"I just felt that everything came tumbling down around me"-Barriers in cancer care for patients with severe mental illness: A qualitative study

BACKGROUND: Patients with severe mental illness experience serious inequity when facing cancer treatment. They are less likely to be referred for cancer treatment following recommended guidelines and have poorer cancer survival than patients without mental illness. Relevant specialties such as psychiatry and general practice are rarely involved, and the patient perspective is rarely represented in research in the field. The present study investigated how patients with severe mental illness experience barriers to and facilitators of patient-centred cancer treatment and care.

METHODS: In this qualitative case study, field observations, semi-structured interviews, and patient file analysis were performed with five patients with cancer in an adult psychiatric setting, included through purposeful sampling.

RESULTS: Our analysis showed one major theme, "Complexity on many levels", and four subthemes: "How the mental illness is affected by the cancer trajectory", "The complexity of patient vulnerability", "Fragmented healthcare system and lack of structure", and "The role of the relationship between patient and health professional." Barriers included the cancer trajectory leading to severe worsening of the mental illness, as well as fragmentation of the healthcare system and a lack of a systematic approach to the patient group. Facilitators included the health professionals acknowledging the patient's own resources and approaching the patient as a person rather than a disease.

CONCLUSION: This study highlights critical focal points to improve care for patients with cancer who also struggle with severe mental illness. By addressing these target areas, healthcare providers can better tailor their approach to meet the unique needs of this population.