Promoting patient perseverance: The morality of continuing treatment during clinical cancer encounters

• In Event: Research in Ethnomethodology and Conversation Analysis: Interactions in Institutional Settings I

Abstract

Beginning cancer treatment presents challenges for patients and oncologists alike with a common big decision being whether to begin invasive but potentially transformative life-extending treatment. Oncology patients do not simply face that one treatment decision, however. Instead, across their cancer journey, there are ongoing questions of whether to persist or to stop treatments. The complex nature of radiation and chemotherapy, including their side effects and uncertain prognoses contribute to exacerbating the challenge of treatment. Moreover, this treatment takes place in a time of shared decision making where patients have, on the one hand, substantially more autonomy than in past decades; but on the other hand, biopower coupled with secular morality may constrain patient freedom. In this paper, we consider the question of how physicians work to maintain ongoing patient compliance to life-extending cancer treatment, striking a balance between recommending standard-of-care practices and patient autonomy. Relying on conversation analysis as our approach, we analyzed a corpus of video-recorded oncology visits to address our question. We argue that a major resource for achieving adherence is through leveraging patients’ moral obligation to persevere with cancer treatment through challenges. We show that physicians consistently orient to this obligation by indicating the moral value of perseverance as well as through their work to attenuate the difficulties of cancer treatment, praise patients’ past compliance, and readily provide solutions to any problems that present themselves. Each of these ways of encouraging perseverance leverages the value of patients to continue treatment yet ultimately leaves acceptance to patients.

Authors

• Alexandra Tate, University of Chicago

• Tanya Stivers, International Society for CA