Collusion in Cancer Care: An Investigation into its Facets at a Tertiary Care Center in South India

Collusion, the practice of concealing a diagnosis or prognosis from a close relative to prevent emotional distress, is a complex issue in cancer care. This study aimed to estimate the prevalence of collusion among cancer patients and identify the associated factors, including educational status, time since diagnosis, and prognosis.

This 6-month cross-sectional study recruited 121 consenting cancer patients (aged >18 years) via convenient sampling at a tertiary care center in South India. Patients with psychiatric conditions or communication difficulties were excluded. The data were collected through qualitative interviews using a modified collusion questionnaire.

The overall prevalence of collusion was 26.4%. Significant associations were found with educational status ( P = 0.024), with collusion being highest among those with primary education (40.7%) and lowest in postgraduates (12.2%). Collusion was also significantly associated with time since diagnosis ( P < 0.001), being 88.9% within 1 month and decreasing to 54.2% by 6 months. Caregivers frequently colluded ( P < 0.001) even when the disease was considered partly curable. Among the collusion positive cases, 96.9% of the caregivers were unwilling to discuss the diagnosis and 87.5% unwilling to inform patients about the disease's course or outcome.

Collusion is prevalent in cancer patients, particularly among those with lower education levels and in the early postdiagnosis period. Caregivers often withhold comprehensive information, highlighting a need for improved communication strategies in oncology.