“I Am Not the One That Caused Your Illness”: Lung Cancer Stigma in Nigeria

Abstract

BACKGROUND: Global illness-related stigma is increasingly recognized as a formidable barrier to health-seeking behavior, engagement in care, and adherence to treatments across a range of disease conditions. Stigma is experienced by many patients with lung cancer (PwLC) in the United States; however, less is known about how lung cancer stigma operates in Nigeria. AIMS: This qualitative study was conducted to describe lung cancer stigma and examine the cultural adaptability of the conceptual model of lung cancer stigma in Nigeria. METHODS: Individual and small group interviews were conducted with PwLC (N = 16) at University College Hospital (UCH), Ibadan and at Obafemi Awolowo University Teaching Hospitals Complex (OAU), Ile-Ife. RESULTS: Data analyses revealed that overall, the responses mapped onto the conceptual model of lung cancer stigma and participants described their perceptions of others' stigmatizing attitudes or behaviors, consistent with "perceived stigma" as well as feelings of self-blame, guilt, shame, and regret, consistent with "internalized stigma." Participants also characterized both adaptive and maladaptive consequences of stigma, including distress/depression and constrained disclosure. Further, participants described some specific cultural contexts (moderators) that are important in understanding the landscape of lung cancer stigma in Nigeria, namely causal attributions, cancer as a spiritual attack, financial constraints, systemic delays, and non-disclosure by clinicians. CONCLUSIONS: PwLC experience stigma in Nigeria, which may get triggered during clinical interactions with oncology care clinicians. Communication skills trainings for clinicians in empathy and compassion may help mitigate lung cancer stigma and improve quality of care for PwLC in Nigeria.