Discursive construction of the patient in online clinical cancer pathways information

Margrethe Aasen, Elin; Crawford, Paul; Misund Dahl, Berit

Abstract

Aim: To explore how the patient is constructed and socially positioned in discourses of web-based pathways information available to cancer patients in Norway.
Design: Mixed qualitative and quantitative design, using Corpus-Assisted Critical Discourse Analysis.
Methods: The study, conducted in January 2020, examined the language of one general and six specific web-based cancer pathways information brochures. The approach combines analysis of word frequencies and concordance lines using corpus analysis software to identify the ‘linguistic fingerprint’ or ‘aboutness’ of the text prior to further qualitative critical discourse analysis.
Results: The analysis identified three core discourses which constructed the patient differently: 1) a participating active person, in a brief, inclusive discourse; 2) a passive person lacking knowledge or perception of their situation within dominant, medical and interprofessional expert discourse; and 3) reduced to a disease and a code in the pathways discourse.
Conclusion: This study offers insight into the construction of patients in online clinical pathways information for cancer treatment. The analysis revealed how governance systems such as New Public Management and its demands on efficiency and productivity influence the cancer pathways. The World Health Organization has promoted a person-centered approach, emphasizing the importance of participation and a partnership of equals. A person-centered approach to care was not evident in the discourse of the online documents. The dominant ideology of these pathways was paternalistic with patients constructed as passive persons who get standardized treatment.
Impact:
This study gives new insight that can be valuable for nurses, other healthcare professionals and the government. The lack of a person-centred focus in the cancer pathway information could have a negative impact on the patient`s health outcomes by promoting a culture of inattention to the patients’ needs and wishes among practitioners. The results may provide a stimulus for discussion about the role of patients in cancer treatment.
Keywords:

Citation

Margrethe Aasen, E., Crawford, P., & Misund Dahl, B. (2020). Discursive construction of the patient in online clinical cancer pathways information. Journal of Advanced Nursing, 76(11), 3113-3122. https://doi.org/10.1111/jan.14513

• Journal Article Type: Article
• Acceptance Date: Jul 24, 2020
• Online Publication Date: Aug 31, 2020
• Publication Date: 2020-11
• Deposit Date: Aug 5, 2020
• Publicly Available Date: Sep 1, 2021
• Journal: Journal of Advanced Nursing
• Print ISSN: 0309-2402
• Publisher: Wiley
• Peer Reviewed: Peer Reviewed
• Volume: 76
• Issue: 11
• Pages: 3113-3122
• DOI: https://doi.org/10.1111/jan.14513
• Keywords: Cancer, Care pathway, Discourse Analysis, Mixed Method Design, Nurse, Patient Participation, Policy
• Public URL: https://nottingham-repository.worktribe.com/output/4812886
• Publisher URL: https://onlinelibrary.wiley.com/journal/13652648