GLOBAL QUALITATIVE STUDY OF PROFESSIONALS’ PERSPECTIVES OF CARING FOR PEOPLE WITH HEAD AND NECK CANCER EXPERIENCING SUICIDAL IDEATION

Introduction
Globally, patients with head and neck cancer (HNC) are twice as likely to die by suicide compared to other cancers. To date, most HNC suicidality studies focus on estimating prevalence, with limited research exploring assessment and suicide management within routine cancer care. To address the gap, this study aimed to explore professionals’ perspectives of how to optimally identify, refer and manage suicidal ideation for this high-risk population.

Methods
Thirty-nine, one-to-one, semi-structured interviews were conducted with a global range of health and social care professionals caring from patients with HNC. Data were analysed using Braun and Clarke’s reflexive thematic analysis.

Results
Three multilevel influences were identified: (1) patient risk factors for suicidal ideation in HNC: from identity disruption to demoralisation, (2) professional navigating role ambiguity and emotional burden within confines of healthcare systems, and (3) societal influences relating to suicidal ideation for people with HNC. There was a divergence in confidence across professional roles in screening and managing patients with HNC experiencing suicidal ideation. Despite this, participants acknowledged a need to screen for suicidal ideation at multiple timepoints; prioritising diagnosis, early post-treatment, when late-effects
prevalent (12-24 months), alongside trigger-based screening determined by risk factors. Barriers to implementation of interventions were a lack of professional knowledge and confidence in screening, referral pathways with timely access to psychological care. Participants highlighted the emotional demands in providing this aspect of care, identifying the need for suicide prevention training and clinical supervision.

Conclusions
To enhance suicidality management of people with HNC, there is a necessity for the implementation of guidelines on screening and effective stepped-care referral pathways with integration of psycho-oncology services. Alongside this, there is a requirement for suicide prevention training and clinical supervision for professionals. HNC suicide management should be a public health priority, in an ardent effort to reduce suicide rates in HNC.