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Learning Objective 1: The learner will be able to effectively translate and disseminate knowledge obtained from his theoretically focused, qualitative dissertation to a broader nursing audience.
Learning Objective 2: The learner will be able to defend and answer questions about the research design, findings, and implications of his doctoral study in a scholarly manner.
Although life-threatening cancer cannot be cured, some patients with advanced disease still actively seek potentially life-extending treatment (e.g. clinical drug trials). Positioning individuals as passive recipients of care, previous studies have focused on the inability of patients to adequately understand their prognosis. Few studies have examined the broader social and clinical implications of this current phenomenon.
Purpose
By using Foucauldian theoretical ideas of discourse (rules of knowledge formation) and subjectivities (the individual as a subject), this study examines the social conditions that cultivate the active search for cancer therapy. The research question is: What are the competing discourses in operation when patients with life-threatening advanced cancer actively seek potentially life-extending medical treatments? The sub-question is: What kinds of subjectivities are constituted by these discourses when patients seek medical treatments?
Methods
Seven qualitative case studies were collected that included 21 semi-structured interviews, documents, and observational field data. Cases included patients with severe metastatic cancer, family members, nurses, oncologists, palliative care physicians, field observations, and documents.
Findings
Two main groups of findings result:
1.) Multiple discourses operate within this issue. Although medical discourse enacts a disciplinary force, several counter discourses threaten the prestige of medicine. Patients subvert the traditional hierarchical arrangement of disease knowledge and utilize their own understanding of medical science to self-advocate for treatment. In response to medicine’s inability to effectively treat advanced disease, discourses of self-healing emerge.
2.) These discourses generate multiple patient subjectivities: The Cancer Expert Subject; The Productive Subject; The Proactive Subject; The Positive Thinking Subject; and The Suffering Subject.
Implications
Individuals who seek medical treatment comprise a new “form of life” that is produced by the conflicting discourses currently in operation. This study illuminates a different kind of suffering from cancer, generated from the sense of ambiguity and incongruence between the multiple subjectivities of patients.