Key principles for clinical specialisms
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Last reviewed: 20/01/2026
Key principles for clinical specialisms
Uncertainty is an inherent part of life, but it can be particularly stressful when managing long-term conditions. For people with neurodiversity, such as autism or ADHD, uncertainty can stem from heterogeneous mental health levels.
Neurodiversity and cancer
A cancer diagnosis for any individual is often a life-changing experience. For neurodivergent individuals, this experience can be more challenging.
This is why nursing staff need to consider the holistic individual experiences of neurodivergent people affected by cancer. Key questions you can answer to help include discussing:
- who the care team is and their individual roles
- who can attend appointments with them
- what adjustments are available to support the neurodivergent person and their specific needs
- what will support look like if a neurodivergent person is anxious or concerned about their treatment
- what resources are available to help patients understand, for example, Macmillan Cancer Support’s neurodiversity resource
- how can you share information about the person affected by cancer with the nursing team
- examples of any previous care provided to those who are neurodivergent and living with cancer
- how to make the nursing team aware if the neurodivergent person someone is feeling uncomfortable throughout any part of their treatment, including offering key contacts and numbers. Additionally, an alternative to phone calls may need to be offered routinely, depending on individual needs
- if the neurodivergent person living with cancer is non-speaking or non-speaking at times, to support their use of alternative augmentative communication. For example, communication apps, photos and symbols (if they use them) or encouraging non-speaking forms of communication, for example, photos and symbols.
When thinking about the neurodivergent person’s experience from diagnosis to living with or beyond cancer, the overall experience needs to be considered by nursing staff, including what adjustments can be made to support those affected.
This needs to be discussed with the patient at the beginning and throughout their experience of cancer – needs can change from day-to-day and will likely change throughout treatment.
Autism and cancer
Autistic people often encounter multiple, overlapping barriers when accessing cancer care, and these challenges rarely exist in isolation. Instead, they accumulate across the care pathway, compounding disadvantage and widening health inequalities.
From difficulties in communication and sensory environments, to fragmented pathways and limited professional awareness, each barrier adds weight to the next. A barrier that may seem minor to others can become a significant source of distress for autistic individuals, leading to delays in diagnosis, reduced engagement with treatment and poorer outcomes.
This is why understanding cumulative exposure to these barriers is critical: it highlights not only the need for individual adjustments, but also systemic change to ensure that cancer services are equitable, accessible and responsive to the needs of autistic individuals.
Below are some suggestions from Dr. Char Goodwin, lead researcher for the Autistic Experiences of Breast Cancer research project. The three-year project, funded by Breast Cancer Now, explores the cumulative effects of autism-specific barriers to health care in relation to cancer care, directly from autistic people themselves.
Infographic was created by Dr Char Goodwin for the Autistic Experiences of Breast Cancer research project and featured in the Autistic and living with cancer: What you need to know – Autistic and Living the Dream blog co-written with Katie Munday.
- Awareness of autism at pre diagnosis (orange): Recognition of autistic needs must begin before diagnosis: accessing cancer screening and when a patient has been recalled after screening or is experiencing symptoms that require investigation. Many GP surgeries rely on telephone booking systems, yet using the phone can be very difficult or even impossible for some autistic individuals.
- Impact of multiple appointments (light blue): Cancer care often involves numerous tests, procedures and treatments. Planning and preparation for these appointments can be challenging, and delays or cancellations may cause significant distress. One poor experience can influence how an autistic patient engages with future treatment and care plans.
- Communication formats and paperwork (dark blue): Appointments generate paperwork and often require navigating electronic systems. It is essential to identify the most accessible format for each patient, whether that is paper, digital or alternative resources, depending on someone’s preference.
- Sensory sensitivities (green): GP surgeries and hospitals can be noisy, brightly lit and filled with unfamiliar smells. Cancer diagnosis and treatment often involve multiple examinations, and some autistic people may find being touched particularly difficult. This can complicate autonomy and consent, making it important to consider alternative examination approaches. It may also involve families or carers to support diagnostic requirements.
- Continuity of care across professionals (yellow): Cancer treatment involves multiple health care professionals. It is important to make sure that those providing care are aware of the autistic patient’s needs and offer consistent support and continuity throughout their treatment experience.
- Supporting patients through treatment and side effects (pink): Cancer treatments such as surgery, chemotherapy, radiotherapy, targeted therapy and hormone/endocrine therapy can cause significant side effects. Understanding what these experiences are like for autistic patients, and how side effects affect daily life, is crucial when it comes to providing effective support.
- Hospitalisation during side effects (purple arrow): When side effects require hospitalisation, autistic patients may face additional challenges in navigating care while feeling acutely unwell. This cumulative burden must be recognised and addressed in service planning.
Support for those living with and beyond cancer who are neurodivergent
Macmillan provides a range of generic resources that can be accessed by patients to support their diagnosis, when having treatment and living beyond cancer. Although not specifically designed to support neurodivergent people, the advice in these resources are transferable. They include access to:
- An online community for people to connect and share their experiences.
- Audiobooks – these are available on prevention, understanding certain cancers, understanding treatments and life beyond cancer.
- Easy-read booklets – these are also available to support understanding in a format relevant to the patient and their needs.
Although these resources were not created by individuals with lived experience of neurodivergence, they provide information that may be useful.. Their purpose is to provide practical guidance, promote understanding and help reduce barriers to care. By offering adaptable approaches, these resources can be applied to meet the diverse needs of neurodivergent individuals, ensuring services are more accessible, equitable and responsive.
Transparency statement
Here at the RCN, we recognise there are currently limited cancer-specific resources and patient leaflets tailored for people who are neurodivergent. As such, the information presented here is grounded in best practice and informed by emerging research in the field.
To ensure accuracy, relevance, and sensitivity, this work has been developed in collaboration with Dr Char Goodwin, whose expertise has guided the adaptation of these materials to improve the support offered to neurodivergent individuals navigating cancer care and reviewed by Katie Munday, whose research explored the experiences of cancer services of Disabled and Neurodivergent people. This will be updated as new research and evidence-based materials emerge in the future.
Below are some suggestions from Katie Munday, community researcher with Help & Care cancer service projects. The ‘What I Would Like to Say…’ project explored disabled and/ or neurodivergent people’s experiences of cancer services, to support the development of recommendations aimed towards improving the accessibility of these services. These recommendations were then solidified in the second phase which entitled, ‘What I Would Like to Change’.
It uses findings from the previous projects to make recommendations for improving the accessibility of cancer services.
Katie also works on the Trans Aware Cancer Care project. Its second phase has linked closely with the earlier projects to support the Southampton and Salisbury Breast Screening Service at University Hospital Southampton. These projects were funded and supported by Wessex Cancer Alliance, Macmillan Cancer Support and the National Institute for Health and Social Care.
From the findings of these projects, several key recommendations emerged to improve accessibility and patient experience:
- Compassion and sensitivity and the importance of using a person-centred and empathetic approach. This can contribute towards mitigating some of the anxiety and isolation felt by disabled communities when navigating cancer services.
- Effective communication to provide disabled patients with clear and accessible information to support informed decision-making regarding matters of their own cancer care.
- Making accessibility a priority through actively supporting and meeting disabled patients’ individual access needs to remove barriers to health care and build more inclusive services.
- Supporting patients’ understanding through improved accessibility to resources, including plain language communication. Communicate clearly and effectively while checking understanding.
- Taking a holistic approach through individualised care, supporting patients’ emotional wellbeing and extending that emotional care to family members.
- Ensure the accessibility of practice. Improve access to health care settings, screening, and appointments. Accessibility adjustments to make services accessible to everyone.
- Expand knowledge of disabled experiences through working through assumptions and stereotypes, appreciate and act on national disability initiatives and take a more empathetic approach.
Neurodiversity and diabetes
ADHD and diabetes
Overall, patients with comorbid ADHD (ADHD that occurs alongside another mental health, neurodevelopmental, or medical condition) tended to have worse glycaemic control. On the other hand, those with ASD did not show this difference when compared to patients with type 1 diabetes alone.
Strategies that can be applied include:
- Consistent routines, such as regular mealtimes and glucose monitoring, can help stabilise blood sugar levels. Developing a structured daily schedule can also make managing insulin injections or medication easier. Structured environments and clear expectations can enhance focus and reduce stress.
- Self-monitoring techniques, such as keeping a journal or using apps, can help track symptoms, triggers, and responses to different strategies. Feedback from these tools can guide behaviour adjustments.
- Setting realistic goals for personal development or daily tasks can help individuals with neurodiversity build skills and achieve a sense of accomplishment. Using visual aids or checklists can support planning and execution.
- Developing coping strategies, such as mindfulness or sensory management techniques, can help manage stress and sensory overload. Building resilience involves recognising and leveraging personal strengths and finding supportive communities.
- Increasing awareness about neurodiversity can foster a better understanding of someone’s condition and how it impacts daily life. Education can also promote self-advocacy and help navigate social or occupational environments.
- Engaging with support groups or online communities. Connecting with others who share similar experiences can offer validation and practical support. Advocating for inclusive environments and building supportive relationships can improve social integration.
Changing behaviour in diabetes care can be difficult because of several factors, such as:
- the long-term nature of the disease
- the requirement for continuous self-management
- the intricate interactions among psychological, social and physiological aspects.
By approaching behaviour change in a systematic and supportive way, individuals with neurodiversity and diabetes can more effectively manage their conditions, decrease uncertainty and improve their overall quality of life.
Dyscalculia and diabetes
Managing dyscalculia alongside diabetes can be particularly challenging, especially when tasks involve mathematical calculations, such as determining insulin doses, counting carbohydrates, and using insulin pumps. However, several strategies can help simplify these processes:
- For insulin injections, using fixed doses can reduce the need for mental arithmetic. This works well for people who eat similar meals every day. For example, if someone always has breakfast with 40g of carbohydrates, and their insulin-to-carb ratio is 1 unit per 10g, they could consistently take 4 units of insulin every morning.
- Diabetes-specific apps can further help with these calculations by allowing carbohydrate ratios and correction factors to be programmed in advance. The app will calculate the correct insulin dose based on what someone eats, so they don’t have to do the maths themselves. Many apps also track how much insulin is still active in someone’s body, helping to avoid taking too much by accident.
- For those using insulin pumps, setting up personalised insulin-to-carbohydrate ratios and correction factors in advance, like diabetes apps, can minimise the need for on-the-spot calculations. People using hybrid closed-loop systems (also known as “artificial pancreas” systems) who eat similar meals can sometimes use fixed doses, too. The system’s algorithm can then fine-tune any small over- or underdoses.
- Visual aids can make managing diabetes even easier. Things like colour-coded charts or cheat sheets with photos of common meals and their carb content can save time and reduce errors. These quick-reference tools help people find the right dose without needing to work it out every time.
Regular consultations with a diabetes nurse or dietitian can ensure that these strategies are tailored to the individual's needs, making diabetes management more accessible and less stressful for those with dyscalculia.
Sick day rules and complications
Managing complications and sick day rules for individuals with neurodiversity requires a thoughtful, flexible approach that respects their unique needs and capabilities.
They may struggle with executive functioning, making it harder to follow complex medical guidelines or recognise early signs of complications. Due to someone’s unique challenges in self-care, it can be key to create a 'sick day rule' with the individual (if possible) and their caregivers. It should outline what to do when unwell, who to contact, and how to adjust the insulin regimen.
This involves creating a personalised plan that accommodates the patient's cognitive and sensory preferences, ensuring clear and simple communication of instructions. This personalised approach helps prevent complications and ensures effective management of both diabetes and neurodiversity conditions during illness, reducing stress, and promoting overall wellbeing.
Information processing and resource formatting
There are certain tasks that those who are neurodivergent may find more challenging about information processing, formatting and communication. In addition to difficulty focusing, these include:
- Changes to routine - reparation and preplanning of appointments, clear aims and objectives, visual planner.
- Taking things literally - sharing precise, clear information and avoiding ambiguity.
- Challenges with social interaction - eye contact and body language. Consider virtual communication where appropriate.
- Issues around sensory-touch and spatial awareness - for example, when demonstrating sensor application, consider social stories
How to offer additional support:
- Visual aids: Use graphs, charts, and illustrations to present information clearly. These can help break down complex topics into manageable chunks, especially for people with ADHD. Visual tools often improve understanding, memory, and engagement. Avoid overly complex or cluttered visuals, as these can be confusing and reduce retention.
- Active listening: Be aware that some individuals are sensitive to body language and facial expressions, so listening attentively and responding thoughtfully is important.
- Speech delivery: Pay attention to how you speak — your pace, tone, and pauses between sentences can all affect how well someone processes what you're saying.
- Repetition: It can help to repeat key points and review what has been discussed to check understanding.
- Step-by-step demonstration: Visually showing a task in small steps can aid learning. In some cases, social stories (using real photos of the individual and those involved in care) can help put the task into context.
- Processing time: Allow individuals time to think about and process information and encourage them to talk to someone they trust if they have questions.
- Written prompts: Encourage individuals to write down questions or use self-advocacy cards to help them express their needs or concerns.
- Preferred communication: Many neurodivergent people prefer online or written communication, as it avoids eye contact and non-verbal cues they may find difficult. Keep written information clear, factual, and free from ambiguity or overload.
- Talking mats: These are useful visual tools that can support individuals who struggle with verbal communication.
- Clear goals: Setting simple objectives and clear aims can help with focus and engagement, especially as planning and organisation can be more challenging.
Sick day rules and complications
They may struggle with executive functioning, making it harder to follow complex medical guidelines or recognise early signs of complications. Due to someone’s unique challenges in self-care, it can be key to create a 'sick day rule' with the individual (if possible) and their caregivers. It should outline what to do when unwell, who to contact, and how to adjust the insulin regimen.
This involves creating a personalised plan that accommodates the patient's cognitive and sensory preferences, ensuring clear and simple communication of instructions. This personalised approach helps prevent complications and ensures effective management of both diabetes and neurodiversity conditions during illness, reducing stress, and promoting overall wellbeing.
Information processing and resource formatting
There are certain tasks that those who are neurodivergent may find more challenging about information processing, formatting and communication. In addition to difficulty focusing, these include:
- Changes to routine - reparation and preplanning of appointments, clear aims and objectives, visual planner.
- Taking things literally - sharing precise, clear information and avoiding ambiguity.
- Challenges with social interaction - eye contact and body language. Consider virtual communication where appropriate.
- Issues around sensory-touch and spatial awareness - for example, when demonstrating sensor application, consider social stories
How to offer additional support:
- Visual aids: Use graphs, charts, and illustrations to present information clearly. These can help break down complex topics into manageable chunks, especially for people with ADHD. Visual tools often improve understanding, memory, and engagement. Avoid overly complex or cluttered visuals, as these can be confusing and reduce retention.
- Active listening: Be aware that some individuals are sensitive to body language and facial expressions, so listening attentively and responding thoughtfully is important.
- Speech delivery: Pay attention to how you speak — your pace, tone, and pauses between sentences can all affect how well someone processes what you're saying.
- Repetition: It can help to repeat key points and review what has been discussed to check understanding.
- Step-by-step demonstration: Visually showing a task in small steps can aid learning. In some cases, social stories (using real photos of the individual and those involved in care) can help put the task into context.
- Processing time: Allow individuals time to think about and process information and encourage them to talk to someone they trust if they have questions.
- Written prompts: Encourage individuals to write down questions or use self-advocacy cards to help them express their needs or concerns.
- Preferred communication: Many neurodivergent people prefer online or written communication, as it avoids eye contact and non-verbal cues they may find difficult. Keep written information clear, factual, and free from ambiguity or overload.
- Talking mats: These are useful visual tools that can support individuals who struggle with verbal communication.
- Clear goals: Setting simple objectives and clear aims can help with focus and engagement, especially as planning and organisation can be more challenging.
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