Global Qualitative Study of Professionals' Perspectives of Caring for People With Head and Neck Cancer Experiencing Suicidal Ideation

Globally, people with head and neck cancer (HNC) are twice as likely to die by suicide compared to all other cancers. Yet most HNC suicidality studies focus on estimating prevalence, rather than how to assess and support people with suicidal ideation within routine cancer care. This study aimed to explore professionals' perspectives of how to optimally identify, refer and support people with HNC reporting suicidal ideation. Thirty-nine, semi-structured interviews were conducted with health and social care professionals caring from people with HNC from 13 countries; and analysed using reflexive thematic analysis. Three multilevel influences were identified: (1) patient risk factors: from identity disruption to demoralisation, (2) role ambiguity and emotional burden for professionals, and (3) sociocultural influences relating to suicidal ideation for people with HNC. Despite a divergence in confidence across professional roles, participants acknowledged a need to screen for suicidal ideation, prioritising diagnosis, early post-treatment, when late-effects are prevalent (12-24 months), alongside trigger-based screening. Barriers to implementation include a lack of professional knowledge and confidence, referral pathways and timely access to psychological care. Professionals highlighted the emotional demands and moral injury, identifying the need for suicide prevention training and clinical supervision. To enhance suicidality management for people with HNC, there is a necessity for clinician-led needs-based psychosocial assessment, collaborative safety planning, and clear, stepped-care referral pathways with integrated psycho-oncology services. Workforce needs include suicide prevention training and structured clinical supervision. Proactive suicide prevention should be a public health priority given this high-risk population.