The online use of Violence and Journey metaphors by patients with cancer, as compared with health professionals: a mixed methods study

Cancer experience in metaphors: patients, carers, professionals, students - a scoping review

The use of metaphors to talk about cancer experiences has attracted much research and debate, especially in the case of military metaphors. However, questions remain about what metaphors are used by different populations for different aspects of the cancer experience. This scoping review aims to answer them.We searched PubMed, PsycINFO, CINAHL, Scopus and Web of Science databases. Eligible sources include peer-reviewed scientific research published in English between 2013 and 2023, investigating patterns of metaphor use from adult populations (age ≥18) for cancer-related topics, such as cancer itself, the general experience of being ill, treatment, and people and relationships.Out of 1929 articles identified, 30 met the criteria, spanning over different populations. While most papers focused on cancer in general, some focused on specific cancer types, such as breast cancer. Both spontaneous and elicited data were collected in ten languages: mostly English (N=12), Swedish (N=3) and Arabic (N=3). The identified metaphors were subsumed under various broad categories, including particularly violence and journey. Other categories include education and non-human animate entity for the cancer itself, confinement and deprivation and cleanliness for the general experience of being ill with cancer, Poison and gardening for cancer treatment, and distance for patients' social relationships.It was found that metaphors help to identify how patients describe experiences of vulnerability and empowerment. To provide patient-centred care, clinicians and researchers should avoid blanket conclusions about helpful or unhelpful metaphors, but consider the ways in which different metaphors are used by different populations in different contexts.

Between loss and restoration: The role of liminality in advancing theories of grief and bereavement

A recent national survey of bereaved partners found high levels of complicated grief and psychological distress, with evidence that loneliness and isolation may contribute to these outcomes. However, the mechanisms of action for this have not been explored. To advance grief theory this paper reports analysis of the survey free-text data to examine the relationship between social support and emotional responses to bereavement. Individuals bereaved of a civil partner or spouse 6-10 months previously were identified through death registration data. 569/1945 (29 %) completed surveys were received. Of those, 311 participants (55 %) provided responses to two free-text questions which asked about their 'feelings since the death of their partner or spouse', and 'about the support around' them. Data were analysed using corpus-assisted discourse analysis and the discourse dynamics approach for figurative language. Participants described diverse emotional responses to the bereavement (e.g. sadness, anger, denial, acceptance), and the value of formal and informal bereavement support. Although many of the experiences described are accounted for in existing grief theory, some participants described a liminal experience not recognised within these theories. They felt trapped, unable to engage with loss or restoration, and unable to move forward as their planned future no longer existed. They sought out 'communitas' (solidarity in experiences), but often found support from their social networks had diminished. Metaphors were used to describe this liminality, with partner grief expressed as a dark agentic force, a monster, an abyss, and as water. The findings of this study offer original insights into experiences and trajectories of bereavement, and our understandings of prolonged or complicated grief. A novel model 'Between Loss and Restoration' is presented to include these experiences. Recognition of the place for liminality within the spectrum of grief experiences could enhance grief literacy and improve formal and informal bereavement support provision.

Sports fanaticism as a disease: a Corpus-based study of metaphors in Saudi newspapers

Sports fanaticism seems to be a social and national concern in Saudi Arabia. This paper aims: 1) to identify the metaphorical manifestations and highlight the discursive construction of disease as associated with sports fanaticism in a corpus of Saudi newspapers articles; and 2) to seek plausible explanations for the emergence and use of disease metaphors in newspapers articles addressing sports fanaticism. King Abdulaziz City for Science and Technology Arabic Corpus (KACSTAC) served the data for the current study. The analytical procedures were informed by the discourse dynamics approach and metaphor-led discourse analysis. Findings show that sports fanaticism could be associated with the following systematic metaphors: 1) disease, in general; 2) disease causes; 3) disease symptoms; 4) disease evaluations; and 5) disease needs for medical solutions, interventions, treatments, and/or prescriptions. The discussion evokes a number of aspects: sports fanaticism emerges as a key topic; disease metaphors seem to be shaped and developed by the societal context and the nature of newspapers texts and discourse; they are enriched and influenced by the discourse situation and the needs to jointly construct and communicate intense experiences through specific evaluations and referential functions, which have a powerful resonance for the Saudi national and social levels; the use of disease metaphorical frames can structure our understanding and can simplify the concept of fanaticism.

Cancer-related pain experienced in daily life is difficult to communicate and to manage - for patients and for professionals

OBJECTIVES

The aim of this study was to gain qualitative insight into cancer patients' experiences, explanations, and management strategies regarding their cancer-related pain (CP).

METHODS

Seventeen patients with CP were interviewed using a semi-structured interview approach. Braun and Clarke's thematic analysis method was used to analyze the transcribed interviews. The patients all participated in cancer rehabilitation courses arranged by the research clinic at The Danish Knowledge Centre for Rehabilitation and Palliative Care.

RESULTS

Three themes were identified: (1) Explaining CP: Patients found it difficult to explain how they experienced their pain. They lacked words, and they frequently used invasive metaphors such as "Pain feels like a heart attack" (2). Strategies and barriers to the management of CP: Initiatives provided by healthcare professionals (HCPs) were perceived as insufficient, and the patients missed guidance in both pharmacological and non-pharmacological approaches to pain management. Several saw medicine as unnatural for their body, and they focused on side effects and the medicine affecting their quality of life. (3) Responsibility for managing CP: A lack of responsiveness from the HCPs and taking on responsibility for pain management were experienced by several of the patients. The patients expressed uncertainty about whom to contact for help with the management of their CP.

CONCLUSION

The patients' difficulties in explaining, understanding, and communicating their pain and pain management contributed to insufficient pain management. They were also uncertain about who had the responsibility to help them to achieve pain relief. These results share the evidence drawn from studies on patients with chronic non-cancer pain. This qualitative study highlights the need for having more focus on a common language and shared understanding between patients and HCPs. It also underpins the importance of HCPs to assume their responsibility to help patients manage their pain conditions.

The use of metaphors by service users with diverse long-term conditions: a secondary qualitative data analysis

Long-term conditions and accompanied co-morbidities now affect about a quarter of the UK population. Enabling patients and caregivers to communicate their experience of illness in their own words is vital to developing a shared understanding of the condition and its impact on patients' and caregivers' lives and in delivering person-centred care. Studies of patient language show how metaphors provide insight into the physical and emotional world of the patient, but such studies are often limited by their focus on a single illness. The authors of this study undertook a secondary qualitative data analysis of 25 interviews, comparing the metaphors used by patients and parents of patients with five longterm conditions. Analysis shows how similar metaphors can be used in empowering and disempowering ways as patients strive to accept illness in their daily lives and how metaphor use depends on the manifestation, diagnosis, and treatment of individual conditions. The study concludes with implications for how metaphorical expressions can be attended to by healthcare professionals as part of shared care planning.

Who works on the 'frontline'? comparing constructions of 'frontline' work before and during the COVID-19 pandemic

This article provides a comparative analysis of how frontline workers were constructed by the UK media prior to and during the COVID-19 pandemic in the UK. Both the News on the Web Corpus and the Coronavirus Corpus, as monitor corpora of web-based new articles, were utilised to identify changes in both the frequency and use of the word front*line from 2010 to 2021. Findings show that, following the outbreak of COVID-19, constructions of frontline work were more frequently associated with medical professions and became more figurative in nature. Our findings provide a counterpoint to claims that the COVID-19 pandemic led to an increased awareness of the critical nature of many types of 'low-skilled' work not previously recognised as essential. The study also extends previous research which has traced changes in language and its deployment during the COVID-19 pandemic.

Metaphor analysis meets lexical strings: finetuning the metaphor identification procedure for quantitative semantic analyses

Recent years have witnessed the development of the Metaphor Identification Procedure (MIP/VU), a step-by-step protocol designed to identify metaphorically-used words in discourse. However, MIP(VU)'s merits notwithstanding, the procedure poses a problem to scholars intending to use its output as the basis for a semantic field analysis involving a quantitative component. Depending on the research question, metaphor analysts may be interested in chunks of language situated above the procedure's standardized level of analysis (i.e., the lexical unit or lexeme), including phrases and sentences. Yet, attempts to decenter the method's exclusive focus on metaphor-related words have been the target of critique, among others on the grounds of their lack of clear unit-formation guidelines and, hence, their inconsistent unit of analysis and measurement. Drawing on data derived from a Spanish-language US-based newspaper's coverage of the migration program known as DACA (Deferred Action for Childhood Arrivals), this article describes challenges that analysts can run into when attempting to use a dataset containing atomized metaphor-related words as the input for subsequent quantitative semantic analyses. Its main methodological contribution consists in a proposal and illustration of three possible methods to extend the existing MIP(VU)-protocol in such a way as to allow it to capture metaphorical strings, on top of lexemes, in a reliable and systematic manner. The first two methods are procedural, and entail formulating a-priori grouping-directives based on the research question(s). One departs from semasiological criteria (Method 1) and the other takes an onomasiological approach (Method 2). The third method works bottom-up, involving the ad hoc grouping of lexemes and adding a descriptive parameter meant to keep track of grouping-decisions made by the analyst, thereby safeguarding transparency at all times.

Metaphors in blogs posted by Chinese lung cancer survivors

Metaphors play a crucial part in human cognition and significantly enhance doctor-patient communication. However, metaphor uses of Chinese lung cancer survivors are still understudied. The aim of the study was to examine how Chinese lung cancer survivors employed metaphors to describe their illness experiences using the method of inductive content analysis. The data analyzed in this study were derived from 15 blogs written by lung cancer survivors and posted on the social media site Xiaohongshu, totaling 204,395 characters. Through the analysis, 1762 metaphor phrases were identified. Five themes emerged: journey metaphor, violence metaphor, burden metaphor, building metaphor, and imprisonment metaphor. The identified metaphors enabled lung cancer survivors to emphasize different aspects of their illness experiences. Consequently, it is imperative for healthcare professionals to pay close attention to the metaphors employed by patients, as they have the potential to shape their understanding of the illness. By recognizing and engaging with these metaphors, healthcare professionals can gain deeper insights into the unique perspectives of Chinese lung cancer survivors, thus facilitating more effective communication and empathetic care.

Metaphors and decision making in parental blogs about their children with life-limiting diseases: who's afraid of the war metaphor?

The use of metaphors aids understanding by allowing us to think of complex problems in terms of relatively simple and more concrete information. As such, metaphors shape thought and guide future action. While metaphors are known to play a role in medical treatment decision-making, the effect of particular metaphors is unknown.This paper explores the metaphors West-European parents use for their child suffering from a life-limiting condition by analysing 15 blogs from Dutch, German and English and Welsh parents. The analysis found that all parents use war metaphors to describe their child and their disease. Describing their child in war metaphors, for example, 'fighter', 'hero' or 'trooper' allows parents to express their pride in their child. To describe the familial situation parents use both 'life as a fight' and a 'time as space' metaphor. Time is conceptualised as a space to be filled with positive experiences to allow the child to live as full a life as possible. In medical treatment decisions, parents balance 'fighting the disease' against their child's ability to live a good life. No evidence was found that the use of war metaphors increase a tendency to treat when benefit is unlikely. Instead, parents primarily use war metaphors as a conduit to express their love for their child and to empower them to manage the familial situation.

Words for the hearts: a corpus study of metaphors in online depression communities

Purpose/significance

Humans understand, think, and express themselves through metaphors. The current paper emphasizes the importance of identifying the metaphorical language used in online health communities (OHC) to understand how users frame and make sense of their experiences, which can boost the effectiveness of counseling and interventions for this population.

Methods/process

We used a web crawler to obtain a corpus of an online depression community. We introduced a three-stage procedure for metaphor identification in a Chinese Corpus: (1) combine MIPVU to identify metaphorical expressions (ME) bottom-up and formulate preliminary working hypotheses; (2) collect more ME top-down in the corpus by performing semantic domain analysis on identified ME; and (3) analyze ME and categorize conceptual metaphors using a reference list. In this way, we have gained a greater understanding of how depression sufferers conceptualize their experience metaphorically in an under-represented language in the literature (Chinese) of a new genre (online health community).

Results/conclusion

Main conceptual metaphors for depression are classified into PERSONAL LIFE, INTERPERSONAL RELATIONSHIP, TIME, and CYBERCULTURE metaphors. Identifying depression metaphors in the Chinese corpus pinpoints the sociocultural environment people with depression are experiencing: lack of offline support, social stigmatization, and substitutability of offline support with online support. We confirm a number of depression metaphors found in other languages, providing a theoretical basis for researching, identifying, and treating depression in multilingual settings. Our study also identifies new metaphors with source-target connections based on embodied, sociocultural, and idiosyncratic levels. From these three levels, we analyze metaphor research's theoretical and practical implications, finding ways to emphasize its inherent cross-disciplinarity meaningfully.

Narratives about Cancer: What Metaphors can tell us about Depressive Symptoms in Breast Cancer Patients

Metaphors are pervasive in cancer discourse. However, little is known about how metaphor use develops over time within the same patient, and how metaphor use and its content relate to the mental health of the patient. Here, we analyzed metaphor use in personal essays written by breast cancer patients shortly after the time of diagnosis and nine months later, in relation to their depressive symptoms at both time points. Results show that metaphor use can provide important insight into a patient's current mental state. Specifically, patients who had no change in their depressive symptom levels used metaphors more densely after nine months. In addition, metaphor valence in the later essay was associated with depressive symptoms at study entry and nine months after. Lastly, we observed a shift in metaphor reference pattern for different symptom trajectories, such that those who recovered from initially elevated depressive symptoms used fewer self-referencing metaphors and more cancer-referencing metaphors in their later essay. Our work suggests that metaphor use reflects how a patient is coping with their diagnosis.

Machines, journeys, prisons and yo-yos: Metaphors of pain, illness and medicine in consultations with chronic pain patients

INTRODUCTION

This paper examines pain, illness and medicine metaphors as used in consultations between chronic pain patients and anaesthesiologists, physiotherapists and psychologists in a Belgian pain clinic. As metaphors frame and highlight aspects of understanding and experiences of life events, including illness, they can provide insight in how health professionals and patients construct illness, pain and medicine in interaction.

MATERIALS AND METHOD

16 intake consultations (collected in Belgium in April-May 2019) between 6 patients and 4 health professionals were qualitatively coded twice ATLAS. TI by a team of 3 coders, using an adjusted form of the Metaphor Identification Procedure. Each metaphor was labelled for source domain, target domain and speaker.

RESULTS

A number of metaphors that have been previously documented in past research were frequent in our data too, such as journey and machine metaphors, although sometimes also used differently, like war metaphors. Our data set also contained many few-used and sometimes more novel metaphors, such as ILLNESS IS A YO-YO. Many metaphors highlight particular aspects of living with and talking about chronic pain, such as its duration and persistent presence, a lack of agency and feelings of powerlessness, and a dualistic perspective on body and mind.

DISCUSSION AND CONCLUSION

The metaphors used by health professionals and patients give insight in the lived experience of having and treating chronic pain. In this way, they can contribute to our understanding of patients' experiences and challenges, how they recur in clinical communication, and how they are related to wider discourses on health, illness and pain.

Metaphors in End-of-Life Dreams in Patients Receiving Palliative Care: A Secondary Qualitative Study

Background: Metaphors are used by patients and professionals in the discourse of disease and can facilitate conversations about difficult topics. There is little information about metaphors present in patients' end-of-life dreams. Objective: Identify and interpret metaphors in end-of-life dreams, directly reported by patients in palliative care. Design: A qualitative study with a secondary analysis of transcribed face-to-face interviews with patients. Setting/Participants: The study includes 25 patients with end-stage disease receiving advanced end-of-life palliative care. In total, 41 interviews were performed. Results: Metaphors applicable to 3 themes were found: the journey toward death, the inevitability of death and death itself. The underlying meaning of the metaphors is often related to topics and emotions commonly relevant in dialogue with patients near death. Patients, however, often seemed unaware of the meaning of their dream metaphors. Conclusion: Metaphors pertaining to death are present in end-of-life dreams in patients with end-stage disease. We hypothesize that encouraging patients to talk about their dreams can expose metaphors that could facilitate end-of-life discussions.

Corpus linguistics and clinical psychology: Investigating personification in first-person accounts of voice-hearing

Triangulating corpus linguistic approaches with other (linguistic and non-linguistic) approaches enhances "both the rigour of corpus linguistics and its incorporation into all kinds of research" (McEnery & Hardie, 2012:227). Our study investigates an important area of mental health research: the experiences of those who hear voices that others cannot hear, and particularly the ways in which those voices are described as person-like. We apply corpus methods to augment the findings of a qualitative approach to 40 interviews with voice-hearers, whereby each interview was coded as involving 'minimal' or 'complex' personification of voices. Our analysis provides linguistic evidence in support of the qualitative coding of the interviews, but also goes beyond a binary approach by revealing different types and degrees of personification of voices, based on how they are referred to and described by voice-hearers. We relate these findings to concepts that inform therapeutic interventions in clinical psychology.

Blogging through dementia: Reworking mainstream discourse through metaphor in online early-onset dementia narratives

Background

The depiction of dementia in public discourse tends to operate on two levels: the tragedy discourse or the living well with dementia discourse, where metaphors play a decisive role in the characterization of the condition and the voice of those living with the condition is usually underrepresented.

Purpose

This article analyzes whether and how mainstream discourse on dementia is reworked in first-person accounts of the disease online and explores the attitudes and assumptions about dementia that illness blogs reflect and defy.

Study design

Drawing on Conceptual Metaphor Theory, the article analyzes a corpus of 10 blogs (622 posts) written by individuals living with early-onset dementia to identify the metaphors used to depict dementia, its impact on the self and its social and relational aspects. Metaphor identification was based on the PRAGGLEJAZ metaphor identification procedure.

Results

The study demonstrates that across blogs no single metaphor alone is capable of capturing the complexity of the dementia experience; instead multiple metaphors are deployed to provide a characterization of the multiple faces of this condition. In this way blogs transcend and reshape the reductionist view of dementia that emerges from the either/or dichotomy of the tragedy versus living well with dementia discourses that dominate in media representations. By reshaping some of the metaphors used in mainstream discourse and introducing new ones, blog narratives draw attention to the complex nature of the experience of dementia, acknowledging both the suffering and social and functional losses that the condition brings, while also claiming recognition for personhood, agency, validation, and the aspiration to grow beyond the diagnosis and live a valued life as part of a family and community.

Conclusions

Overall, this study demonstrates that metaphor is a useful tool for providing insights into people’s experience of dementia and that blogs are a platform where stereotypes may be defied and mainstream representations of dementia reworked offering a more holistic view of the condition and granting narrative agency to those who live with dementia.

"More than conquerors": a qualitative analysis of war metaphors for patients with cancer

PURPOSE

Meaning-making is fundamental to the cancer experience and communication within cancer care is saturated with metaphors. The objective of this study was to better understand the impact and function of war metaphors among patients with cancer.

METHODS

Patients at the Duke Cancer Center were purposively sampled for inclusion based on type and stage of their cancer. Each patient underwent a semi-structured interview to explore their use of metaphors in their lived experience with cancer. Qualitative interviews broadly explored two key areas of interest: (1) frequency and use of metaphors to describe cancer diagnosis, treatment, or survivorship; (2) function and impact of the war metaphor on the patient experience of cancer.

RESULTS

Fifteen participants with either breast, lung, or colorectal cancer were interviewed. Most patients used metaphor themes of journey, war, and mystery to describe their cancer. All patients with non-metastatic disease used war metaphors and described how these metaphors facilitated meaning-making by promoting positivity and situating cancer within a larger life story. The few patients who did not use war metaphors had metastatic disease, and they explained that war metaphors were unhelpful due to feeling a lack of control over their metastatic disease and outcomes.

CONCLUSION

The war metaphor should remain an integral part of cancer care. Disregarding war metaphors robs patients of an important framework for meaning-making-one that may promote strength, continuity, and resilience in navigating cancer.

'I don't live in my body somehow': metaphorical talk in women's accounts of vaginismus and dyspareunia

Vaginismus and dyspareunia are common sexual difficulties; they often take a long time to be appropriately diagnosed, and their origins remain unclear. This paper examines the metaphors used by women to describe bodily experiences associated with vaginismus and dyspareunia, and highlights the contribution this form of analysis can make to the study of sexuality and sexual difficulties. A secondary analysis was conducted on primary data from biographic interviews exploring women's experiences of sexual pain and difficulties with sexual intercourse. Metaphor analysis was used to analyse a data subset of 28 interviews translated from German into English. Metaphorical concepts lying at the basis of the metaphors used were identified and grouped into three themes: characterisation of sexual difficulties; split body and 'self'; and sexual agency and objectification. Results are discussed with in the context of literature regarding the function of metaphors and the utility of metaphor analysis for research, and healthcare research and interventions more generally.

The Road Less Traveled: How COVID-19 Patients Use Metaphors to Frame Their Lived Experiences

Metaphor provides an important intellectual tool for communication about intense disease experiences. The present study aimed to investigate how COVID-19-infected persons metaphorically frame their lived experiences of COVID-19, and how the pandemic impacts on their mental health burden. In-depth semi-structured interviews were conducted with 33 patients afflicted with COVID-19. Metaphor analysis of patient narratives demonstrated that: (1) COVID-19 infection impacted patient conceptualization of themselves and the relationship between the "self" and the body, as well as social relationships. (2) Metaphors relating to physical experience, space and time, and integrative behaviors tended to be used by COVID-19 patients in a negative way, whereas war metaphors, family metaphors, temperature metaphors, and light metaphors were likely to express positive attitudes. (3) Patients preferred to employ conventional metaphors grounded on embodied sensorimotor experiences to conceptualize their extreme emotional experiences. This study has important implications with respect to the therapeutic function of metaphors in clinical communication between healthcare professionals and COVID-19 patients.

Medical Metaphors: Increasing Clarity but at What Cost?

BACKGROUND

Clinicians often use metaphors to explain complex ideas. Metaphors also have the potential to reinforce unhelpful thinking regarding symptoms. We surveyed musculoskeletal specialists regarding use of metaphors in their daily practice and then assessed the contexts in which they are used, the themes of metaphors, and potential for reinforcement of common misconceptions (unhelpful thinking). Two primary research questions were posed: 1- What are the common characteristics of the medical metaphors used in patient-clinician communication by musculoskeletal specialists? And, 2- What percentage of medical metaphors used in patient-clinician communication have potential to induce unhelpful thinking and what are the characteristics of those metaphors?

METHODS

Eighty-one orthopedic and trauma specialists provided examples of metaphors they use in daily practice. Qualitative analysis of responses was performed through open coding of the data with the use of a constant-comparative technique involving several rounds of reading and rereading the data.

RESULTS

The 157 metaphors were categorized into 15 different themes. The most common themes were mechanical, objects, and sports and leisure. We also classified metaphors as addressing the natural history of the disease, treatment, mechanism, anatomy, or other. Thirty-five metaphors (22%) were identified as having the potential to reinforce unhelpful thinking. The most common purpose of these metaphors was for explaining the mechanism or natural history of the disease.

CONCLUSION

Metaphors can either reinforce or reorient potentially unhealthy misconceptions. They can also reinforce despair and worry, or they can improve hope and sense of control. Orthopedic surgeons can be strategic and thoughtful in their use of metaphors, planning and practicing specific metaphors for optimal mental, social, and physical health.

"Your Ovaries Are Expired, Like an Old Lady" Metaphor Analysis of Saudi Arabian Women's Descriptions of Breast Cancer: A Qualitative Study

Background

Assessing and understanding the language that women use to express physical, emotional, and social concerns of breast cancer experiences can often be overlooked, even though there is evidence that effective communication between cancer patients and health care providers improves quality of life. This study aims to assess the use of metaphors in conceptualizing breast cancer experience lived by Saudi Arabian women.

Materials and Methods

This is an interpretative phenomenological qualitative study, a purposeful sample of 18 breast cancer patients at an oncology outpatient's clinic in Saudi Arabia were invited to engage in face-to-face interviews. Data was analyzed using Metaphor Identification Procedure (MIP).

Results

Four themes were constructed: dark hidden force, battling imminent death, dreaming and awakening calls, and inner and outer transformation.

Conclusion

Identifying metaphors may be beneficial toward improving communication between health care providers and breast cancer patients, who often experience difficulties expressing their needs.

Language matters: representations of 'heart failure' in English discourse-a large-scale linguistic study

AIMS

Heart failure (HF) has a lower public profile compared with other serious health conditions, notably cancer. This discourse analysis study investigates the extent to which HF is discussed in general contemporary English, UK parliamentary debates and the ways in which HF is framed in discussions, when compared with two other serious health conditions, cancer and dementia.

METHODS

The Oxford English Corpus (OEC) of 21st century English-language texts (2 billion words) and the UK Hansard Reports of parliamentary debates from 1945 to early 2021 were used to investigate the relative frequencies, contexts and use of the terms 'heart failure', 'cancer' and 'dementia'.

RESULTS

In the OEC, the term 'heart failure' occurs 4.26 times per million words (pmw), 'dementia' occurs 3.68 times pmw and 'cancer' occurs 81.96 times pmw. Cancer is talked about 19 times more often than HF and 22 times more often than dementia. These are disproportionately high in relation to actual incidence: annual cancer incidence is 1.8 times that of the other conditions; annual cancer mortality is two times that caused by coronary heart disease (including HF) or dementia.'Heart failure' is used much less than 'cancer' in UK parliamentary debates (House of Commons and House of Lords) between 1945 and early 2021, and less than 'dementia' from 1990 onwards. Moreover, HF is even mentioned much less than pot-holes in UK roads and pavements. In 2018, for example, 'pot-hole/s' were mentioned over 10 times pmw, 37 times more often than 'heart failure', mentioned 0.28 times pmw. Discussions of HF are comparatively technical and formulaic, lacking survivor narratives that occur in discussions of cancer.

CONCLUSIONS

HF is underdiscussed in contemporary English compared with cancer and dementia and underdiscussed in UK parliamentary debates, even compared with the less-obviously life-threatening topic of pot-holes in roads and pavements.

Everyday discrimination and cancer metaphor preferences: The mediating effects of needs for personal significance and cognitive closure

Metaphors are often used to describe cancer experiences (e.g., battle, journey). Few studies explore how social threats (e.g., discrimination) shape metaphor preferences. We examined the relationship between discrimination and preferences for cancer battle metaphors (i.e., concrete, action-based) versus journey metaphors (i.e., open-ended, reflective) and mediating effects of needs for personal significance and cognitive closure. We also stratified the analysis when discrimination was/was not attributed to race and by racial/ethnic group. Four-hundred twenty-seven U.S. participants completed an online survey. Items included everyday discrimination, need for personal significance, need for cognitive closure, and preference for cancer scenarios using battle or journey metaphors. Multigroup structural equation modeling examined: serial mediation (i.e., discrimination predicting metaphor preference via needs for personal significance and cognitive closure) stratified by discrimination attribution; and single mediation (i.e., discrimination predicting need for cognitive closure via need for personal significance) stratified by racial/ethnic group. Discrimination was associated with battle metaphor preferences through serial mediation when discrimination was not attributed to race (β = 0.02, 95% CI [0.01,0.05]). Discrimination was directly associated with journey metaphor preferences (β = -0.20, 95% CI [-0.37,-0.06]) and the serial mediation was nonsignificant when discrimination was attributed to race. The single mediation model varied across racial/ethnic groups and was strongest for Non-Hispanic White participants (β = 0.17, 95% CI [0.07,0.30]). Discrimination may shape cancer metaphor preferences through needs for personal significance and cognitive closure, yet these relationships differ based on whether discrimination is attributed to race and racial/ethnic group. Given that the U.S. health system often focuses on battle metaphors when framing cancer treatment and screenings, individuals who prefer journey metaphors (i.e., those who experienced more frequent racial discrimination in the present study) may experience a systematic disadvantage in cancer communication. A more careful consideration of cultural, racial, and ethnic differences in metaphor use may be a crucial step towards reducing cancer disparities.

Embodied metaphor in communication about lived experiences of the COVID-19 pandemic in Wuhan, China

The study investigated how a group of 27 Wuhan citizens employed metaphors to communicate about their lived experiences of the Corona Virus Disease 2019 (COVID-19) pandemic through in-depth individual interviews. The analysis of metaphors reflected the different kinds of emotional states and psychological conditions of the research participants, focusing on their mental imagery of COVID-19, extreme emotional experiences, and symbolic behaviors under the pandemic. The results show that multiple metaphors were used to construe emotionally-complex, isolating experiences of the COVID-19 pandemic. Most metaphorical narratives were grounded in embodied sensorimotor experiences such as body parts, battling, hitting, weight, temperature, spatialization, motion, violence, light, and journeys. Embodied metaphors were manifested in both verbal expressions and nonlinguistic behaviors (e.g., patients' repetitive behaviors). These results suggest that the bodily experiences of the pandemic, the environment, and the psychological factors combine to shape people's metaphorical thinking processes.

Epistemologies of evidence-based medicine: a plea for corpus-based conceptual research in the medical humanities

Evidence-based medicine has been the subject of much controversy within and outside the field of medicine, with its detractors characterizing it as reductionist and authoritarian, and its proponents rejecting such characterization as a caricature of the actual practice. At the heart of this controversy is a complex linguistic and social process that cannot be illuminated by appealing to the semantics of the modifier evidence-based. The complexity lies in the nature of evidence as a basic concept that circulates in both expert and non-expert spheres of communication, supports different interpretations in different contexts, and is inherently open to contestation. We outline a new methodology that combines a social epistemological perspective with advanced methods of corpus linguistics and elements of conceptual history to investigate this and other basic concepts that underpin the practice and ethos of modern medicine. The potential of this methodology to offer new insights into controversies such as those surrounding EBM is demonstrated through a case study of the various meanings supported by evidence and based, as attested in a large electronic corpus of online material written by non-experts as well as a variety of experts in different fields, including medicine.

Social Media Monitoring of the COVID-19 Pandemic and Influenza Epidemic With Adaptation for Informal Language in Arabic Twitter Data: Qualitative Study

BACKGROUND

Twitter is a real-time messaging platform widely used by people and organizations to share information on many topics. Systematic monitoring of social media posts (infodemiology or infoveillance) could be useful to detect misinformation outbreaks as well as to reduce reporting lag time and to provide an independent complementary source of data compared with traditional surveillance approaches. However, such an analysis is currently not possible in the Arabic-speaking world owing to a lack of basic building blocks for research and dialectal variation.

OBJECTIVE

We collected around 4000 Arabic tweets related to COVID-19 and influenza. We cleaned and labeled the tweets relative to the Arabic Infectious Diseases Ontology, which includes nonstandard terminology, as well as 11 core concepts and 21 relations. The aim of this study was to analyze Arabic tweets to estimate their usefulness for health surveillance, understand the impact of the informal terms in the analysis, show the effect of deep learning methods in the classification process, and identify the locations where the infection is spreading.

METHODS

We applied the following multilabel classification techniques: binary relevance, classifier chains, label power set, adapted algorithm (multilabel adapted k-nearest neighbors [MLKNN]), support vector machine with naive Bayes features (NBSVM), bidirectional encoder representations from transformers (BERT), and AraBERT (transformer-based model for Arabic language understanding) to identify tweets appearing to be from infected individuals. We also used named entity recognition to predict the place names mentioned in the tweets.

RESULTS

We achieved an F1 score of up to 88% in the influenza case study and 94% in the COVID-19 one. Adapting for nonstandard terminology and informal language helped to improve accuracy by as much as 15%, with an average improvement of 8%. Deep learning methods achieved an F1 score of up to 94% during the classifying process. Our geolocation detection algorithm had an average accuracy of 54% for predicting the location of users according to tweet content.

CONCLUSIONS

This study identified two Arabic social media data sets for monitoring tweets related to influenza and COVID-19. It demonstrated the importance of including informal terms, which are regularly used by social media users, in the analysis. It also proved that BERT achieves good results when used with new terms in COVID-19 tweets. Finally, the tweet content may contain useful information to determine the location of disease spread.

Communication About End of Life for Patients Living With Amyotrophic Lateral Sclerosis: A Scoping Review of the Empirical Evidence

Background: Communication about end of life, including advance care planning, life-sustaining therapies, palliative care, and end-of-life options, is critical for the clinical management of amyotrophic lateral sclerosis patients. The empirical evidence base for this communication has not been systematically examined. Objective: To support evidence-based communication guidance by (1) analyzing the scope and nature of research on health communication about end of life for amyotrophic lateral sclerosis; and (2) summarizing resultant recommendations. Methods: A scoping review of empirical literature was conducted following recommended practices. Fifteen health-related and three legal databases were searched; 296 articles were screened for inclusion/exclusion criteria; and quantitative data extraction and analysis was conducted on 211 articles with qualitative analysis on a subset of 110 articles that focused primarily on health communication. Analyses summarized article characteristics, themes, and recommendations. Results: Analysis indicated a multidisciplinary but limited evidence base. Most reviewed articles addressed end-of-life communication as a peripheral focus of investigation. Generic communication skills are important; however, substantive and sufficient disease-related information, including symptom management and assistive devices, is critical to discussions about end of life. Few articles discussed communication about specific end-of-life options. Communication recommendations in analyzed articles draw attention to communication processes, style and content but lack the systematized guidance needed for clinical practice. Conclusions: This review of primary research articles highlights the limited evidence-base and consequent need for systematic, empirical investigation to inform effective communication about end of life for those with amyotrophic lateral sclerosis. This will provide a foundation for actionable, evidence-based communication guidelines about end of life. Implications for research, policy, and practice are discussed.

Prostate Cancer From a Sex and Gender Perspective: A Review

INTRODUCTION

Factors influencing patient behavior regarding risk of prostate cancer (PCa) and outcomes of PCa treatments are poorly understood. Similarly, how PCa treatments affect patient sexual function and sense of their masculinity has not been fully investigated. A better understanding of the relationship between sex and gender for patients with PCa could significantly improve their care and quality of life.

OBJECTIVES

To review how concerns about sex and gender influence men's attitudes toward PCa screening, diagnosis, and treatment. To explore how PCa influences sexual function and self-perceived masculine identity. To examine contexts for PSA screening for transgender individuals.

METHODS

We reviewed biomedical and sociological literature exploring the impact of PCa on patient sexual function and self-perceived masculinity using OVID, PubMed, and other databases. We similarly reviewed how masculine gender norms influence patient willingness to engage with PCa screening, diagnoses, and treatment.

RESULTS

Gender norms and sexual function concerns influence patient engagement in all aspects of PCa care. This includes PSA screening, digital rectal examinations, active surveillance, and androgen deprivation therapy (ADT) amongst others. ADT is particularly challenging to sexual function, self-esteem, and masculine identity. Our research suggests that sex and gender are not separate concepts, but rather tightly intertwined, particularly when dealing with the realities experienced by patients with PCa.

CONCLUSION

Interventions to help patients deal with the challenges of PCa and its treatment are likely to be most effective if they concurrently address patients' sexual needs and understanding of gender norms. PSA screening should be considered for transgender individuals who are at greater risk of cancer and on long-term hormone therapy. More research is needed on how concerns over sex and gender influence PCa screening, diagnosis, and treatment. There is also a need for long term data on the oncological outcomes of prolonged exposure to hormone therapy for patients who are transgender. Muermann MM, Wassersug RJ. Prostate Cancer From a Sex and Gender Perspective: A Review. Sex Med Rev 2021;XX:XXX-XXX.

Eliciting the Concept of Cancer in Nursing Students in Turkey: an Exploratory Metaphor Analysis

OBJECTIVES

Although there are promising studies on cancer treatment, it is still a frightening disease. For effective treatment, an integrative and positive perspective is required. Using the power of metaphors to facilitate understanding of complex and intangible ideas, this study aims to define cancer from the perspective of Turkish nursing students.

SAMPLE AND SETTING

This study was conducted with 166 nursing students at a nursing faculty in Turkey. It was a mixed method study using qualitative and quantitative methods.

METHODS AND VARIABLES

To capture the picture in a human mind of the complexity of feelings for cancer, writing a description and elicitation interviews were employed. Moreover, to reach ontological and epistemological level thoughts in the deepest layers of elicited metaphors, the data were analyzed in an analytical framework.

RESULTS

The study provides a conceptualization of "Cancer." The students produced 92 valid metaphors. The most commonly used metaphors were found to be 'death', 'war', 'a virus', 'a malady' and 'a spider'. It was found that the metaphors produced by the students on the concept of cancer generally used negative themes.

IMPLICATIONS FOR NURSING

This study provides a framework for understanding all aspects of the concept of cancer on the metaphor axis. It is believed that the results will provide an holistic approach toward the concept of cancer, especially in nursing education, and will increase awareness of this concept.

"Not Soldiers but Fire-fighters" - Metaphors and Covid-19

Metaphors have been widely used in communication about the Covid-19 pandemic. The virus has been described, for example, as an "enemy" to be "beaten," a "tsunami" on health services and even as "glitter" that "gets everywhere." This paper discusses different metaphors for the pandemic, and explains why they are used and why they matter. War metaphors are considered first, as they were particularly frequent and controversial at the beginning of the pandemic. An overview of alternative metaphors is then provided, drawing from the "#ReframeCovid" crowd-sourced multilingual collection of metaphors for Covid-19. Finally, based on both the #ReframeCovid collection and a systematic analysis of a large corpus of news articles in English, it is suggested that Fire metaphors are particularly appropriate and versatile in communication about different aspects of the pandemic, including contagion and different public health measures aimed at reducing it.

Your Father's a Fighter; Your Daughter's a Vegetable: A Critical Analysis of the Use of Metaphor in Clinical Practice

There are two widespread beliefs about the use of metaphors in clinical medicine. The first is that military metaphors are harmful to patients and should be discouraged in medical practice. The second is that the metaphors of clinical practice can be judged by and standardized in reference to neutral criteria. In this article, I evaluate both these beliefs, exposing their shared flawed logic. This logic underwrites the false empiricist assumptions that metaphorical language and literal language are fundamentally distinct, play separate roles in communication, and therefore can be independently analyzed, systematized, and prescribed. Next, using the resources of ordinary language philosophy, I lay out a theoretical view of medical metaphors that is grounded in metaphor use within clinician-patient relationships. Finally, drawing on the work of philosopher Max Black, I diagram a practical conceptual framework for clinicians to use when they consider whether a metaphor is appropriate for a specific patient encounter.

The War on Prevention II: Battle Metaphors Undermine Cancer Treatment and Prevention and Do Not Increase Vigilance

Bellicose metaphors for cancer are ubiquitous. But are they good metaphors for health communicators to use? Because metaphors can guide reasoning about abstract concepts, framing cancer with metaphors of battle, war, and enemies leads people to apply attributes of these concepts to cancer. The current research investigates how this affects inferences about cancer treatment, prevention, and monitoring. Battles and war are usually seen as being difficult. Indeed, reading about a person's "battle" or "fight" against cancer makes cancer treatment seem more difficult (studies 1-4). One way to approach a battle is to surrender and give up control. Consistent with this implication, battle metaphors increase fatalistic beliefs about cancer prevention (e.g. believing that there is little one can do to prevent getting cancer; study 3). Finally, even though battles invoke vigilance and action, Study 4 failed to find that such metaphors motivate people to immediately see their doctor when imagining a cancer scare. These findings suggest that bellicose metaphors for cancer can influence the health beliefs of nonpatients in ways that may make them less willing to enact healthy behaviors.

Framing COVID-19: How we conceptualize and discuss the pandemic on Twitter

Doctors and nurses in these weeks and months are busy in the trenches, fighting against a new invisible enemy: Covid-19. Cities are locked down and civilians are besieged in their own homes, to prevent the spreading of the virus. War-related terminology is commonly used to frame the discourse around epidemics and diseases. The discourse around the current epidemic makes use of war-related metaphors too, not only in public discourse and in the media, but also in the tweets written by non-experts of mass communication. We hereby present an analysis of the discourse around #Covid-19, based on a large corpus tweets posted on Twitter during March and April 2020. Using topic modelling we first analyze the topics around which the discourse can be classified. Then, we show that the WAR framing is used to talk about specific topics, such as the virus treatment, but not others, such as the effects of social distancing on the population. We then measure and compare the popularity of the WAR frame to three alternative figurative frames (MONSTER, STORM and TSUNAMI) and a literal frame used as control (FAMILY). The results show that while the FAMILY frame covers a wider portion of the corpus, among the figurative frames WAR, a highly conventional one, is the frame used most frequently. Yet, this frame does not seem to be apt to elaborate the discourse around some aspects involved in the current situation. Therefore, we conclude, in line with previous suggestions, a plethora of framing options—or a metaphor menu—may facilitate the communication of various aspects involved in the Covid-19-related discourse on the social media, and thus support civilians in the expression of their feelings, opinions and beliefs during the current pandemic.

Parallel worlds and personified pain: A mixed-methods analysis of pain metaphor use by women with endometriosis

OBJECTIVES

Endometriosis is a long-term condition in which endometrial-like tissue grows outside of the womb, causing intense chronic pain. Previous work has demonstrated the physical and emotional impact on women who live with endometriosis, and metaphors can play an influential role in communicating the experience of pain, but there exists little understanding of the role and impact of such language for women with endometriosis.

DESIGN

A qualitative, semi-structured interview design.

METHODS

Conceptual Metaphor Theory (CMT) and Interpretative Phenomenological Analysis (IPA) were utilized in a mixed-methods study to examine the prevalence, types, and meaning of metaphors and metaphor use as a health communication strategy. Twenty-one women aged between 23 and 53 years (mean age 36.1 years) with endometriosis took part in audio-recorded interviews.

RESULTS

The women reported experiencing symptoms for an average of 11 years before receiving a formal diagnosis of endometriosis, and the mean age of diagnosis was 27.6 years. Seven distinct conceptual metaphors were identified in 221 metaphorical expressions used across all participants, with most common ones referring to pain as physical properties of elements such as temperature and pressure, physical damage, and an external attacker. IPA revealed three themes pertaining to the feeling of vulnerability and helplessness, pain being incomprehensible, and a drive to manage and conceal pain simultaneously.

CONCLUSIONS

This study demonstrates the power of language in facilitating understanding and empathy in the listener, alongside the challenge of communicating endometriosis pain to others. Imagery-based techniques may assist in adaptation to, interpretation, and acceptance of pain to reduce pain-related distress.

Coping by metaphors: the versatile function of metaphors in blogs about living with advanced cancer

Living with a life-limiting cancer illness can entail a turmoil of feelings such as constant fear of loss, suffering and dying. Because patients live longer with life-limiting illness, there is a need for enhanced understanding of how people make sense of and cope with the complicated aspects that this life situation brings on. In this article, we explore how bloggers with advanced cancer use metaphors as ways of making sense of their experiences. Our study is theoretically grounded in Conceptual Metaphor Theory, where metaphors are seen as a powerful phenomenon that both reflects and affects our thinking. The data consist of a corpus of blogs written in Swedish by individuals with advanced cancer, and the findings from our linguistic metaphor analysis are consistently interpreted against the backdrop of literature on coping. Our study thus highlights the intersection of linguistic metaphor analysis and psychological theories of coping by illustrating the many and complex functions metaphors can have as part of sense-making processes. Our hermeneutic approach enables us to show some differences among the three most pervasive metaphor domains in our material, battle, journey and imprisonment: the journey and imprisonment domains are more flexible than the battle domain in terms of the different kinds of coping strategies that are actualised by the bloggers' use of metaphors. One particular finding from our analysis is the way in which the bloggers make use of metaphors to compartmentalise experiences and emotions. Our contention is that careful attention to the metaphors used by patients can improve communication in healthcare and enhance understanding of the complex role language use plays in coping processes more generally. By highlighting the relation between metaphor use and coping, our analysis also provides a way to discuss coping strategies based on the patient's own use of language.

Praying to win this battle: Cancer Metaphors in Latina and Spanish Women's Narratives

This study closely examines 51 breast cancer narratives Latina and Spanish women wrote for other patients to illuminate how they conceptualize their health, with insights for addressing health disparities. Using discourse analysis of the role of language and culture in health care communication, this study focuses on the use of metaphors in the narratives. This provides revelations about the cultural and linguistic aspects of how the writers conceptualize their disease. Building on past research on metaphor use in cancer discourse in the English language, this study reveals the prevalence of metaphors comparing cancer to combat, or more generally, violence (e.g., "my battle against cancer"), or a journey (e.g., "my path with cancer"). Writers used this metaphorical language to offer advice to others with cancer and to mark their membership in a larger community of people with cancer. We also find that Spanish women use metaphors more frequently than Latinas and that they differed in their metaphorical portrayals of cancer. This research uncovers culturally embedded themes that are central to how women with cancer think about the disease, such as the prominence of spirituality in Latinas' metaphorical constructions, a pattern not evident in Spanish women's narratives.

Battle, Journey, Imprisonment and Burden: patterns of metaphor use in blogs about living with advanced cancer

BACKGROUND

The significance of metaphors for the experience of cancer has been the topic of extensive previous research, with "Battle" and "Journey" metaphors standing out as key. Adaptation to the patient's use of metaphor is generally believed to be an important aspect of person-centered care, especially in palliative care. The aim of this study was to investigate the use of metaphors in blogs written in Swedish by people living with advanced cancer and explore possible patterns associated with individuals, age and gender.

METHODS

The study is based on a dataset totaling 2,602,479 words produced some time during the period 2007-2016 by 27 individuals diagnosed with advanced cancer. Both qualitative and quantitative procedures were used, and the findings are represented as raw frequencies as well as normalized frequencies per 10,000 words. Our general approach was exploratory and descriptive. The Mann-Whitney U test was used to analyze statistical significance.

RESULTS

Our results confirm the strong foothold of "Journey" and "Battle" metaphors. "Imprisonment" and "Burden" metaphors were also used by the majority of the individuals. The propensity to use metaphors when describing the cancer experience was found to differ extensively across the individuals. However, individuals were not found to opt for one conceptualization over the other but tended to draw on several different metaphor domains when conceptualizing their experience. Socio-demographic factors such as age or gender were not found to be strong predictors of metaphor choice in this limited study.

CONCLUSIONS

Using a range of different metaphors allows individuals with advanced cancer to highlight different aspects of their experience. The presence of metaphors associated with "Journey", "Battle", "Imprisonment" and "Burden" across individuals could be explained by the fact that the bloggers are part of a culturally consistent cohort, despite variations in age, sex and cancer form. Awareness of metaphors commonly used by patients can enhance health professionals' capacity to identify metaphorical patterns and develop a common language grounded in the patients' own metaphor use, which is an important requisite for person-centered palliative care.

Using Social Media to Track Geographic Variability in Language About Diabetes: Analysis of Diabetes-Related Tweets Across the United States

Background

Social media posts about diabetes could reveal patients’ knowledge, attitudes, and beliefs as well as approaches for better targeting of public health messages and care management.

Objective

This study aimed to characterize the language of Twitter users’ posts regarding diabetes and describe the correlation of themes with the county-level prevalence of diabetes.

Methods

A retrospective study of diabetes-related tweets identified from a random sample of approximately 37 billion tweets from the United States from 2009 to 2015 was conducted. We extracted diabetes-specific tweets and used machine learning to identify statistically significant topics of related terms. Topics were combined into themes and compared with the prevalence of diabetes by US counties and further compared with geography (US Census Divisions). Pearson correlation coefficients are reported for each topic and relationship with prevalence.

Results

A total of 239,989 tweets from 121,494 unique users included the term diabetes. The themes emerging from the topics included unhealthy food and drink, treatment, symptoms/diagnoses, risk factors, research, recipes, news, health care, management, fundraising, diet, communication, and supplements/remedies. The theme of unhealthy foods most positively correlated with geographic areas with high prevalence of diabetes (r=0.088), whereas tweets related to research most negatively correlated (r=−0.162) with disease prevalence. Themes and topics about diabetes differed in overall frequency across the US geographical divisions, with the East South Central and South Atlantic states having a higher frequency of topics referencing unhealthy food (r range=0.073-0.146; P<.001).

Conclusions

Diabetes-related tweets originating from counties with high prevalence of diabetes have different themes than tweets originating from counties with low prevalence of diabetes. Interventions could be informed from this variation to promote healthy behaviors.

Journeying together: A visual exploration of "engagement" as a journey in HIV programming and service delivery

The experiences of people living with, or impacted by HIV, who participate in research and programming are relatively-well documented. However, how stakeholders within the HIV sector understand engagement, or how it functions discursively, is undertheorized. We used a comparative case study design and photovoice to explore engagement in three community-based organizations providing HIV programs or services in Toronto, Canada. We invited stakeholders to photograph their subjective understandings of engagement. We employ a visual and thematic analysis of our findings, by focusing on participants' use of journey metaphors to discuss engagement within and across sites. Visual metaphors of journey were employed by participants to make sense of their experience, and demonstrated that for many, engagement was a dynamic, affective and relational process. Our findings illustrate how journey may be an apt metaphor to explore the relational, contingent and socio-spatial/political specificities of engagement within and across HIV organizations. We conclude with a discussion on implications for practice.

Content shared on social media for national cancer survivors day 2018

BACKGROUND

Studies estimate that the number of cancer survivors will double by 2050 due to improvements in diagnostic accuracy and treatment efficacy. Despite the growing population of cancer survivors, there is a paucity of research regarding how these individuals experience the transition from active treatment to long-term surveillance. While research has explored this transition from more organized venues, such as support groups for cancer survivors, this paper explores the discourses surrounding cancer survivorship on social media, paying particular attention to how individuals who identify as cancer survivors represent their experience.

METHODS

We identified social media posts relating to cancer survivorship on Twitter and Instagram in early June 2018, in order to coincide with National Cancer Survivorship Day on June 3, 2018. We used nine pre-selected hashtags to identify content. For each hashtag, we manually collected the 150 most recent posts from Twitter and the 100 most recent plus the top 9 posts from Instagram. Our preliminary sample included 1172 posts; after eliminating posts from one hashtag due to irrelevance, we were left with 1063 posts. We randomly sampled 200 of these to create a subset for analysis; after review for irrelevant posts, 193 posts remained for analysis (118 from Instagram and 75 from Twitter). We utilized a grounded theory approach to analyze the posts, first open-coding a subset to develop a codebook, then applying the codebook to the rest of the sample and finally memo writing to develop themes.

RESULTS

Overall, there is substantial difference in the tone and thematic content between Instagram and Twitter posts, Instagram takes on a more narrative form that represents journeys through cancer treatment and subsequent survivorship, whereas Twitter is more factual, leaning towards advocacy, awareness and fundraising. In terms of content type, 120 posts (62%) of the sample were images, of which 42 (35%) were images of the individual posting and 28 (23%) were images of patients posted by family or friends. Of the remaining images, 14 (12%) were of support groups and 7 (6%) were of family or friends. We identified four salient themes through analysis of the social media posts from Twitter and Instagram: social support, celebrating milestones and honoring survivors, expressing identity, and renewal vs. rebirth.

DISCUSSION

We observed a marked relationship between physical appearance, functional status and survivorship. Additionally, our findings suggest the importance of social support for cancer patients and survivors as well as the role social media can pay in identity formation.

CONCLUSION

Our findings suggest that individuals who identify as survivors on social media define their identity fluidly, incorporating elements of physical, emotional and psychological health as well as autonomy.

Illness Cognitions Among Adolescents and Young Adults Who Have a Parent with Cancer: a Qualitative Exploration Using the Common-Sense Model of Self-regulation as a Framework

BACKGROUND

Individuals construct beliefs about an illness based on their own perceptions, interpretation, and understanding of the illness and its treatment. These beliefs (collectively referred to as "illness cognitions" or "representations") can have implications for psychological outcomes in family members and carers of an individual with an illness. The aim of this study was to explore young people's perceptions of their parent's cancer using the Common-Sense Model of Self-Regulation as a theoretical framework.

METHODS

Semi-structured, one-on-one interviews were conducted with young people who had a parent diagnosed with cancer. Interview transcripts were analysed using deductive thematic analysis techniques.

RESULTS

Eleven young people aged 15-24 years participated in the study. Major themes aligned with the dimensions of the Common-Sense Model of Self-Regulation. Young people described their experiences with parental cancer with reference to cognitive representations (beliefs about the illness identity, their understanding or coherence of the illness, and consequences, curability or controllability, timeline, and cause of the illness) and emotional representations (emotional beliefs and subjective feelings about the illness).

CONCLUSIONS

Findings indicate that young people's perceptions of their parent's cancer can be usefully described within the framework of the Common-Sense Model of Self-Regulation. Future research should investigate the relationships between young people's illness cognitions, coping strategies, and psychological adjustment following their parent's cancer diagnosis. This will provide valuable insights for the development of interventions that target specific types of illness cognitions associated with maladaptive coping strategies and poor adjustment.

A Metaphor Analysis of Patients' With Chronic Conditions Experiences With Holistic Nurse Coaching

The purpose of this study was to examine metaphors used by patients with chronic conditions to describe their experience with holistic nurse coaching. A secondary analysis was conducted using Metaphor Identification Procedure to analyze the corpus of 112 pages of typed transcription. Five metaphors emerged: (1) taking personal power back like acquiring a new toolbox; (2) seeing health challenges from different angles like a duck pond race; (3) shifting perception of a chronic condition like a spider turned into a friend; (4) engaging in self-care like caring for a favorite plant; and (5) choosing to focus on the positive like a collage that changed from dark to light. Specific interventions can be developed to address each of these metaphors to help patients live well with chronic conditions.

“Al-Khabith”—The malignant cunning disease: Sociocultural complexity and social representations of cancer in the occupied Palestinian territory

This qualitative research aims to understand the sociocultural complexity and social representations of cancer in the occupied Palestinian territory. The researcher conducted 16 in-depth semi-structured individual interviews with Palestinians from the occupied Palestinian territory, using thematic analysis as a methodology and social representation theory as the theatrical framework. The findings revealed three main themes. The first theme is social representations of cancer and cancer treatments divided into four subthemes: (1.1) manifestations of dilemmatic indeterminacy and vagueness. The second subtheme (1.2) refers to social representations of cancer in close proximity with death. The third subtheme (1.3) is constituted by metaphorical social representations of cancer, and the fourth (1.4) refers to social re-presentations of cancer. The second theme is the paradoxical social representations of cancer patients as divided into three subthemes: (2.1) pity-based societal responses, (2.2) manifestations of stigma, and (2.3) cancer rumors, a form of collective sense-making. The third theme, religious discourses and social representations of cancer, is divided into three subthemes: (3.1) cancer as predestined by the will of God, (3.2) cancer as a punishment or a trial, and (3.3) a spiritual journey of healing. The implications of this research suggest that social representations research can take a lead in promoting social and health change. The biomedical paradigm alone is failing in Palestine to encounter the sociocultural complexity connected to representations of cancer and its impact on future-health behaviors. Thus, stakeholders and policy-makers in Palestine need to build a mutual interaction between scientific encounters and lay thinking encounters. This requires building community-based health interventions and a sustainable health promotion programs to ensure higher penetration to the social outreach (families, hospital setting, clinics, and schools). To combat ill-health beliefs, stakeholders can benefit from utilization of community participation through creating space for dialogue and debate about cancer and its representations, which accordingly moving towards social and health change.

"I feel like I'm being stabbed by a thousand tiny men": The challenges of communicating endometriosis pain

Endometriosis, as a widespread gynecological condition, affects an estimated 1 in 10 women and yet has a worldwide average diagnosis length of 7.5 years. Causing incapacitating pain, among other associated manifestations, the condition severely impacts on women's lives. This article uses online survey data to investigate how pre-diagnosis endometriosis pain is conceptualized and articulated in order to explore communication challenges reported in early consultations that can potentially be seen to play a role in diagnosis delay. The findings of this study indicate that women feel that they do not have the appropriate tools to describe their pain and, in many instances, feel dismissed therefore prolonging diagnosis. The article finds that the majority of the pain descriptors identified use elaborate metaphorical scenarios to convey the intensity of the pain and concludes with some reflections on the issue of metaphorical language in endometriosis pain communication practices while calling for interdisciplinary work in order to devise appropriate tools for endometriosis pain communication.

Content Analysis of Metaphors About Hypertension and Diabetes on Twitter: Exploratory Mixed-Methods Study

Background

Widespread metaphors contribute to the public’s understanding of health. Prior work has characterized the metaphors used to describe cancer and AIDS. Less is known about the metaphors characterizing cardiovascular disease.

Objective

The objective of our study was to characterize the metaphors that Twitter users employ in discussing hypertension and diabetes.

Methods

We filtered approximately 10 billion tweets for keywords related to diabetes and hypertension. We coded a random subset of 5000 tweets for the presence of metaphor and the type of metaphor employed.

Results

Among the 5000 tweets, we identified 797 (15.9%) about hypertension or diabetes that employed metaphors. When discussing the development of heart disease, Twitter users described the disease as a journey (n=202), as transmittable (n=116), as an object (n=49), or as being person-like (n=15). In discussing the experience of these diseases, some Twitter users employed war metaphors (n=101). Other users described the challenge to control their disease (n=34), the disease as an agent (n=58), or their bodies as machines (n=205).

Conclusions

Metaphors are used frequently by Twitter users in their discussion of hypertension and diabetes. These metaphors can help to guide communication between patients and providers to improve public health.

'If I can walk that far': space and embodiment in stories of illness and recovery

Illness and recovery transform embodied experience, and transform the experience of space. Space, in turn, is a valuable resource in the telling of an illness narrative. Starting from a phenomenological perspective that takes the body to be the centre of experience, and hence of selfhood and storytelling, this article offers an argument for and an approach to analysing space as a narrative resource in stories about illness and recovery. Using a case study of one woman's stories about her amputation, it demonstrates how both narrated space and narrating space can be used as devices to structure the narrative and position its characters and interlocutors to construct the narrator's embodied experiences and identities. The article reveals intersections between embodied experience, space, and narrative identity construction, offering a new way of attending to illness narratives and a new way of engaging with narrative space.