# Cultural Capital, Stigma, Class, and Hospice Care Access Among Low-Income Patients With Cancer

## TL;DR

This study explores why low-income cancer patients in China have limited access to hospice care, finding that poverty, stigma, and lack of knowledge work together to block access.

## Contribution

The study identifies a self-reinforcing cycle of hospice exclusion driven by cultural capital deficits, stigma, and socioeconomic hardship in low-income cancer patients.

## Key findings

- Limited cultural capital leads to cognitive and communication barriers in accessing hospice care.
- Stigma around cancer and death discourages open discussion and seeking hospice care.
- Economic hardship restricts care options and access to social support.

## Abstract

This qualitative study investigates the association of cultural capital, disease-related stigma, and class-based disadvantage with hospice care access among low-income patients with cancer in China.

What factors are associated with decreased access to hospice care for low-income patients with cancer in China?

In this qualitative study of 16 low-income patients with advanced cancer, limited cultural capital, pervasive stigma, and socioeconomic hardship emerged as interconnected barriers that were jointly associated with restricted access to hospice care. Informal coping strategies were associated with some relief but not with overcoming structural exclusion.

These findings suggest that equitable hospice access for socioeconomically disadvantaged patients may require integrated interventions that address informational, psychosocial, and financial barriers simultaneously.

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.

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.

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.

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.

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.

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.