Rehabilitating the sick role: the experiences of high-risk women who undergo risk reducing breast surgery

Abstract

In recent years, Talcott Parsons’ work has come under renewed scrutiny by sociologists who argue that his concept of the sick role has a role to play in current accounts of health and illness. In this paper we describe the ways in which Australian women who had undergone elective risk-reducing breast surgery (with or without ovarian surgery) spoke about their convalescence. Women presented two contrasting recovery narratives in describing their experiences, with the negative effects of breast surgery either minimised or emphasised. In an effort to explain these differences, we draw upon the Parsonian concept of the sick role and argue that the extent to which women either embraced or rejected the sick role in their accounts was related to the amount of external legitimation they had received from healthcare professionals. We conclude that the concept of the sick role may provide useful insight into women's experiences of risk-management today.

Keywords:

• breast cancer
• sick role
• risk
• genetics
• Talcott Parsons

Acknowledgements

We would like to thank all of the women who took part in the interviews. We also thank Heather Thorne, Eveline Niedermayr, the kConFab research nurses and staff, the heads and staff of the Family Cancer Clinics, the Clinical Follow Up Study (previous funding from NHMRC, the National Breast Cancer Foundation and Cancer Australia, currently funded by NIH) and the many families who contribute to kConFab, for their contributions to this resource.

We would also like to thank Deepa Patel from the kConFab Psychosocial Group for her input during the early phases of data analysis. The kConFab Psychosocial Group includes the following in addition to the authors listed in the author group: B. Bennett and K. Tucker, Department of Medical Oncology, Prince of Wales Hospital, Randwick, Australia; S-A McLachlan Department of Oncology and Department of Medicine, St Vincent's Hospital, Melbourne, Australia; K-A Phillips, Division of Cancer Medicine, Peter MacCallum Cancer Centre, Victoria, Australia; C.C. Tennant, Sydney Medical School (Northern), The University of Sydney, Sydney, Australia. P. Butow is in receipt of a Principal Research Fellowship from NHMRC.

N.H. would like to thank the Leverhulme Trust for its generous support in the form of a Study Abroad Fellowship and The Universities of Sydney (Centre of Medical Psychology and Evidence-based Decision-making (CeMPED), School of Psychology), Melbourne (the Centre for Health and Society) and Adelaide (Department of Psychology) for accommodating her while she was writing this paper. She thanks Karen Willis for the interesting conversations we had about Parsons on the Island of Devils and Julia Lawton for her reading tips.

Funding

kConFab is supported by grants from the National Breast Cancer Foundation, the National Health and Medical Research Council (NHMRC) and by the Queensland Cancer Fund, the Cancer Councils of New South Wales, Victoria, Tasmania and South Australia, and the Cancer Foundation of Western Australia. The kConFab Psychosocial study has been funded by National Health and Medical Research Council Project Grants [153824] [301930] [457316].

Notes

1 kConFab is a large epidemiological and clinical study of multiple-case breast cancer families from Australia and New Zealand (kConFab). Families were recruited after the index family member attended a consultation at one of 16 family cancer clinics (FCC). Eligibility criteria included a strong family history of breast cancer and/or ovarian cancer, or a documented BRCA1 or BRCA2 mutation (Mann et al., 2006). Longitudinal follow-up and psychosocial data were collected from unaffected women, using three-yearly self-report questionnaires and a semi-structured interview (Phillips et al., 2005).