"One a Day Keeps the Prison Away": Understanding the Experiences of Individuals Convicted of Sexual Offences Receiving Anti-Androgens for the Treatment of Problematic Sexual Arousal

Problematic sexual arousal (PSA) is an umbrella term to describe a range of clinical presentations related to excessive sexual thinking (e.g., sexual preoccupation) and sexual behavior (e.g., hypersexuality). Although such concepts are known to affect sexual recidivism among individuals convicted of sexual offences, PSA is not routinely or directly targeted in offending behavior programs in England and Wales. However, in recent years, there have been moves to incorporate pharmacological interventions for addressing this among people with sexual offence histories. Although some work to understand the experiences of those taking SSRI medication for this purpose has emerged, little is known about the experiences of service users taking anti-androgen medication. In this study, we interviewed all individuals in prison taking anti-androgens for the treatment of problematic sexual arousal following convictions for sexual offences in England at the time of data collection (N = 10). Using a phenomenologically oriented thematic analysis, we established themes pertaining to "Differing needs: Motivations for treatment," "Medication as a risk management strategy," and how the medication helped the men in their pursuit of "Discovering a 'new me'." This work contributes important knowledge to inform the development of ethical and effective prescribing of anti-androgen medication with this population and offer recommendations for both future research and the development of clinical practice.

"Falling Through the Cracks": A Retrospective Exploration of the Barriers to Help-Seeking Among Men Convicted of Sexual Crimes

The prevalence and impact of sexual abuse is of global concern, and the alarming rates of victimization have inspired a focus on its prevention. Whilst research has begun to explore the experiences of non-offending individuals to inform prevention initiatives, there is limited exploration of those who have struggled with their sexual interests and go on to commit sexual crime. Arguably these individuals hold key information about gaps in service provision, which may inform approaches to crime prevention. This study aimed to provide a phenomenological exploration of the pre-offense experiences of convicted individuals' beliefs about help-seeking, their desires for support, and any barriers that might have prevented them from coming forward for help. Semi-structured interviews were conducted with 14 individuals convicted of sexual offenses (n = 13 against children; n = 1 sexually motivated violence), and interpretative phenomenological analysis elicited three superordinate themes: Desperation, Barriers to Help-seeking and A Way Forward. The findings shed light on the distressing experience of living with sexual interests that are so openly rejected by society and the many ways participants attempted to cope with this, including multiple failed attempts to seek help. Implications and limitations are discussed.

The FATHER Model of Loss and Grief After Child's Life-Limiting Illness

CONTEXT

Loss of a child to a life-limiting condition (LLC) is 1 of the most traumatic life events for parents. Research focusing on fathers' experiences is in its infancy.

OBJECTIVES

Using a meta-ethnographic approach, we systematically reviewed the literature around fathers' predeath and postdeath experiences of loss and grief.

DATA SOURCES

We searched Medline, Scopus, Cumulative Index to Nursing and Allied Health Literature, and Science Direct, and used the meta-ethnography reporting guidelines; the Preferred Reporting Items for Systematic Reviews and Meta-Analyses; and sampling strategy, type of study, approaches, range of years, limits, inclusion and exclusions, terms used, and electronic sources recommendations.

STUDY SELECTION

We used the Guide to Children's Palliative Care and the directory of LLCs to select qualitative articles published up until the end of March 2023 that described fathers' predeath and postdeath experiences of loss and grief after their child's LLC. We excluded studies that failed to differentiate outcomes between mothers and fathers.

DATA EXTRACTION

Extracted data included study details, participants' characteristics, response rate, source of participants, method and time of data collection, children's characteristics, and quality assessment. First-order and second-order data were also extracted.

RESULTS

Forty studies informed a FATHER model of loss and grief. This highlights both similarities (ambivalence, trauma responses, fatigue, anxiety, unresolved grief, guilt) and distinct features defining the predeath and postdeath experiences of loss and grief.

LIMITATIONS

There was a bias toward greater mother participation in research. Specific categories of fathers remain underrepresented in palliative care literature.

CONCLUSIONS

Many fathers experience disenfranchised grief and deterioration in mental health after a child's diagnosis and postdeath. Our model opens possibilities for personalized clinical support in the palliative care system for fathers.

Identifying and working with appropriate treatment targets with people who are sexually attracted to children

Research has shown that people within society experience sexual attractions to children, and a substantial number of these seek support related to this. However, professional practices around working with minor-attracted persons (MAPs) are variable. Clinicians possess low levels of knowledge about this population and are unclear about the correct treatment goals. In this work we explored the prioritization of different treatment goals by MAPs (n = 150), before investigating the demographic, sexuality-related, and psychological predictors of treatment target prioritization. Self-compassion drove many treatment targets among MAPs. We offer recommendations about how professionals might work collaboratively and effectively with this population.

Primary Health Professionals' Beliefs, Experiences, and Willingness to Treat Minor-Attracted Persons

There is a desire and need among minor-attracted persons (MAPs) to access support within the community, and this often begins with an approach to healthcare providers working in general medical/mental health settings. However, little is known about the experiences of these non-specialist professionals in relation to their beliefs, knowledge, and decision-making processes when working with patients who disclose sexual attractions to children. Using an online survey, this study explored the knowledge, comfort, competence, and treatment willingness of 220 non-specialist healthcare providers when faced with patients who disclose sexual attractions to children. We investigated how often such disclosures were made, clinician stigma, treatment priorities, and professionals' willingness to report MAPs to external agencies because of their sexual attractions. Some key differences were found when comparing primary medical vs. mental health professionals, including increased likelihood to view MAPs as dangerous, unable to control behaviors and that sexual attractions are an avoidable choice, in the former group. Both groups prioritized mental health treatment targets above controlling attractions and living with stigmatized attractions, although controlling or changing attractions were still relatively high priorities. Results indicated a need for further training, focusing on increasing comfort around working with MAPs, as this was associated with a greater willingness to work with this group. We identify current gaps in service provision for MAPs seeking professional support and discuss recommendations for professional training.

A Study Protocol to Explore and Improve Access to Medical Services and Information for Recently Diagnosed Elderly Patients with Cancer in Rural Settings

Introduction

This two-phase study seeks to contribute to research in the field of rural cancer health; specifically, the aim is to gain insight into the experiences of seeking, accessing and using information and health services throughout the cancer journey (diagnosis, treatment and follow-up care) for recently diagnosed (≤6 months) older patients (≥65 years) in rural areas.

Methods and analysis

Data will be collected through in-depth semi-structured interviews. In phase 1 (before 23^rd March 2020) interviews were conducted with healthcare professionals (HCP) to explore their experiences of delivering care to their elderly patients. In the second phase (starting January 2021) we will conduct interviews with cancer patients to understand the impact of COVID-19 and shielding on their experiences of being diagnosed, attending appointments and accessing and receiving support from community organisations and informal support from family and friends. Data gathered will be analysed using the Framework Method.

Ethics

The study has been approved by the Health Research Authority and the United Lincolnshire Hospitals NHS Trust. Initial favourable ethical opinion was granted on 1^st October 2019. Second favourable ethical opinion for amendments to reflect the impact of COVID-19 was received on 10^th August 2020. The study protocol has been registered on Research Registry.

A meta-ethnographic study of fathers' experiences of caring for a child with a life-limiting illness

BACKGROUND

There is a growing body of qualitative studies examining parents' experiences of caring for a child with a life-limiting condition, coinciding with recent evidence that indicates an increasing incidence of paediatric life-limiting conditions. However, research focusing on fathers' needs remains sparse and is often diluted among a predominant 'mother's voice', raising questions about whether practices in clinical settings meet fathers' needs.

AIM

To provide an in-depth assembly of the current state of knowledge around fathers' experiences of caring for their children diagnosed with life-limiting conditions and understand the implications for healthcare services and policies.

DESIGN

A meta-ethnography was conducted to synthesise findings from existing qualitative studies exploring fathers' experiences of caring.

DATA SOURCES

Four electronic databases (PubMed, PsycINFO, CINAHL and Science Direct) were searched up until April 2020. Qualitative studies exploring fathers' care experience and published in English language were included. The Critical Appraisal Skills Programme (CASP) checklist was employed for study quality appraisal. No temporal limits were used.

RESULTS

Sixty-three studies met the inclusion criteria. Thirty life-limiting conditions were included. Based on responses from 496 fathers, a conceptual model was developed which translates key experiences within the fathers' caregiving journeys. The overarching concepts identified were: the paradox of support, challenges in the caring process, 'nobody thinks of men', impact on family life and the fall of the curtain: an irrevocably altered world. These and associated sub-concepts are discussed, with recommendations for future research and practice provided.

CONCLUSION

The findings indicate the value of a family-oriented approach to develop psychosocial interventions and support channels for fathers, thus empowering them whilst reducing the care-giving burden on the family unit.

A note on the frequency of gastric ulcers detected during post-mortem examination at a pig abattoir

There is growing interest in using findings from post-mortem meat inspection as indicators of on-farm and preslaughter animal welfare. This study considered whether oesophago-gastric ulcers might be a useful feature in pigs. The stomachs of 9827 finishing pigs from 60 farms were examined to provide an estimate of the frequency of oesophago-gastric ulcers in England. Stomachs were graded using a four-point scale ranging from normal, hyperkeratotic, eroded or ulcerated with or without stenosis. Over 79% of stomachs had either an oesophago-gastric ulcer or visible pre-ulcerative changes, including hyperkeratosis of the epithelium lining the pars oesophagea. The frequency of severe ulceration (Grade 3) was 6%, and mild ulcers (Grades 1 and 2) 73%. There was a significantly higher frequency of oesophago-gastric lesions in the groups of pigs that were held at the abattoir overnight, compared with those slaughtered on the day of arrival. This could have been due to the combined effect of overnight fasting plus stress in an unfamiliar environment. However, the exact fasting times of the animals were unknown and so it was not possible to provide a precise assessment of the effect of feed withdrawal.