A discursive psychological investigation of patients' preferences in post-diagnostic prostate cancer treatment appointments

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Baker, CW, 2021. A discursive psychological investigation of patients' preferences in post-diagnostic prostate cancer treatment appointments. PhD, Nottingham Trent University.

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Abstract

This thesis examines the role of patients' preferences in post-diagnostic prostate cancer treatment appointments, focusing specifically on patients’ preferences as interactive constructions. Patients' preferences are acknowledged as key to shared decision-making while prostate cancer treatment decisions are considered highly preference sensitive. Despite recognition of patients' preferences and a desire for routine shared decision-making, little is known about patients' preferences in situ with empirical observational research scarce. Prostate cancer is an ideal site for investigating patients' preferences because treatment options for localised prostate cancer have equivalent effectiveness.

Twenty-one naturally occurring post-diagnostic prostate cancer treatment appointments were recorded to collect the empirical materials. A combination of discursive psychology and conversation analysis was used to analyse the recordings and explore the role of patients' preferences.

Across the three analytic chapters I focused on the ways that patients constructed preferences and the forms patients' preferences could take and made the following observations. First, patients indeed constructed preferences in situ and there was heterogeneity both in the forms of preferences and the interactive work comprising their construction. Second, I reported that rather than being straightforwardly elicited and integrated into decision-making business, preferences met with two distinct patterns of receipt and handling by clinical nurse specialists. Third, the production of laughter was revealed to be consequential for decision-making business by functioning to perform subtle preference work and sanction progress.

This thesis therefore provides support for treating patients' preferences as interactive constructions and extends our understanding of preference construction in treatment decision-making by demonstrating heterogeneity in the conversational and discursive resources that patients mobilise. Observations about the distinct handling of patients' preferences responsive to their interactional consequences also extend conversation analytic work on differences between shared decision-making behaviour as modelled and attempts at accomplishment in situ.

Item Type:	Thesis
Creators:	Baker, C.W.
Date:	April 2021
Rights:	This work is the intellectual property of the author. You may copy up to 5% of this work for private study, or personal, non-commercial research. Any re-use of the information contained within this document should be fully referenced, quoting the author, title, university, degree level and pagination. Queries or requests for any other use, or if a more substantial copy is required, should be directed to the owner of the Intellectual Property Rights.
Divisions:	Schools > School of Social Sciences
Record created by:	Linda Sullivan
Date Added:	19 Oct 2021 13:32
Last Modified:	19 Oct 2021 13:32
URI:	https://irep.ntu.ac.uk/id/eprint/44472