Patient-centred advanced cancer care: a systemic functional linguistic analysis of oncology consultations with advanced cancer patients

This thesis provides a linguistic description of the practice of patient-centred care based on a corpus of 69 transcribed oncology consultations with advanced cancer patients. Using tools from Halliday’s systemic functional linguistics, the thesis identifies ways in which personhood and patient-centredness is realized semiotically in a series of papers. First, a systematic literature review provides an overview of the previous research on the linguistic operationalisation of patient-centredness and the theoretical approaches applied. This is followed by three types of analyses including (1) looking at the nature of the social context around and enacted by the discourse of oncology consultation and analysing a sub-corpus of10 consultations; (2) looking at how the patients identify themselves and construct their experience and sense of self during the consultations; and (3) considering how two contrasting oncologists in the sample construct their role and that of the patient through their answers to the questions asked by the patients and their companions. The findings suggest that a patient-centred practice involves the enactment of a ‘facilitating’ role by the oncologist. Through this role, the oncologist facilitates a new doctor-patient relationship in which the degree of ‘classification’ and ‘insulation’ (Bernstein, 1990) between them is reduced. The data shows that this is done by considering and discussing the patients’ personal circumstances and their personal lives as affected by the illness as well as through informing the patients about their body, their illness, their options, rights and entitlements, and generally through enabling them to be an informed patient who is the centre of healthcare. Such practice acknowledges that the dying patients are semiotically agentive. It also appreciates the patient’s experience of maintaining a sense of normalcy in the face of a life-limiting illness. A patient-centred practice is further characterised with elaborated reasoning to provide more information and precise information to the conscious and semiotically agentive patient.