Keywords
Older adult, prostate cancer, prostatic neoplasms, patient experience, qualitative, evidence synthesis, health services accessibility, health equity
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Williams S, Peters N, Dillon S et al. Experiences of older men with prostate cancer in accessing health services: a protocol for a qualitative evidence synthesis [version 1; peer review: awaiting peer review]. HRB Open Res 2026, 9:49 (https://doi.org/10.12688/hrbopenres.14415.1)
NOTE: If applicable, it is important to ensure the information in square brackets after the title is included in all citations of this article.
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Study Protocol
Experiences of older men with prostate cancer in accessing health services: a protocol for a qualitative evidence synthesis
[version 1; peer review: awaiting peer review]
PUBLISHED 09 May 2026
OPEN PEER REVIEW
REVIEWER STATUS
This article is included in the Ageing Populations collection.
Abstract
Corresponding author:
Susan Williams
Competing interests:
No competing interests were disclosed.
Grant information:
This work is supported by the Movember Foundation.
The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
Copyright:
© 2026 Williams S et al.
This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
How to cite: Williams S, Peters N, Dillon S et al. Experiences of older men with prostate cancer in accessing health services: a protocol for a qualitative evidence synthesis [version 1; peer review: awaiting peer review]. HRB Open Res 2026, 9:49 (https://doi.org/10.12688/hrbopenres.14415.1)
First published: 09 May 2026, 9:49 (https://doi.org/10.12688/hrbopenres.14415.1)
Latest published: 09 May 2026, 9:49 (https://doi.org/10.12688/hrbopenres.14415.1)
The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
1.1 Introduction
Prostate cancer prevalence has risen steadily over the last three decades, with more than 10 million men living with prostate cancer worldwide in 2021, a 188.85% increase since 1990 (Zhao et al. 2025). Projections indicate that the number of new cases diagnosed annually will rise from 1.4 million in 2020 to 2.9 million by 2040 (James et al. 2024). In Ireland, prostate cancer accounts for almost 30% of newly diagnosed cancers in men, with approximately 3,500 men receiving a diagnosis annually, at a median age of 68 (National Cancer Registry Ireland 2020). In those diagnosed with prostate cancer at an early stage, the life expectancy can be as high as 99% at ten years (Wasim et al. 2022). Timely access to cancer care across all stages - prevention, screening, diagnosis, treatment, survivorship and end-of-life – is key to reducing the cancer burden (Bourgeois et al. 2024).
For older men, a prostate cancer diagnosis can lead to a combination of emotional, physical and social challenges, shaped by age-related vulnerabilities and long-term treatment effects. Qualitative research suggests that older men struggle with adapting to treatment related changes such as urinary and/or sexual dysfunction, relying on family for emotional and practical support, while experiencing a loss of identity and independence (Bekele and Martinez-Hernaez 2025; Li et al. 2025). Qualitative evidence further suggests systemic issues, such as delays in diagnosis and fragmented care pathways increase the overall burden faced by prostate cancer patients and their caregivers (Mumuni et al. 2024).
In accessing prostate care services, research consistently shows that older men face a range of clinical, psychological and systemic barriers (Graham et al. 2023). Older men are often under-represented in clinical trials, which limits the applicability of existing treatment guidelines and creates uncertainty for optimal care planning, while frailty status, pre-existing co-morbidities and functional ability can limit therapeutic options (Prashar et al. 2022). Qualitative research would suggest that older men may hesitate in seeking healthcare support due to fear, embarrassment and disease-related stigmatisation, potentially delaying their subsequent treatment plan (Buote et al. 2020). Socioeconomic factors such as education, income and access to healthcare systems are known to be associated with patient outcomes, with men living in marginalised areas experiencing greater difficulty in accessing specialist care, diagnostics and consistent treatment pathways (Coughlin 2020).
While significant progress has been made in recent times in terms of screening, diagnosing and treating prostate cancer, disparities remain in older men’s accessibility to prostate cancer services. Furthermore, while research has explored older men’s experiences of prostate cancer care, there is a dearth of evidence exploring older men’s experiences with regards to health service accessibility. Similarly, there has been a lack of consideration for the experiences of caregivers and healthcare professionals with regards to access to prostate cancer care.
1.2 Methods
1.2.1 Study design
A QES approach will be used to address the research question. QES, also known as qualitative systematic review, offers a means of aggregating or integrating findings from multiple qualitative studies (Booth and Fryer 2026). The conduct and reporting of this QES will adhere to ENTREQ guidelines (Tong et al. 2012).
1.2.2 Search strategy
The following databases will be accessed to determine relevant studies: CINAHL, PubMed Central, Embase, Medline, PsycINFO, Sage, Academic Search Complete, Directory of Open Access Journals, The Cochrane Library, PsycARTICLES and Scopus. Reference lists of included studies will also be searched to locate any additional studies. A detailed search string for all databases is included in Appendix 1.
1.2.3 Study selection
Population: older men (aged ≥65 years) with a diagnosis of prostate cancer, their relatives/caregivers or healthcare professionals. If the study contains a mixed population, there must be >50% of the population meeting the above criteria to be included.
Phenomenon of interest: lived experiences of accessing health services (the processes, perceptions, barriers, facilitators, feelings, journey, interactions etc).
Study types: Studies will be included that utilise qualitative study designs. Mixed methods studies where qualitative data can be extracted will also be included. All included studies will be in English and will have been peer reviewed. Excluded studies will include those that are quantitative, systematic reviews, protocols, opinion pieces, grey literature and editorials.
Context: eligible studies must focus on experiences specific to prostate cancer care within any healthcare settings/services.
Outcomes/evaluation: studies must report on experiences, perceptions, views, or meanings related to accessing services.
All studies will be imported into Rayyan, a reference management system, to remove duplicates as well as studies not suitable for inclusion. Two reviewers will independently screen the titles and abstracts of all the articles generated from the database search to identify studies suitable for inclusion. A third reviewer will be consulted to screen the titles and abstracts if consensus cannot be reached. This ensures rigor during the screening phase as well as transparency during the decision-making process (Soilemezi and Linceviciute 2018).
Full text articles will be independently screened by two reviewers to make final decisions around the inclusion of these however should there be any disagreement or uncertainty regarding the inclusion or exclusion of a study, the third reviewer will be consulted regarding the final decision of the inclusion of these full text articles.
1.2.4 Quality appraisal
The quality of the studies included in this review will be evaluated using the Critical Appraisal Skills Programme (CASP) checklist for qualitative research ( Critical Appraisal Skills Programme 2023). This tool contains ten questions that guide reviewers in considering three key aspects: the validity of the findings, the nature of the results, and the usefulness of those results in a local context. The CASP checklist is concise and supports clear comparison of methodological quality across studies (Chenail 2011; Nadelson and Nadelson 2014). All included studies will be independently assessed by two reviewers, and any disagreements will be resolved through discussion with a third reviewer.
1.2.5 Data extraction and synthesis
A summary table outlining the key descriptive characteristics of the included studies will be created. Data will be extracted on the authors, year of publication, study setting, methodology, participant characteristics, data collection techniques, analytical approach and key findings (Connor et al. 2020).
All findings from the studies selected for synthesis will be imported into NVivo Version 15 (NVivo qualitative data analysis software [program] 2015). NVivo offers several advantages for qualitative work, particularly in terms of improving efficiency and enhancing transparency in the analytic process (Hoover and Koerber 2009). The data will then be analysed using the three-step approach to thematic synthesis described by Thomas and Harden (2008). This involves: (1) inductive line-by-line coding, (2) the development of initial descriptive themes, and (3) the generation of higher-level analytical themes. Thematic synthesis is a widely used and accessible method that supports the production of findings with direct implications for policy and intervention development (Barnett-Page and Thomas 2009; Flemming et al. 2019). To ensure rigour and strengthen trustworthiness, a reflexive analytical stance will be adopted. Reflexivity is a key component of qualitative research, promoting transparency by encouraging researchers to critically examine their own assumptions, biases, preferences and their relationship to the study (Korstjens and Moser 2018). It also requires consideration of the dynamic influence between researchers and participants throughout the research process (Finlay 2002). Reflexivity will be supported through maintaining a reflective diary and through regular discussion with supervisors and independent reviewers.
1.2.6 Assessing the confidence of the QES findings
Allowing researchers and decision makers determine the certainty of evidence in QES can support the judgement of how closely a review finding is likely to represent the phenomenon of interest. The GRADE CER-Qual approach will be used to systematically evaluate certainty of the findings of this review, supporting more transparent and trustworthy decision making to inform future components of this research project (Lewin et al. 2018).
1.2.7 Dissemination
On completion of the analysis, it is anticipated that the findings will be disseminated to men with prostate cancer through knowledge, exchange and dissemination events and will also be submitted for publication in a peer-reviewed journal. The findings will be subject to consultation with a Cancer Services Public and Patient Involvement (PPI) group in the MidWest of Ireland to ensure their relevance and alignment with stakeholder perspectives to inform the subsequent phases of the work.
1.3 Discussion
While the experiences of older men with prostate cancer have been explored extensively, their experiences of accessing prostate cancer services specifically are yet to be explored. This QES will systematically gather, evaluate, and integrate findings from existing research, in addition to contributing to the empirical evidence base with regards to the lived experiences of older men, their family members/caregivers and healthcare professionals in accessing prostate cancer services. The synthesis of the experiences of multiple stakeholders will contribute to the clinical and scientific understanding of prostate cancer service accessibility, along with identifying gaps in the existing evidence base and areas for future research. The findings of this review will inform both clinicians, researchers and policy makers involved in prostate cancer care, and future stages of this body of work.
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Williams S, Peters N, Dillon S et al. Experiences of older men with prostate cancer in accessing health services: a protocol for a qualitative evidence synthesis [version 1; peer review: awaiting peer review]. HRB Open Res 2026, 9:49 (https://doi.org/10.12688/hrbopenres.14415.1)
NOTE: If applicable, it is important to ensure the information in square brackets after the title is included in all citations of this article.
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