Barriers to cancer care for people with significant mental health difficulties: What healthcare staff say?

Abstract

Objectives: Despite similar rates in cancer morbidity, patients with comorbid significant mental health difficulties (SMHD) experience higher mortality rates. This population has largely been neglected in cancer care research. Little is known about how to improve cancer outcomes for patients with SMHD. The aim of this research is to explore the views of healthcare professionals concerning the provision of cancer care to individuals with SMHD in an Irish context.Methods: Semi-structured interviews were conducted with healthcare professionals (n = 28) providing care to people with SMHD and cancer. This included oncology and psychiatry consultants (n = 10); clinical nurse specialists (n = 8); clinical psychologists (n = 6); and medical social workers (n = 4). Data were analysed using thematic analysis.Results: Four overarching themes were generated from the data highlighting the challenges associated with healthcare provision for this cohort. The themes were:Fragmentation of Care, Healthcare Providers' Understanding of SMHD, Complex Nature of Presentation, and Specialised Care Needs. Conclusions:The findings contribute to advancing our understanding of cancer care provision for patients with SMHD. They identify important barriers and facilitators to cancer care provision for this population from the perspective of healthcare professionals in Ireland. These findings will help to shape future research and contribute to improving the quality-of-care for people with SMHD and cancer. K E Y W O R D Scancer, cancer care, health inequities, medical oncology, mental health, mental illness, oncology, psychiatry, psycho-oncology, quality of health care 1 | BACKGROUND Individuals with significant mental health difficulties (SMHD), including schizophrenia, bipolar disorder and major depressive disorder, experience additional challenges in receipt of healthcare. [1][2][3] Irrespective of factors such as individuals' lifestyle and the risks that long-term use of psychiatric medications pose to health, 4 individuals with SMHD have poorer physical health compared to the general population and experience higher mortality rates. 5,6 Indeed, almost half of all chronic medical conditions go undiagnosed in individuals with SMHD. [7][8][9] This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.

Cancer incidence and stage at diagnosis among people with recent‐onset psychotic disorders: A retrospective cohort study using health administrative data from Ontario, Canada

“…We observed higher odds of advanced stage at diagnosis in people with NAPD, which is consistent with the findings of prior meta‐analyses of people with serious mental illnesses in countries with universal healthcare 6 . This finding may be indicative of a diagnostic delay due to disparities in access to healthcare services, stigma, or differences in healthcare‐seeking behavior 6,26 . Previous studies have shown that people with schizophrenia are less likely to participate in screening for breast, cervical, prostate, and colorectal cancer 27–29 .…”

“…The elevated incidence of cancer at several sites among people with non‐affective psychotic disorders should underline the importance of collaboration across disciplines and provision of cohesive psychiatric care to meet the specialized needs of patients with psychotic disorders 26,39,40 . In addition, the greater odds of having more advanced stage cancer at diagnosis among people with psychotic disorders is indicative of a diagnostic delay and differences in accessing healthcare.…”

“…6 This finding may be indicative of a diagnostic delay due to disparities in access to healthcare services, stigma, or differences in healthcare-seeking behavior. 6,26 Previous studies have shown that people with schizophrenia are less likely to participate in screening for breast, cervical, prostate, and colorectal cancer. [27][28][29] Furthermore, people with psychotic disorders have higher prevalence of many chronic health conditions, which may be dismissed or misattributed to the psychiatric diagnosis, known as diagnostic overshadowing, 30 and thereby reduce the likelihood of receiving specialized services for these conditions.…”

Disparities and inequalities in cancer care and outcomes in patients with severe mental illness: Call to action

“…Stigma, in terms of both self-and social stigma, is one of the main topics on which the psychiatric literature has concentrated attention over the last 40 years. [19][20][21] In this issue, D'Alton et al 22 explore the opinions of health care cancer professionals, including oncology and psychiatry consultants, nurses, psychologists and social workers. The study found that there were barriers to cancer care provision for patients affected by SMI: fragmentation of care; healthcare providers' understanding of SMI; complex nature of presentation; and specialized care needs.…”

“…Stigma, in terms of both self‐ and social stigma, is one of the main topics on which the psychiatric literature has concentrated attention over the last 40 years 19‐21 . In this issue, D’Alton et al 22 . explore the opinions of health care cancer professionals, including oncology and psychiatry consultants, nurses, psychologists and social workers.…”