Psychosocial Outcomes and Experiences of those at Risk of Minoritisation in the Irish Adult Cancer Population

As cancer incidence rises globally, more people are living with and beyond a diagnosis. However, cancer often has a significant psychosocial impact. Individuals at risk of minoritisation are more likely to experience adverse psychosocial outcomes and challenges throughout the cancer journey. Clinical psychologists working in psycho-oncology play a vital role in supporting patients through such adversity. Yet, those at risk of minoritisation are also more likely to be underserved in healthcare, facing barriers to access, recognition, and appropriate care. In Ireland, there has been limited research into the psychosocial needs, outcomes, and experiences of people at risk of minoritisation in cancer care. This thesis aimed to address this gap in order to inform clinical psychology practice in Irish oncology services. Much existing research conceptualises minoritisation as static, linked to binary social identities. This approach has failed to explain why disparities in cancer care persist. In contrast, intersectionality theory views minoritisation as a dynamic, relational, and context-specific process shaped by overlapping structures of power and inequality. Guided by this framework, the thesis investigated the psychosocial experiences of groups at risk of being underserved in the Irish adult cancer population through two studies. Study I was a rapid review of 105 papers drawn from a larger dataset. It explored how existing literature addresses the psychosocial impact of cancer on underserved groups. Study II was a secondary analysis of qualitative interview data (18 participants), including people with lived experience of cancer, community workers, and oncology clinicians. It examined first-hand perspectives on psychosocial care and minoritisation in the Irish context. Findings from both studies were synthesised and considered in relation to existing research, policy, and clinical practice. Results showed that many individuals at risk of minoritisation face poorer psychosocial outcomes and experiences across the cancer continuum. However, the research also found that not all individuals within identified groups experience minoritisation in the same way. Conversely, some people outside traditionally defined groups may also be underserved. This underscores the importance of recognising minoritisation as a process rather than a fixed status. The thesis identified cross-cutting factors contributing to being underserved in healthcare, regardless of group identity. These include low health literacy, limited self-efficacy, social isolation, and language barriers. A recurring theme across both studies was the critical role of the patient-practitioner relationship in shaping psychosocial outcomes. Systemic issues can restrict relational care and limit the capacity to respond to complexity. Importantly, the study contributes novel insights into the psychosocial experiences of specific groups underrepresented in prior research, particularly Irish Travellers. This makes it one of the few academic works to explore psychosocial cancer care experiences among minoritised populations in Ireland. Clinical implications include the need for culturally informed care without assumptions, standard psychosocial screening that considers minoritisation-related risk factors, and systemic support for staff wellbeing. This thesis offers evidence to guide more equitable, context-sensitive psychological support in Irish oncology.