The online use of Violence and Journey metaphors by patients with cancer, as compared with health professionals: a mixed methods study

Abstract

ObjectiveTo compare the frequencies with which patients with cancer and health professionals use Violence and Journey metaphors when writing online; and to investigate the use of these metaphors by patients with cancer, in view of critiques of war-related metaphors for cancer and the adoption of the notion of the ‘cancer journey’ in UK policy documents.DesignComputer-assisted quantitative and qualitative study of two data sets totalling 753 302 words.SettingA UK-based online forum for patients with cancer (500 134 words) and a UK-based website for health professionals (253 168 words).Participants56 patients with cancer writing online between 2007 and 2012; and 307 health professionals writing online between 2008 and 2013.ResultsPatients with cancer use both Violence metaphors and Journey metaphors approximately 1.5 times per 1000 words to describe their illness experience. In similar online writing, health professionals use each type of metaphor significantly less frequently. Patients’ Violence metaphors can express and reinforce negative feelings, but they can also be used in empowering ways. Journey metaphors can express and reinforce positive feelings, but can also be used in disempowering ways.ConclusionsViolence metaphors are not by default negative and Journey metaphors are not by default a positive means of conceptualising cancer. A blanket rejection of Violence metaphors and an uncritical promotion of Journey metaphors would deprive patients of the positive functions of the former and ignore the potential pitfalls of the latter. Instead, greater awareness of the function (empowering or disempowering) of patients’ metaphor use can lead to more effective communication about the experience of cancer.

Healthcare professionals' online use of violence metaphors for care at the end of life in the US: a corpus-based comparison with the UK

“…The final part of the present analysis involves the notion of agency, which was identified as important in the MELC analysis of the UK data (see Semino et al, 2015). We manually analysed the concordance lines from each USAS tag that contained Violence metaphorical expressions and described the roles of the various social actors construed as being engaged in acts of metaphorical violence (see Research Questions 3 and 4).…”

“…Recent work Semino et al, 2015) has combined qualitative analysis with corpus-based quantitative methods to analyse the frequency and variety of Violence metaphors in the language of UK-based patients, family carers, and healthcare professionals talking about cancer and/or end-of-life care. A new, 250,324-word corpus of US health professionals' online discourse has been collected to add a contrastive, crosscultural element to the study of metaphors in end-of-life care.…”

“…We apply an innovative corpus-aided approach to the identification of openended sets of Violence metaphors (e.g. aggressive palliative care), and compare the frequencies, forms and functions of these metaphors to those found in a comparable corpus from the UK Semino et al, 2015). We also introduce and demonstrate a new approach to 'agency' in the analysis of metaphorical expressions.…”

“…From a methodological point of view, MELC combined 'manual' qualitative analysis with the exploitation of corpus tools for the systematic identification of metaphorical expressions in large quantities of data Semino et al 2015). Metaphor was chosen as the focus of the MELC project because it is well-known to be an important tool in talking and thinking about subjective, complex and sensitive experiences such as illness and death (Lakoff and Johnson, 1980;Gibbs and Franks 2002;Semino, 2008).…”

A computer-assisted study of the use of Violence metaphors for cancer and end of life by patients, family carers and health professionals

“…Salmon & Hall (2003: 1975 argue that the concept of the 'fighting spirit' of cancer patients has become culturally popular because it underlies an idea that fighting can improve the chances for survival. They argue, however, that the fighting process does not reflect the same attitude or emotions for every patient, and can be focused not only towards the disease (potentially empowering) but also against the emotions of the patient (potentially disempowering) (see Semino et al 2015 for further discussion of Violence metaphors used in empowering or disempowering ways by patients and healthcare professionals). To a lesser extent, patients also use Violence metaphors to frame their relationship and interactions with healthcare professionals.…”