Making Sense of Gynecologic Cancer: A Relational Dialectics Approach

ABSTRACT

This study used the relational dialectics theory (RDT) as a theoretical lens to examine how the interplay of competing discourses shaped meaning making about gynecologic cancer. A reflexive thematic analysis of the narratives of 12 survivors of cervical cancer, ovarian cancer, and uterine cancer in Arkansas showed two discursive struggles at play, including continuity of care versus change, and voicing versus repressing of feelings. The findings showed that long history of care with physicians contributed to how participants privileged the discourse of continuity of care when faced with a decision to travel for care or receive care locally. We also found that cultural discourses about concealing women’s cancer-afflicted bodies, lack of supportive spaces for women to discuss side effects of cancer treatments, and appropriate communication behavior between patients and physicians shaped the interplay of the discursive struggle of voicing versus repressing. The findings extend the RDT by showing that geographic location, disease characteristics, history of care between patients and physicians, and prevailing cultural discourses can contribute to the interplay of discursive struggles in the gynecologic cancer context. Further, the findings suggest to healthcare professionals to address harmful discourses about gynecologic cancer to help create support avenues for survivors.

Acknowledgements

We are grateful to the Faculty Research Awards Committee (FRAC) at Arkansas State University for the grant to conduct this study

Disclosure statement

No potential conflict of interest was reported by the author(s).

Notes

1. Data included only invasive cancers; thus, there was no information for other gynecologic cancer such as vaginal cancer and vulvar cancer.

2. A 2022 report put mortality rate for ovarian cancer in the United States in 2019 at 6.0 per 100,000 women (Giaquinto et al., 2022).

3. Medically underserved means “residents have a shortage of personal health services” (Arkansas Department of Health, 2020a, p. 81). It is important to note that some urban areas in Arkansas have excellent health facilities and do not share the health profile of many counties in the state (Rural Profile of Arkansas, 2013).

4. One participant was diagnosed with both ovarian cancer (stage II) and uterine cancer (stage I) at the same time.

5. Percentages for cancer stage are based on a sample size of 13 because one participant had two primary cancers.

6. Memphis, TN is about 70 miles from the city in Arkansas where many of the participants resided.

7. The city in northeast Arkansas where the majority of participants lived has three major hospitals serving residents.

Additional information

Funding

The author(s) reported there is no funding associated with the work featured in this article.