Lived experiences of well-intended but hurtful cancer communication: Insights for death literacy.

Background: Living with cancer can position individuals in a liminal space marked by uncertainty, proximity to death, and experiences of grief. In everyday interactions, attempts at comfort may become hurtful when they constrain acknowledgment of mortality or emotional complexity. This study draws on Allan Kellehear's public health palliative care approach (2013) to examine such interactions through the lens of death literacy. Objectives: To explore how people living with cancer experience well-intended but hurtful communication, and to interpret these interactions in relation to death literacy and community capacity to engage with illness and mortality. Design: The study is based on a qualitative analysis of responses to an open-ended survey item. Methods: Belgian adults diagnosed with cancer within the previous three years (N = 733), all of whom had received treatment beyond surgery, completed an online psychosocial survey. An open-ended item invited participants to describe potentially well-intended but hurtful communication. 710 responses were analyzed inductively and subsequently interpreted through a death literacy and public health palliative care lens. Results: Participants described recurring communicative patterns clustering into five themes: existential minimization and denial; normative disciplining of illness; experiential invalidation; relational withdrawal and narrative displacement. Across themes, communication was shaped not only by content but by timing, relational positioning, and emotional attunement. Comments about death, recovery, or coping were experienced as harmful when misaligned with participants' illness trajectory or emotional state. Conclusion: Interpreted as socially situated signals rather than direct measures of death literacy, these findings suggest that everyday cancer communication may reflect constraints in community-level communicative resources for remaining present with uncertainty and implicit mortality. Strengthening community capacity through public health palliative care initiatives - such as compassionate communities approaches and accessible psychosocial support infrastructures (e.g., walk-in centers) - may broaden the socially available repertoires for attuned support in everyday life.