Surprise Reveals the Affective-Moral Economies in Cancer Illness Narratives

'Staying cool, calm and positive': A dialogical narrative analysis of emotional reactions in narratives about operable lung cancer

BACKGROUND

Patients with lung cancer suffer from physical, psychosocial and particularly emotional challenges. Twenty-five percent of patients with lung cancer are offered surgery as a potential cure. Nevertheless, 40% of surgically treated patients will experience recurrence. Paradoxically, research shows a dominant narrative of operable lung cancer patients 'being lucky', which silences other narratives about suffering, worries and emotional challenges.

AIM

To explore narratives about operable lung cancer, particularly emotional reactions to illness and suffering in these narratives.

METHODS

A qualitative design was applied. Six women and four men diagnosed with operable lung cancer were included from one university hospital in Denmark and interviewed 1 month after surgery using active interviews. The interviews were subject to dialogical narrative analysis. The theoretical foundation is social constructivism, with socio-narratological inspiration.

FINDINGS

A typology of three emotional narratives emerged: 'staying cool', 'staying calm' and 'staying positive'. All three types of narrative are characterised by managing emotional reactions. Staying cool is characterised by not showing emotional reactions; staying calm narratives acknowledge emotional reactions, but that they need to be managed so that they do not burden relatives; and the last, staying positive, is characterised by managing emotional reactions in a positive direction. Together this typology of three emotional narratives revealed that operable lung cancer patients are under normative pressure from these socially preferred narratives of ideal emotional reactions to lung cancer.

CONCLUSION

A typology of three emotional narratives were identified and can be called 'feeling rules' that guide patients after lung cancer surgery to manage their emotions. Consequently, if patients do not live up to these three emotional narratives of staying cool, calm and positive, they may be socially isolated and restricted from access to support.

The good pain patient: a critical evaluation of patients' self-presentations in specialist pain clinics

Established research supports collaborative patient-clinician communication as a means of improving pain management and decreasing opioid use by patients with chronic pain. However, much of this scholarship emphasises clinicians' capacities to shape and improve communication; limited research investigates patients' roles in this process. Drawing on 40 ethnographic observations of patient-clinician interactions, clinical spaces and case conferences within one specialist pain clinic in Brisbane, Australia, this paper investigates how and why patients present themselves in particular ways within consultations. Our theoretical lens combines concepts from Goffman on patienthood and stigma with Foucauldian theories of pastoral and disciplinary power. Findings suggest that elements of the clinical environment - namely posters - usher patients towards presenting in what we conceptualise as the 'good pain patient' role. In this role, patients demonstrate that they are moral, responsible, and contributing members of society. Yet, such a role is problematic to opening communication, with the role constraining what is socially acceptable for patients with chronic pain to say, do, or feel. In recognising how clinical contexts facilitate problematic good pain patient presentations, this paper directs attention to the spatial and relational nature of implicit clinical expectations and constrained good pain patient presentations.

Navigating whiteness: affective relational intensities of non-clinical psychosocial support by and for culturally and linguistically diverse people

Mental health is political, with intersecting economic, cultural, racialized, and affective dimensions making up the care assemblage, signalling how care is conceptualised and who is deserving of care. In this article, we examine emotions circulating in a non-clinical psychosocial support program for culturally and linguistically diverse people experiencing mental ill-health, foregrounding the relations between culture, race, economy, and assumptions underpinning understandings of care. The mental health program under study offers psychosocial support for culturally and linguistically diverse people to manage life challenges and mental ill-health exacerbated by navigating the complexities of Australia's health and social care systems. We draw on interviews with clients, staff, and providers of intersecting services, employing Ahmed's concept of affective economies and Savreemootoo's concept of navigating whiteness to examine the care assemblage within interview transcripts. We provide insight into affective intensities such as hate, anger, and indifference embedded in white Anglo-centric services, positioning culturally and linguistically diverse people on the margins of care. Non-clinical psychosocial support programs can counter such affective intensities by training and employing multicultural peer support workers-people with lived experience-prioritising relational and place-based approaches to care and supporting and providing clients with relevant skills to navigate an Anglo-centric care system. However, this support is filled with affective tensions: (com)passion, frustration and fatigue circulate and clash due to the scarcity of resources, further signalling what type of care (and with/for whom) is prioritised within Australian relations of care.

Fear of Cancer Recurrence and Coping Strategies among Prostate Cancer Survivors: A Qualitative Study

BACKGROUND

Fear of cancer recurrence (FCR), as a commonly reported problem among prostate cancer survivors, has not been fully understood. This study aimed to explore the experience of FCR and relevant coping strategies among Iranian prostate cancer survivors.

METHODS

Qualitative research was conducted on 13 men who completed treatments for prostate cancer in the last 24 months. The participants were selected through purposeful sampling, and in-depth semi-structured interviews were used for data collection. Conventional content analysis was used for data analysis.

RESULTS

Data analysis led to the emergence of three themes. "Living with insecurity" describes the participants' experiences regarding what triggers FCR with two categories, including "fear of incomplete cure" and "fear of cancer return." In addition, "struggling to cope" with two categories, including "psychological strategies" and "spiritual coping," presents coping strategies used by the participants for reducing FCR. Furthermore, "trying to prevent cancer recurrence" with two categories, "seeking health" and "lifestyle modification," indicates coping strategies used by the participants to prevent cancer recurrence.

CONCLUSIONS

Healthcare providers need to consider the cultural characteristics of prostate cancer survivors when assessing their FCR, encourage them to disclose their concerns and fears, and provide tailored interventions in order to reduce FCR among them.

Entanglements and imagined futures: The subject(s) of precision in oncology

Precision oncology holds an increasingly powerful social function. In the era of precision, how people encounter, live with, and experience cancer, how they imagine their lives, how they navigate treatment regimens, and experience side effects, have been radically transformed. Innovations in oncology - in this case precision-related - are always more-than-clinical; their circulation exceeds the laboratory and the hospital, but what this 'circulation of innovation' produces has been thus far opaque. To begin to comprehend what is emergent at the cancer-precision nexus in people's everyday lives, we draw on qualitative interviews with twenty people diagnosed with metastatic non-small cell lung cancer undergoing immunotherapy and/or targeted therapy and we discuss how precision inflects survivorship, entangles subjects in chronic living, and induces novel temporalities. Through such inflections of survivorship, precision innovation re-shapes expectations and possibilities, and sometimes enacts new, unexpected (or, for some, unwanted) futures. Such illness and survivorship narratives indicate the importance of orientating the social science scholarship toward considerations of temporality and entanglements for comprehending precision innovation in oncology. And in doing so, provide a nuanced account of how innovations unsettle and recast, rather than unravel, the normative scene of cancer.