Academic journal article Psychology in Russia

Is the Oncology Patient a Participant Actor?: Designing Psychosocial Profiles

Academic journal article Psychology in Russia

Is the Oncology Patient a Participant Actor?: Designing Psychosocial Profiles

Article excerpt

Introduction

In this article, I analyze the information given to patients with breast cancer throughout a processual medical chain in a health-care institution; this study cov­ered patients from their first contact with the institution to the execution of a thera­peutic strategy. The negotiations among the different actors involved in the interac­tions are also identified.

The empirical results analyzed are based on an investigation carried out dur­ing 18 months. The methodological strategy was field research through participant and continued observation of the selected unit. Content analysis of structured in­terviews with doctors, nurses, social workers, and patients who agreed to be inter­viewed was carried out as a complementary information-gathering technique.

From medical paternalism to patient autonomy

Relaying a diagnosis to any patient presents an ethical dilemma to doctors. If, on the one hand, patients have the right to know the truth about their disease, doc­tors, on the other hand, have the duty to inform patients, trying at the same time to keep their hopes and spirits up and striving for the recovery of their autonomy. Is the performace of this task possible in the case of oncology patients? Although the questions related to giving out information to patients are not specific to oncology patients, in this particular situation they seem to become more dramatic as well as deserving of more attention (Goldberg, 1984).

The controversy around informing or not informing oncology patients about their condition goes back to ancient Greece (Reiser, 1980) and has lasted through­out the history of medicine. Increased emphasis on this controversy has been pro­moted mostly by changes in the traditional roles of doctors and patients and the increasing life expectancy of oncology patients and by concern for the quality of their survival, which is made possible by improvements both in diagnosis and in the strategies adopted for cancer treatment.

The radical change in mortality rates through the conquest of epidemic disease led to the outbreak of chronic diseases at all age levels, most of them being sequels to infectious diseases whose mortal power has been successfully controlled (Coe, 1984). What seems to remain are the most chronic conditions, which now are the dominant pathologies in our societies (Baszanger, 1986) and for which there are no effective methods for disease remission. Adaptation to the disease--more than its cure--becomes the goal to achieve, and providing information is one of the most effective strategies for doing so.

However, social values, the meaning of the disease, and the role of the doctor have developed radically from the time of patriarchal societies to our own day. From a historical point of view, the doctor/patient relationship has been dominated by the traditional Parsonian model, in which the doctor solves problems by giving out orders that are passively followed by "good patients" (Parsons, 1951), to the extent that the "active-doctor-responsible-for-passive-patient" is still the predomi­nant model in most cases (Sharf, 1988).

The traditional concept of the doctor/patient relationship places patients in a passive, dependent role that involves cooperating with doctors to effect a cure (Brody, 1980). Doctors set the priorities, take the initiative in evaluating patients' health conditions, and control the process through their autonomy and profession­al dominance, thanks to the corpus of knowledge they possess.

Szasz and Hollander (1956) suggested the active involvement of patients in the decision-making process as an alternative to the passive-patient role defend­ed by Parsons (1951). Observers with a progressive focus countered the Parso- nian model of the paternalist doctor, seen as a one-sided authority for decisions concerning health care, with a new pattern for doctor/patient relationships that included individualism and shared responsibility without, however, a loss of rec­ognition of doctors' knowledge, capability, opinions, and experience (Bone, 1992; Goldfield & Rothman, 1987; Mackillop, Stewart, Ginsburg, & Stewart, 1988; Schain, 1980). …

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