Experiencing cancer in old age: a qualitative systematic review.

Our purpose in this study was to find, report, and interpret the results of qualitative studies which investigated the experiences of older people living with cancer. We conducted systematic literature searches, identified and extracted the findings from 11 studies, and analyzed them systematically. We interpreted the findings to suggest that living with cancer in old age is to live in a perpetual state of ambiguity. The experience is characterized by a sense of disintegration, diminished identity, suffering, and social retraction. These experiences are balanced by sources of comfort and strength found within the self and among diverse relationships. The results of our study illuminate the complex, multidimensional character of living with cancer in old age. They show that older people living with cancer are resilient as well as vulnerable. We argue for changes in attitudes and behavior that will enable health care professionals to foster older peoples' resilience.

The self-reported learning style preferences of female Macmillan clinical nurse specialists.

Individuals typically adopt and prefer one or two learning styles and therefore, by default, remaining learning styles are underutilised. Insight into learning style preferences confers interpersonal benefits to both learners and teachers. Enlightened learners and teachers can identify their dominant learning styles and potentially strengthen underutilised ones. Findings from a retrospective study commissioned by Macmillan Cancer Relief that investigated learning style preferences of 137 female Macmillan Clinical Nurse Specialists (CNSs) showed that the majority (73.7%) displayed a strong-very strong preference for one or two learning styles. Mean scores across four learning styles were highest for the reflector learning style (mu=14.85+/-3.16) followed by theorist (mu=12.2+/-2.87), pragmatist (mu=11.5 (2.85) and activist (mu=7.95+/-3.11). An understanding of individual learning style preferences, particularly the strengthening of those that are underutilised is said to cultivate both flexible and resourceful learners and effective teachers. Such characteristics would confer considerable benefits within the remit of a Macmillan CNS position.

"A thoughtful and experienced physician": William Munk and the care of the dying in late Victorian England.

William Munk (1816-1898) qualified as a physician in 1837 and practiced in London for more than 60 years. Munk became well known in the medical profession during the second half of the nineteenth century for his emphasis on the importance of narcotics for the relief of pain in incurable disease and was also a recognized authority on smallpox. In addition to his medical practice Munk was the Harveian Librarian of the Royal College of Physicians for almost 40 years and, among other biographical works, single-handedly produced the Roll of the Royal College of Physicians of London 1518-1700. His most significant clinical publication, Euthanasia, or Medical Treatment in Aid of an Easy Death, appeared toward the end of his career and was enthusiastically received by the medical and nursing professions. This paper gives a more detailed account of Munk's life and work than has yet appeared and focuses in particular on the contents and contemporary influence of his important late nineteenth century treatise on the care of the dying.

Personal identity and the role of 'carer' among relatives and friends of people with multiple sclerosis.

Informal caregiving continues to be a crucial part of health and social care provision in the developed world, but the processes by which the identity of informal caregiver is conferred, or assumed, remain unclear. In this article we draw on data from a qualitative research study which examined the experiences of family members and friends of people with multiple sclerosis (pwMS) to explore how they interpret the label 'carer'. We conducted narrative interviews with forty people throughout the United Kingdom between June 2011 and January 2012. Participants were spouses, partners, parents, children, siblings or friends of people who have had multiple sclerosis between 6 months and fifty years. We carried out thematic analysis of the interviews, informed by identity theory. Identity theory illuminated variation in peoples' perceptions of themselves as carers, suggesting that self-identification with the role and label of carer is nuanced, shifting and variable. We propose a taxonomy of caring activity including emotional support, personal care, physical care, household tasks, advocacy and activism and describe four categories, with fluid and overlapping boundaries, in which the identity of carer was apparently embraced, enforced, absorbed or rejected. Variability and fluidity in self-identification as a carer are related to apparent expectations about whether one should assume a caring role. Those who were caring from the more tangential (and less taken for granted) relationship of sibling or ex-partner were among those who apparently embraced the role. Those who were expected to assume the caring role (typically spouses) were not always comfortable with doing so. It may be difficult to gain acknowledgement from family members and others that they occupy the role of carer if people resist the label as a bureaucratisation of their personal relationships.