use assessment tools that are relevant to trans people’s lives. •That if you are a practitioner and you make a mistake that you acknowledge it and learn from it, and that you critically reflect on some of the discourses that you hear in society and that you interrogate the views of others, especially when they’re transphobic but at other times too, rather than accepting them as true. Matty Donaldson •I think training’s really important, but I think people have to buy into really good quality training. They need to give themselves a full day and then they also need to give themselves space to go away and reflect on what they’re going to do with what they’ve just learnt in that training, and put some of the things they’ve learnt into action. •I often say that if you’re good at working with young people you’re probably pretty good at working with trans young people, because a lot of the skills are transferable in terms of listening to them, respecting them, letting them lead conversations, and giving them space to talk about themselves. That’s really important, not to just forget all that when you’re working with a trans young person, because you feel like it’s a completely different set of skills. So asking them what name they want to use, asking them what pronouns they want to use, and respecting that and giving them the space if they want to explore gender to do that. If they’re not interested, they’re not interested.
  • Towards LGBTQ-affirmative cancer care and support: Barriers and opportunities
    Towards LGBTQ-affirmative cancer care and support: Barriers and opportunities Williamson, I. R.; Fish, Julie; Wildbur, D.; Bell, Katie; Padley, Wendy; Brown, Jayne Background: Survey data suggest that LGBT people report lower levels of satisfaction with healthcare for cancer than heterosexuals. This presentation summarises findings from recent qualitative research to understand the experiences of British LGBT people with cancer and their long-term partners. Methods: Participants were recruited through 5 oncology units at British hospitals, 2 cancer support charities and through media campaigns. In-depth interviews typically lasting between 45 and 75 minutes were carried out with 31 cancer patients who identified as lesbian (N=13), gay (N=14), bisexual (N= 3) and queer (N=1) and 9 long-term partners of cancer patients who identified as lesbian (N= 5), gay (N= 2) and trans* (N=2). Data were analysed through thematic analysis. Findings: Three themes are presented: Understanding the Motives, Meanings and ‘Mechanics’ of Disclosure explores how decisions around whether to ‘come out’ as LGBTQ are influenced by several factors including anticipated stigma, perceived moral or political ‘obligation’ and the manner of healthcare professionals. Creating and Communicating LGBTQ-Affirmative Spaces outlines anxieties faced by LGBTQ patients in interactions with staff and patients in clinical spaces such as waiting-rooms and hospital wards and the desire for more explicit evidencing of an anti-discriminatory culture. Finally Seeking LGBTQ-tailored Information and Support shows how current cancer support typically fails to meet psychosocial and psychosexual needs of LGBTQ patients. Discussion: The findings can be used to influence policy and practice by statutory and voluntary agencies to ensure that effective oncology treatment is accompanied by an holistic understanding of the needs and concerns of LGBTQ patients
  • It’s all right now? Re-thinking queer activism for the 21st century
    It’s all right now? Re-thinking queer activism for the 21st century Fish, Julie; Almack, K.; King, Andrew
  • Promoting good outcomes in Lesbian, Gay and Bisexual cancer care: a qualitative study of patients’experiences in clinical oncology
    Promoting good outcomes in Lesbian, Gay and Bisexual cancer care: a qualitative study of patients’experiences in clinical oncology Fish, Julie; Williamson, I.; Brown, Jayne; Padley, Wendy; Bell, Kathleen; Long, J. EXECUTIVE SUMMARY Cancer inequalities, including differences in cancer outcomes and patient satisfaction, affect a range of groups including lesbian, gay and bisexual (LGB) people. In its strategy to reduce these inequalities, the Department of Health commissioned the Cancer Patient Experience Survey (CPES) providing baseline data in which LGB patients were more likely to say their experiences were less positive than those of heterosexual patients. These differences included accessible information, psychosocial support and the human rights concerns of dignity and respect. The CPES, which was carried out in four successive years (2010-2014), suggesting that these are intractable problems, found that LGB patients were more likely to disagree with statements such as they ‘never felt treated as a set of cancer symptoms rather than as a whole person’ or the ‘doctor never talked about me as if I wasn’t there’. The CPES did not collect qualitative data and consequently the reasons for these differences were not known. This De Montfort University study, funded by Macmillan, illuminates some of the reasons for these survey findings as we were able to gather people’s accounts of their treatment and care. This report identifies key moments in the cancer journey where care provided for LGB cancer patients can contribute to their recovery and well-being. Alongside this evidence of unmet need, NHS England (2017) has recently issued guidance to support the introduction of mechanisms for recording sexual orientation across all health services in England for patients over 16. It recommends that sexual orientation monitoring occurs at every face to face contact with the patient. The collection of this monitoring data has implications; not only for cancer professionals, but also that patients themselves understand why this information is being requested. The report draws on LGB cancer patients’ motivations and methods for disclosing their sexual orientation and the perceived benefits of doing so for their quality of life. The findings will contribute to understanding the health benefits of coming out and how disclosure might be facilitated in hospital settings. This study provides compelling data about some of the factors underpinning inequalities in the experiences and, potentially, cancer outcomes for LGB patients. Managing the worry about whether it is safe to disclose their sexual orientation to professionals and the uncertainty about how this will be received presents an additional burden for LGB people with cancer. Participants in this study were sometimes hesitant to disclose because the opportunity did not arise or they were uncertain about its relevance. The report identifies some moments that matter in the care relationship where professionals could seek to facilitate disclosure thus contributing to Achieving World Class Cancer Outcomes (Department of Health, 2015) for LGB patients. In addition, the findings point to the importance of creating an inclusive care environment; participants noted that even in the Cancer Centres of Excellence, there were few visible signs of inclusion for LGB cancer patients. Steps to promote inclusion may entail a diversity policy statement, imagery on walls or the display of a LGB staff network on a hospital notice-board. participants also shared experiences where they were accepted in an everyday manner by hospital staff. They often talked about a whole hospital approach where they were acknowledged by staff from porters, health care assistants, nurses and consultants. These cancer narratives also highlight the need for LGB cancer support groups and tailored resources. The lack of LGB support groups in the UK mean that some participants were coping with their cancer with few forms of social and emotional support and they found few sources of information which addressed their needs. There was a clear demand for a greater range of LGB support resources that were relevant to the challenges and concerns of specific cancer types and reports of rather patchy provision in this regard, with differences influenced primarily by geographic location and cancer type. Finally, our findings suggest that participants had heterogeneous expectations of cancer care requiring complex .skills from professionals. Yet there is little or no curricula content in university programmes of Medicine or Nursing. This might suggest a lack of recognition of distinctive cancer care needs and may explain why participants reported different patient experiences even within the same hospital. The inclusion of research with LGB patients alongside heterosexual populations and relevant case studies to underpin Learning and Development and Continuous Professional Development to inform understanding of patient experience, psychosocial concerns and cancer risk is urgently needed.
  • Queerying activism through the lens of the sociology of everyday life
    Queerying activism through the lens of the sociology of everyday life Fish, Julie; King, A.; Almack, K. The approaching 30th anniversary of the introduction of the 1988 Local Government Act offers an opportunity to reflect on the nature of lesbian, gay and bisexual (LGB) activism in Britain. The protests against its implementation involved some of the most iconic moments of queer activism. Important though they are, these singular, totemic moments, give rise to, and are sustained by small, almost unobtrusive, acts which form part of LGB people’s everyday lives. In this paper, we aim to contribute to a re-thinking of queer activism where iconic activism is placed in a synergetic relationship with the quieter practices in the quotidian lives of LGB people. We interrogate a series of examples, drawn from three studies, to expand ideas about how activism is constituted in everyday life. We discuss the findings in relation to three themes: the need to forge social bonds often formed a prompt to action; disrupting the binary dualism between making history and making a life; and the transformative potential of everyday actions/activism. The lens of the sociology of everyday life i) encourages a wider constituency of others to engage in politics; ii) problematizes the place of iconic activism. The file attached to this record is the author's final peer reviewed version. The Publisher's final version can be found by following the DOI link
  • An Exploration of Domestic & Sexual Violence Services and Service User Involvement
    An Exploration of Domestic & Sexual Violence Services and Service User Involvement Turgoose, Di; Szabo, A.; Fish, Julie
  • Domestic & Sexual Violence Services and Service User Involvement: An Exploration
    Domestic & Sexual Violence Services and Service User Involvement: An Exploration Fish, Julie; Szabo, A.; Turgoose, Di
  • Exploring approaches to Service User Involvement in Sexual Violence and Domestic Violence Services
    Exploring approaches to Service User Involvement in Sexual Violence and Domestic Violence Services Fish, Julie; Szabo, A.; Turgoose, Di A cross disciplinary (Community & Criminal Justice & Social Work) research project.

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Social work and LGBT

 
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