Abstract
PURPOSE: Individuals with lung cancer (LC) experience significant stigma regarding their diagnosis due to its association with smoking behaviours. To our knowledge, LC sigma has yet to be explored from the perspective of family members. Family members are often the primary caregiver for individuals with LC and as a result may witness firsthand stigmatising behaviours towards their loved ones. Additionally, family members may experience stigma regarding their loved one’s diagnosis due to stigma by association. Thus, the current study sought to investigate their experiences and perspectives of LC stigma. METHODS: Eight participants were recruited using purposive and snowball sampling. A qualitative, cross-sectional design was implemented using both virtual and in-person semi-structured interviews. Interviews were audio-recorded, transcribed and analysed using thematic analysis. RESULTS: Five themes were identified: Stigma through blame: Navigating social assumptions about smoking, Discrimination and unfair treatment from healthcare providers, Feeling judged by association, Contemporary cultural and public views of smoking have fuelled stigma, Cognitive strategies for managing and resisting stigma. CONCLUSION: Family members perceived their loved ones to have experienced stigma related to their diagnosis through externalised and internalised stigma. Externalised stigma was perceived through stereotypical questioning, blame, judgements, discrimination and unfair treatment. Family members stated that this led to internalised feelings of guilt and shame. Importantly, family members stated they have also experienced stigma by association through external judgements from family and society and a loss of friendships. IMPLICATIONS FOR CANCER SURVIVORS AND FAMILY MEMBERS: Interventions need to be put in place focusing on empathic communication skills for healthcare providers, communication training for family members and interventions focused on helping both survivors and family members cope with the impact of LC stigma. Future research should focus on further examining the experiences and perspectives of family members in order to gain a broader understanding. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s40359-026-04070-y.