Healthcare Providers' Attitudes Toward Oncology Patients With Mental Disorders

Official title

Healthcare Providers' Attitudes Toward Oncology Patients With Mental Disorders: A Multicentre Mixed-Method Design Study

Overview

ONCO-MinD is a multicentre, cross-sectional, non-interventional mixed-method study aimed at investigating healthcare providers' attitudes towards oncology patients with mental disorders in Italian cancer centres. The study will assess levels of mental health-related stigma among healthcare professionals and explore factors associated with these attitudes, including professional background, clinical setting, experience, and previous exposure to mental health conditions. Quantitative survey data collected using the Italian version of the Opening Minds Scale for Health Care Providers (OMS-HC) will be integrated with qualitative findings from semi-structured interviews to provide a comprehensive understanding of how stigma may influence clinical relationships, decision-making processes, and equity of cancer care.

Detailed description

Background People living with mental disorders experience substantial health inequalities, including reduced life expectancy and higher mortality rates from physical illnesses, including cancer. In oncology settings, evidence suggests that patients with mental disorders are less likely to receive guideline-concordant treatment, are more likely to experience delays in diagnosis, and often have lower treatment adherence. Multiple factors contribute to these disparities, including patient-related, organisational, and healthcare provider-related determinants.

Among healthcare provider-related factors, stigma towards people with mental disorders may influence communication, therapeutic relationships, treatment decisions, and access to appropriate care. One particularly relevant mechanism is diagnostic overshadowing, whereby physical symptoms may be misattributed to a patient's psychiatric condition, potentially resulting in delayed diagnosis and suboptimal management. Despite growing recognition of these issues, limited evidence is available regarding stigma among oncology healthcare professionals, particularly within the Italian context.

Study Objectives The primary objective is to evaluate the level of stigma among healthcare professionals towards oncology patients with mental disorders.

Secondary objectives are:

To identify associations between stigma levels and individual or professional characteristics, including years of experience, professional role, clinical area, education, and previous personal or professional exposure to mental health conditions.

To explore healthcare professionals' experiences, perceptions, and attitudes towards caring for oncology patients with mental disorders.

To investigate potential barriers affecting clinical interactions and care pathways, including the role of diagnostic overshadowing and other stigma-related mechanisms.

Study Design

ONCO-MinD is a multicentre, observational, cross-sectional, non-interventional study using a sequential explanatory mixed-method design. The study consists of two consecutive and integrated phases:

Phase 1: Quantitative Component

Eligible healthcare professionals working in participating oncology centres will be invited to complete an anonymous electronic questionnaire through a secure REDCap platform. The questionnaire includes:

Socio-demographic and professional characteristics. The Italian version of the Opening Minds Scale for Health Care Providers (OMS-HC), a validated instrument measuring stigma towards individuals with mental disorders.

The survey will remain available for approximately three months. Phase 2: Qualitative Component Following analysis of the quantitative findings, a purposive sample of healthcare professionals will be invited to participate in semi-structured interviews. Interviews will explore experiences, perceptions, barriers, facilitators, and the impact of mental health conditions on oncology care and clinical decision-making. Interviews will be audio-recorded, transcribed, anonymised, and analysed using thematic analysis.

Integration of Findings Quantitative and qualitative results will be integrated through a mixed-method approach using joint displays and meta-inferences. This strategy will allow a deeper understanding of the factors underlying stigma and its potential influence on cancer care delivery.

Study Population

The study population includes healthcare professionals directly involved in oncology care at participating centres, including:

Physicians Nurses Psychologists Radiation therapy technologists Healthcare assistants

All eligible professionals working within participating institutions will be invited to participate.

Participating Centres

Veneto Institute of Oncology (IOV-IRCCS), Padua, Italy Centro di Riferimento Oncologico (CRO-IRCCS), Aviano, Italy Istituto Tumori "Giovanni Paolo II" (IRCCS), Bari, Italy

Expected Impact The study is expected to generate evidence on mental health-related stigma in oncology settings and to identify educational and organisational strategies that may improve equity, inclusiveness, and quality of cancer care for patients living with mental disorders.

Interventions

• Other OMS-HC Questionnaire and Semi-Structured Interviews
  Participants complete an anonymous questionnaire and, where selected, participate in a semi-structured interview for research data collection purposes. No clinical or behavioural intervention is administered.

Primary outcome measures

• Mental health-related stigma among oncology healthcare professionals [Time frame: At survey completion (up to 3 months)]

Secondary outcome measures (3)

• Factors Associated With OMS-HC Scores [Time frame: Up to 3 months]
• Healthcare professionals' experiences and perceptions regarding oncology patients with mental disorders [Time frame: Up to 9 months]
• Integrated mixed-method understanding of stigma towards oncology patients with mental disorders [Time frame: Up to 13 months]

Eligibility criteria

Inclusion criteria

• Healthcare professionals working in participating oncology centres.
• Physicians, nurses, psychologists, radiation therapy technologists, and healthcare assistants.
• Direct involvement in the clinical care of oncology patients.
• Employed at one of the participating study sites at the time of enrolment.
• Able to understand the study information and provide informed consent.
• Willing to participate in the study.

For the qualitative phase, a purposive sample of participants will be selected from survey respondents who agree to be contacted for a semi-structured interview.

Exclusion criteria

• Refusal to participate or failure to provide informed consent.
• Students in training.
• Healthcare personnel working in services with very limited patient contact and without direct responsibility for oncology patient care.

Criteria are shown verbatim from the registry (in English). Final eligibility is always assessed by the study center.

Healthy volunteers: No

Study design

Observational model

Cohort

Study locations

Italy · 3 centers

• Centro Riferimento Oncologico CRO IRCCS — Aviano
• Istituto Tumori IRCCS Giovanni Paolo II — Bari
• The Padua, Castelfranco Veneto, and Schiavonia campuses of the Veneto Institute of Oncolog — Padova

Publications

• Destrebecq A, Ferrara P, Frattini L, Pittella F, Rossano G, Striano G, Terzoni S, Gambini O. The Italian Version of the Opening Minds Stigma Scale for Healthcare Providers: Validation and Study on a Sample of Bachelor Students. Community Ment Health J. 2018 Jan;54(1):66-72. doi: 10.1007/s10597-017-0149-0. Epub 2017 Jun 24. PMID 28647819
• Pasere E, O'Hara D, Ballard E, Kilgour C, Holland L. A narrative review of medical and surgical nurses' attitudes and perceptions when caring for patients with a secondary diagnosis of mental illness. Nurse Educ Today. 2025 Aug;151:106684. doi: 10.1016/j.nedt.2025.106684. Epub 2025 Mar 20. PMID 40168912
• Kisely S, Sadek J, MacKenzie A, Lawrence D, Campbell LA. Excess cancer mortality in psychiatric patients. Can J Psychiatry. 2008 Nov;53(11):753-61. doi: 10.1177/070674370805301107. PMID 19087469
• Ivankova, N. V., Creswell, J. W., & Stick, S. L. (2006). Using mixed-methods sequential explanatory design: From theory to practice. Field methods, 18(1),
• Giandinoto JA, Stephenson J, Edward KL. General hospital health professionals' attitudes and perceived dangerousness towards patients with comorbid mental and physical health conditions: Systematic review and meta-analysis. Int J Ment Health Nurs. 2018 Jun;27(3):942-955. doi: 10.1111/inm.12433. Epub 2018 Feb 5. PMID 29399940
• Firth J, Siddiqi N, Koyanagi A, Siskind D, Rosenbaum S, Galletly C, Allan S, Caneo C, Carney R, Carvalho AF, Chatterton ML, Correll CU, Curtis J, Gaughran F, Heald A, Hoare E, Jackson SE, Kisely S, Lovell K, Maj M, McGorry PD, Mihalopoulos C, Myles H, O'Donoghue B, Pillinger T, Sarris J, Schuch FB, Shiers D, Smith L, Solmi M, Suetani S, Taylor J, Teasdale SB, Thornicroft G, Torous J, Usherwood T, PMID 31324560
• Elliott K, Haworth E, Bolnykh I, McAllister-Williams RH, Greystoke A, Todd A, Sharp L. Breast cancer patients with a pre-existing mental illness are less likely to receive guideline-recommended cancer treatment: A systematic review and meta-analysis. Breast. 2025 Feb;79:103855. doi: 10.1016/j.breast.2024.103855. Epub 2024 Dec 7. PMID 39708443
• Creswell JW, Inoue M. A process for conducting mixed methods data analysis. J Gen Fam Med. 2024 Oct 3;26(1):4-11. doi: 10.1002/jgf2.736. eCollection 2025 Jan. PMID 39776872

Identifiers

NCT: NCT07748221 · ONCO-MinD

Primary sources (government registries)

• ClinicalTrials.gov (US NIH)

View this study on ClinicalTrials.gov ↗