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Background Timely and equitable access to cancer treatment are important markers of the quality and accessibility of cancer care, yet socially disadvantaged people experience a range of barriers to receiving cancer treatment, significantly impacting cancer outcomes, including survival and quality of life. However, interventions designed to improve treatment access for these populations have not been comprehensively mapped. This scoping review aimed to identify and summarize interventions, services, and models of care intended to improve access to cancer treatment among socially disadvantaged groups. Methods We conducted a scoping review to identify and summarize interventions designed to improve access to cancer treatment for people experiencing varying forms of social disadvantage. MEDLINE, EMBASE, and CINAHL were searched for relevant studies published before 2025. Data on study characteristics, intervention types, targeted barriers, and outcomes related to treatment access were extracted and synthesized descriptively. A formal risk-of-bias assessment was not conducted, consistent with scoping review methodology. Findings A total of 57 studies met the inclusion criteria, with nearly half published since 2020. Most studies were conducted in the United States (56) and used observational designs. Interventions addressed various treatment modalities, most commonly surgical treatment (37%), followed by radiotherapy and systemic therapy. Policy-focused interventions, particularly Medicaid expansion, were most frequently evaluated, followed by patient navigation programs. Education-based interventions were relatively few (7%). Institutional and system-level interventions showed more consistent improvements in treatment access. The barriers most commonly targeted included insurance coverage, financial constraints, and transportation. Conclusions Most interventions focused on financial or insurance-related disadvantage, highlighting gaps in evidence-informed strategies addressing other forms of social disadvantage. The predominance of U.S.-based studies also indicates a need for evidence on effective interventions in other health system contexts.

Background: Active involvement of residents, family members and staff in proactive end-of-life conversations remains uncommon in residential care facilities for older people, although these are common settings for the end-of-life. This study derives from a Participatory Action Research project with an intervention aimed at developing Death Literacy among residential care staff, to promote implementation of proactive end-of-life conversations. Objectives: This article has a two-fold aim: (1) to investigate effects and forms of impact derived from this project intending to improve Death Literacy, and (2) to discuss challenges in this investigation and contribute to critical debate and further inform the use and development of the Death Literacy concept and related index (DLI). Methods: We combined quantitative analysis of pre-post intervention DLI survey data from staff and qualitative framework analysis of official documents along with transcribed interviews and workshop data from various staff groups. The framework was based on a matrix with Death Literacy features on one axis and forms of impact on the other. Results: The DLI showed no positive change over time. Effect evaluation was challenged by high baseline mean scores and ceiling effects on the DLI, and issues associated with the use of a participatory research approach, e.g. baseline differences between groups related to recruitment strategies. However, qualitative findings indicated all three forms of impact described in Kleijberg et al.’s model: impact on individual and group development, action-oriented impact, and strategy-oriented impact. These were seen to be related to all Death Literacy features, most notably experiential learning and social action. Conclusion: Features of Death Literacy were relevant in understanding impact, although the usefulness of the DLI to measure change over time was limited in this study. A matrix framework provided nuanced insight beyond either model alone. Congruence of different methodological assumptions should be carefully considered when designing investigations of effect and impact of complex interventions with limited researcher control.

Background The Mind Youth Questionnaire is a multidimensional health-related quality-of-life questionnaire designed for pediatric diabetes care and exists in Dutch, English, and Spanish. Methods The aim of this study was to linguistically and psychometrically validate the Mind Youth Questionnaire (My-Q) for Swedish-speaking youths with type 1 diabetes. The linguistic process of the Dutch version followed ISPORs guidelines. For face validity, youths with type 1 diabetes and diabetes nurses were interviewed. Three stigma items were included. The final Swedish My-Q consists of 38 items. A total of 166 youths (10-19 years) completed the My-Q and Pediatric Quality of Life Inventory diabetes module. A 2nd -order confirmatory factor analysis was conducted using the nine-factor Dutch and five-factor Spanish versions. Results The 2nd -order nine-factor solution (social impact, parents, diabetes control perceptions, responsibilities, worries, treatment satisfaction, body image and eating behavior, stigma, and mood) showed adequate fit: chi 2(551) = 828.36 (p < .01), Comparative Fit Index (CFI) = 0.90, Root Mean Square Error of Approximation (RMSEA) = 0.05 [0.05,0.06], Standardized Root Mean Square Residual (SRMR) = 0.08. The nine-factor solution and grouping of the items followed a clear rationale. The reliability coefficients of the total scale were adequate, alpha = 0.86, Omega = 0.90, and Omega for all the factors ranged from 0.49 to 0.88. The relationships between My-Q factors and sociodemographic variables revealed that boys had better health-related quality of life than girls. Younger youths reported better health-related quality of life in terms of body image and eating behavior (p=.005). Concurrent validity was confirmed, as all the factors were positively related to all the Pediatric Quality of Life Inventory diabetes module factors. A negative correlation was found between the level of glycated hemoglobin and the My-Q score (r=-.258, p < .001). Conclusion The Swedish My-Q has adequate psychometric properties and can be used in research and for routine psychosocial assessment.

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.

Most studies gather data on children’s Covid-19 experiences from proxy adults rather than from children. We explore depictions of end-of-life issues in drawings created by children in Sweden about their experiences during the Covid-19 pandemic, generated in response to an open invitation to schools, teachers, culture centers, etc. from a public archive of children’s art. A transdisciplinary team inductively analyzed 172 drawings containing images of care, dying, death and loss, finding qualitatively different portrayals differentiated by focus on (re)actors versus victims in the pandemic. The virus was often drawn as an aggressive, active agent, while humans, including professionals, appeared reactive and at a loss. The largest group of victims were without identity, although some children depicted themselves as victims. These children illustrate Covid-19-related questions, concerns, and fears about the end of life, reflecting “epistemological uncertainty” resulting from the pandemic. This uncertainty should be addressed, for example by trustworthy support in making sense of surrounding world, and by pro-active death educational approaches for both children and the adults who are in contact with them.

Research on young people's perspectives on COVID-19 remains limited. This qualitative serial picture analysis of Swedish children's drawings, predominately from spring 2020 (N = 169), aimed to explore their views and meaning-making processes. The focus was on the interconnections of two global crises in the drawings–pandemic and environmental crisis–revealing several links, such as negative emotions and dystopian expectations, as well as a lack of hope and agency, yet also resistance and utopian optimism for solutions. Our findings offer insights into young people's responses to contemporary global crises and their implications.

Background: During the past two decades, differences in health and living conditions based on sexual orientation and gender minority status (e.g., those who identify as lesbian, gay, bisexual, and transgender) have received increased attention. The majority of these studies have been conducted among adolescents and young adults, and there is a need for more knowledge about the health situation among older generations of sexual and gender minority individuals. This study provides one of the most comprehensive population-based examinations of health disparities among older sexual orientation and gender minority adults outside the United States. Methods: This study explores disparities in health, well-being, and social determinants of health by sexual orientation and gender minority status in Sweden using data from 87,456 individuals aged 65 and older from the Swedish National Public Health Survey (2018–2022). We examined self-rated health, physical symptoms, psychological distress, and mental well-being, alongside social and economic health determinants such as discrimination, victimization, isolation, and financial stress. Results: While sexual and gender minority individuals reported higher levels of social and economic stressors, differences in health outcomes were modest. Gay men showed slightly higher psychological distress, and lesbian women reported lower positive well-being compared to heterosexual peers. There were no significant differences between cisgender and gender minority participants on any of our measures of health and well-being. Further, effect modification analyses showed that disparities were influenced by sociodemographic factors, with education level, migration background, and urbanicity acting as moderators. Conclusions: These findings suggest that despite elevated stressors, older sexual and gender minority adults may demonstrate resilience shaped by life experiences. Public health efforts should address structural inequalities while recognizing the strengths and diversity within this population. 

Timely access to guideline-recommended cancer treatment is known to be an indicator of the quality and accessibility of a cancer care system. Yet people who are socially disadvantaged experience inequities in access to cancer treatment that have significant impacts on cancer outcomes and quality of life. Among people experiencing the intersecting impacts of poor access to the social determinants of health and personal identities typically marginalized from society ('social disadvantage'), there are significant barriers to accessing cancer, many of which compound one another, making cancer treatment extremely difficult to access. Although some research has focused on barriers to accessing cancer treatment among people who are socially disadvantaged, it is not entirely clear what, if anything, is being done to mitigate these barriers and improve access to care. Increasingly, there is a need to design cancer treatment services and models of care that are flexible, tailored to meet the needs of patients, and innovative in reaching out to socially disadvantaged groups. In this paper, we report the protocol for a planned scoping review which aims to answer the following question: What services, models of care, or interventions have been developed to improve access to or receipt of cancer treatment for adults who are socially disadvantaged? Based on the methodological framework of Arksey and O'Malley, this scoping review is planned in six iterative stages. A comprehensive search strategy will be developed by an academic librarian. OVID Medline, EMBASE, CINAHL (using EBSCOhost) and Scopus will be searched for peer-reviewed published literature; advanced searches in Google will be done to identify relevant online grey literature reports. Descriptive and thematic analysis methods will be used to analyze extracted data. Findings will provide a better understanding of the range and nature of strategies developed to mitigate barriers to accessing cancer treatment.

Worse socioeconomic conditions (e.g., having a migration background, lower income, and lower educational level) may lead to barriers for cancer prevention and early detection. Community-based initiatives providing tailored and accessible information are found to increase cancer screening participation and improve health outcomes for people with challenging socioeconomic conditions. To inform such initiatives, more research is needed from the perspective of those working with them. This article focuses on the Swedish “peer advisor project” in which the Regional Cancer Centre Stockholm Gotland (RCC) collaborates with community-based peer advisors to reduce cancer inequities in areas with challenging socioeconomic conditions. We aim to investigate the perspectives of people working with the peer advisor project in relation to challenges they face, strategies they use, and forms of impact they perceive their work to have. We used a participatory action research approach, involving 12 peer advisor representatives and three RCC representatives. Underlying data (interviews and participant observations) were qualitatively analyzed. Findings are presented in relation to three themes: (1) Peer advisors bridge a gap between the cancer care system and communities through dialogues with communities and RCC representatives. (2) Peer advisors navigate culturally based sensitivities through efforts to create safe spaces for discussing cancer prevention and early detection. (3) Peer advisor and RCC representatives described forms of impact in relation to personal contexts, community contexts, RCC’s organizational context, and societal context. Sustainability and structural challenges may limit the peer advisor project to create impact. We discuss that peer advisors may act as cultural brokers through dialogues with communities and the cancer care system, thereby increasing an understanding of communities’ contexts and needs. Findings from this study can inform development and implementation of similar community-based peer-to-peer initiatives in other contexts. More research is needed to investigate the long-term impact of the project including community-based perspectives.