Decision-making processes, gendered dimensions and the culture of hope among lung cancer patients in Sylhet, Bangladesh

Abstract

Introduction With rising lung cancer cases in Bangladesh, the uncontrolled pluralistic healthcare system creates a ‘delay’ in the decision-making process of the lung cancer patients and a detrimental effect on their health and well-being. This study explored how the healthcare system influences the decision-making process of lung cancer patients—both male and female—during their treatment journey in an urban setting in Sylhet, Bangladesh. Methods Ten male and ten female patients diagnosed with lung cancer and six healthcare professionals were included in this qualitative study. Participants were recruited through purposive sampling for in-depth interviews and key informant interviews from the Northeast Medical College Hospital (the only cancer-dedicated hospital in Sylhet, Bangladesh). Data were analysed thematically. Results Findings highlight gender-specific challenges in treatment decision-making for lung cancer patients. The six emergent themes focused on knowledge, access and decision-making processes of these patients. Male patients often face financial constraints, logistical difficulties and limited healthcare options. Female patients encounter compounded barriers due to sociocultural norms, financial dependency and limited autonomy. Both male and female groups are significantly affected by shortcomings in existing health policies and the absence of targeted awareness initiatives. These factors significantly exacerbate patient vulnerabilities and restrict access to comprehensive care. Among lung cancer patients with financial stability, ‘hope’ was often tied to access to advanced treatments and a sense of control over healthcare decisions. In contrast, economically disadvantaged patients, particularly women, experienced a more constrained form of hope, focused primarily on survival, pain relief or maintaining household stability. Conclusion We recommend introducing health literacy programmes, establishing more cancer-dedicated hospitals in underserved regions, providing gender-sensitive training for healthcare professionals and implementing early detection awareness programmes to address the limitations.