[Show abstract][Hide abstract] ABSTRACT: Social expectations surrounding sickness have undergone a transformation in Western welfare states. Emerging discourses about patients' roles and responsibilities do not however always map neatly onto patients' actions, experiences or desires. This paper emerges from a study in Ontario, Canada. Drawing on in-depth interviews with 5 women diagnosed with breast cancer we explore the activity and effort prompted for patients by the routine professional practice of outlining treatment options and encouraging patients to choose between them. We highlight research participants' complex responses to their responsibility for treatment decisions: their accepting, deflecting and reframing and their active negotiation of responsibility with professionals. The literature on treatment decision making typically characterizes people who resist taking an active role as overwhelmed, misinformed about the nature of treatment decisions, or more generally lacking capacity to participate. In this paper we suggest that patients' expressions of ambivalence about making treatment choices can be understood otherwise: as efforts to recast the identities and positions they and their physicians are assigned in the organization of cancer care. We also begin to map key features of this organization, particularly discourses of patient empowerment, and evidence-based medicine.
Social Science [?] Medicine 09/2010; 71(6):1094-101. DOI:10.1016/j.socscimed.2010.06.005 · 2.89 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: The experiences that marginalized breast cancer populations have in common are rarely considered.
The authors look across 3 qualitative studies to explore the experiences of older, lower-income, and Aboriginal women diagnosed with cancer and treated by the cancer care system in Ontario, Canada.
The research examines critical moments in participants' narratives that parallel one another and are categorized within 2 themes: Not Getting Cancer Care and Not Getting Supportive Care.
Although exploratory, the findings merit attention both for what they tell us about women's experiences, and because they suggest disparities in access to treatment and psychosocial support.
Journal of Cancer Education 10/2009; 24(4):308-14. DOI:10.1080/08858190902997324 · 1.23 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: To understand how older age affects cancer care, from the perspectives of older women.
Urban southern region of Ontario, Canada.
Purposive sample (age groups and income) of 15 women diagnosed with cancer at age 70 or older; 10 women were diagnosed with breast cancer, 5 with gynecologic cancer.
Two face-to-face interviews, with data analysis in collaboration with the project team based on constructivist grounded theory, including negative case analysis.
Age, experience of cancer care.
Age-related life and health circumstances intersect with professional practice and wider social contexts and are implicated in treatment decision making, including decisions against treatment, as well as in the day-to-day "getting around" that cancer care requires.
The nursing history should be holistic in scope, attending to the supportive care domains to elicit older women's physical, social, practical, informational, psychological, and spiritual needs after a diagnosis of cancer. History taking should draw forward older women's life contexts and examine these contexts in relation to cancer care, including treatment decision making.
Individual-level care and systems advocacy are required to ensure that older women's worries about sustaining independence, including worries generated by inadequacies in home-based care, do not act as determinants of treatment choices.
Oncology Nursing Forum 12/2005; 32(6):1169-75. DOI:10.1188/05.ONF.1169-1175 · 2.79 Impact Factor