JAMA Netw Open. 2026 Jan 2;9(1):e2554797. doi: 10.1001/jamanetworkopen.2025.54797.
ABSTRACT
IMPORTANCE: Socioeconomic disparities in hospice care access are well recognized, but their structural drivers remain underexplored. Low-income patients with cancer often face compounded informational, psychosocial, and financial barriers at the end of life.
OBJECTIVE: To examine how limited cultural capital, disease-related stigma, and class-based disadvantage may be jointly associated with hospice care access among low-income patients with cancer in China.
DESIGN, SETTING, AND PARTICIPANTS: This descriptive qualitative study was conducted at a tertiary hospital in southwestern China from July 2024 to July 2025. Adult patients with advanced cancer receiving government social assistance were purposively sampled.
MAIN OUTCOME AND MEASURES: Semistructured in-depth interviews were conducted, transcribed verbatim, and thematically analyzed using a 6-phase approach. Two researchers independently coded transcripts, with analytic consensus achieved through iterative discussion. NVivo 12 software was used for data management. Analysis occurred from August to October 2025.
RESULTS: Among 16 adults with advanced cancer (median [range] age, 55 years [late 30s to early 70s]; 9 men [56.2%]), 4 themes emerged: (1) Limited cultural capital was associated with cognitive and communicative barriers, including low health literacy, reliance on informal sources, and poor digital navigation. (2) Stigma surrounding cancer and death was associated with moral dilemmas and inhibition of open discussion of hospice. (3) Economic deprivation was associated with restricted care options, reinforced curative treatment priorities, and weakened access to social support. (4) Patients and families used resilience strategies, including peer networks, communication tactics, and value redefinition. These domains interacted synergistically; poverty was associated with reduced access to education and digital literacy, with exacerbated stigma internalization and discouraged care-seeking.
CONCLUSIONS AND RELEVANCE: This study found that cultural capital deficits, stigma, and socioeconomic hardship were jointly associated with a self-reinforcing cycle of hospice exclusion. These outcomes suggest that interventions must address these factors simultaneously by improving health literacy, reducing stigma, and expanding financial and systemic support.
PMID:41557349 | DOI:10.1001/jamanetworkopen.2025.54797
