Exploring Patient Centered Perspectives on Suicidal Ideation: A Mixed Methods Investigation in Gastrointestinal Cancer Care. (Preprint)
Authors: Choudhury Avishek , Shahsavar Yeganeh , Ahmed Imtiaz , Al-Mamun M Abdullah , Elkefi Safa 
Published: December 2023

BACKGROUND

Gastrointestinal (GI) cancer patients face a 4-fold higher risk of suicide than the general US population. While efforts to reduce suicide risk in cancer patients have been crucial, the issue remains urgent.

OBJECTIVE

This study explores the psychosocial aspects of GI cancer patient experiences. It focuses on assessing the prevalence and
intensity of suicidal ideation and behavior, evaluating mental distress during different treatment phases, and examining the impact of psychosocial factors on mental health.

METHODS

We used a two-phase mixed-methods approach. The research began with a web-based survey targeting individuals across the US who were undergoing or had completed GI cancer treatment. Survey respondents were then debriefed and invited to engage in a
follow-up interview, which were conducted via video conferencing, recorded, transcribed, and anonymized for analysis. Quantitative data analysis involved confirmatory factor analysis to validate constructs related to mental health and suicidal ideation. Subsequently,
significant correlations with mental health and suicidal ideation were extracted and scaled for further bivariate analyses. Qualitatively, an inductive thematic analysis was performed on both survey responses and interview transcripts. The patient journey was charted from
diagnosis through the treatment continuum, with sentiment analysis enriching the thematic findings.

RESULTS

Two hundred-two individuals responded to the survey. Of all the participants, 76 respondents were from the rural Appalachian region, and 78 were undergoing treatment during the study. Quantitative analysis revealed a higher prevalence of passive suicidal ideation compared to active planning. The post-treatment recovery period was reported as the most emotionally challenging. Qualitative data emphasized the crucial role of emotional support, with patients feeling particularly vulnerable to isolation. The quality of care received was another concern, with calls for more individualized treatment plans and better communication. Patients also expressed a need for clear, comprehensive information about their treatment and potential side effects. The in-depth interview with 4 GI cancer
patients indicated a healthcare system that prioritizes expedient treatment over comprehensive care, with a noted lack of formal psychological support. The role of artificial intelligence (AI) emerged as a promising avenue for enhancing patient
understanding of their condition and treatment options. Patients valued clear, empathetic communication and the provision of comprehensive, understandable information from their healthcare providers. The sentiment analysis associated with their experiences
reflected a spectrum of emotional responses, from shock and disbelief at diagnosis to fluctuating emotions during treatment.

CONCLUSIONS

Our research advocates for a more patient-centric model of care, enhanced by the thoughtful integration of technology and consistent, empathetic communication. These findings contribute to a deeper understanding of the GI cancer patient experience and provide a foundation for improving cancer care practices to better address the holistic needs of patients.