ArticleBMJ open2019
Multilevel model of stigma and barriers to cancer palliative care in India: a qualitative study.
Article in BMJ open, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. An erratum has been issued. Cited by 20 papers, 1 of them a synthesis that pooled it.
What it found
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Who cites it
20 citing papers in PubMed, 1 synthesis or guideline pooled it, 45 citations in OpenAlex.
- Pooled it
- From Mechanisms to Manifestations: A Scoping Review Exploring Cancer-Related Discrimination.Psycho-oncology · 2026Article
- Implementation, Processes and Outcomes of Advance Care Planning: A Culturally and Contextually Appropriate Programme Theory Developed in Chinese Long-Term Care Facilities.Health expectations : an international journal of public participation in health care and health policy · 2025Article
- Clinicians' lived experience of concealing bad news: a qualitative study in Malaysia and the UK.BMJ open · 2025Article
- Promoting interdisciplinarity and the timely integration of palliative care through the development and implementation of a blended learning elective for medical students.GMS journal for medical education · 2025Article
- Access to palliative care in India: situational analysis and modeling of access from public healthcare centers.Ecancermedicalscience · 2025Article
- A "What Matters Most" approach to investigating intersectional stigma toward HIV and cancer in Hanoi, Vietnam.Journal of the National Cancer Institute. Monographs · 2024Article
- Palliative and end-of-life care initiatives for people dying from cancer in India: a narrative review.Ecancermedicalscience · 2024Review
- Patient and caregiver perspectives of select non-communicable diseases in India: A scoping review.PloS one · 2024Article
- Myths, beliefs, and attitude toward cancer among the family caregivers of cancer patients: A community-based, mixed-method study in rural Tamil Nadu.Journal of family medicine and primary care · 2023Article
- Expectations and barriers to the utilization of specialist palliative care services among persons living with cancer in Ghana: an exploratory qualitative study.Palliative care and social practice · 2023Article
- The roles and experiences of informal carers providing care to people with advanced cancer in Africa-A systematic review and critical interpretive analysis.PLOS global public health · 2023Article
- Perspectives, perceived self-efficacy, and preparedness of newly qualified physicians' in practising palliative care-a qualitative study.BMC palliative care · 2022Article
- Health literacy in communication, decision-making and outcomes among cancer patients, their families and clinicians in India: A multicentre cross-sectional qualitative study.Psycho-oncology · 2022Article
- Stigma about palliative care: origins and solutions.Ecancermedicalscience · 2022Article
- Prognostic disclosure in cancer care: a systematic literature review.Palliative care and social practice · 2022Review
- Building evidence and capacity in global health palliative care.Ecancermedicalscience · 2022Article
- Article
- The Question-prompt list (QPL): Why it is needed in the Indian oncology setting?Cancer reports (Hoboken, N.J.) · 2021Review
- Impact of stigma and stigma-focused interventions on screening and treatment outcomes in cancer patients.Ecancermedicalscience · 2021Review
Corrections and comments
- Erratum issuedCorrection:2019
Authors and funding
3 authors at 3 institutions in 3 countries.
Funding
Abstract
introductionPalliative care coverage and opioid consumption in India are relatively low compared with global data. The literature suggests commonplace concealment and collusion in withholding information, but these hypotheses lack evidence.
objectivesThis study aimed to develop an explanatory evidence-based model of stigma, communication and access to cancer palliative care in India that can be used to develop, test and implement future interventions.
designThis cross-sectional qualitative study sampled advanced cancer patients (n=10), their family caregivers (n=10) and oncologists (n=10). Grounded theory procedures were utilised to analyse transcripts, and a theoretical model generated.
settingA tertiary teaching hospital in South India.
resultsThe model explains how stigma associated with communicating a diagnosis of advanced cancer is enacted by treating oncologists, family members and community. This leads to patient expectations of cure and futile treatment uptake. Patients commonly only present needs with respect to pain, not within psychological, social or spiritual domains, likely due to the lack of patients' insight into their diagnosis and prognosis. As a result of oncologists' and families' unwillingness to disclose the prognosis, and patient focus on pain due to their lack of insight, palliative care clinicians view their services as under-utilised, and patients perceive palliative care as a pain management service that is not 'different' from other clinical services. Advanced care needs and purchase of futile treatments lead to lost employment among families, increased family debt and high care costs, which are rarely disclosed due to their unwillingness to discuss their needs.
conclusionOur novel theoretical model is an essential first step to ensure that complex interventions are plausible, with mechanisms of action that address the needs of relevant stakeholders. A family-centred approach with an oncology workforce skilled in communication and an enabled patient population could increase access to palliative care, and improved outcomes may be attainable.
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