Patient pathways as social drama: a qualitative study of cancer trajectories from the patient’s perspective

ABSTRACT

Purpose: The number of persons living with and beyond cancer is increasing. Such persons often have complex needs that last, and change, over time. The aim of this study is to get insights of lived experience of person diagnosed with colorectal cancer and to create an understanding of cancer trajectories as a dynamic process. This study thus explores Victor Turner’s model of social drama in a cancer care context. Method: Turner suggests that crisis is a dynamic process structured by four phases: 1) breach of norm 2) crisis 3) redressive actions 4) reintegration or schism. The research team employed content analysis to explore material gathered through a series of qualitative interviews with nine Norwegian cancer patients over a period of one year. Results: To the authors’ knowledge, Turner’s model has not earlier been applied to such materials. The results show that Turner’s model of social drama is useful in achieving new and possibly important knowledge on illness trajectories from a lived experience perspective. Conclusions: The model of social drama may contribute to a deeper understanding of the processes patients are going through in long-term illness trajectories, demonstrating that illness is not a static matter.

KEYWORDS:

• Victor Turner
• illness pathways
• patient perspective
• process
• cancer

Acknowledgments

The authors are grateful to all the participated who shared their experiences and thoughts in this study. We are grateful for the financial assistance given by the Norwegian Cancer Society and regional health authorities and for the technical support by Brit J Drageset, Per Schrader, and Åsa Sohlèn. The publication charges for this article have been funded by a grant from the publication fund of UiT The Artic University of Norway.

Disclosure statement

No potential conflict of interest was reported by the authors.

Ethical approval

The Regional Committees for Medical and Health Research Ethics (REK) approved the study (2009/1293/REK Nord).

Additional information

Funding

This work was supported by the Regional Health Authority (Helse Nord) under Grant HST1024-11; Norwegian Cancer Society (Kreftforeningen) under Grant S-581431001.

Notes on contributors

Frank Hansen

Frank Hansen is a PhD fellow at National Research Center in Complementary and Alternative Medicine (NAFKAM), Department of Community Medicine, Faculty of Health Sciences at UiT The Arctic University of Norway. His anthropological research explores long term, complex illness from people`s own perspectives. In particular, Hansen focuses on what matters for persons diagnosed with colorectal cancer and their lived experiences in context of illness.

Gro K. Rosvold Berntsen

Gro K. Rosvold Berntsen is a professor at the Norwegian center for eHealth research and Department of Primary Care, Department of Community medicine at UiT, The Arctic University of Norway. She has a PhD in epidemiology. She was research director of the Centre of Clinical documentation and Evaluation, from 2005–2009. Berntsen’s research is currently focused on mixed methods studies on quality assurance, patient pathways, and person-centered, integrated and proactive care for patients with complex and long-term needs.

Anita Salamonsen

Anita Salamonsen is associate professor at the Regional Centre for Child and Youth Mental Health and Child Welfare, Faculty of Health Sciences, UiT The Arctic University of Norway. Her research includes multi-diciplinary studies of user involvment, cultural sensitive and person centered care, doctor-patient communication, risk understandings and health and arts.