Healthcare Providers' Attitudes Toward Oncology Patients With Mental Disorders

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.

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.