UCSF

This dissertation uses Black Feminist Theory as a theory-methods package to examine the lived experience of terminal illness for Black women with advanced cancer. I developed and implemented a Black Feminist Methodology, which seeks to center the voices and experiences of Black women in order to challenge positivist constructions of knowledge production and increase research on, by and for Black women. This dissertation explores the intersections of race, gender, class, spirituality and health within the lives of Black women. Analysis of multiple in-depth interviews with Black women and observations of clinical interactions with their providers reveal new insights into the way these intersections co-constitute and shape the patienthood experience, the patient-provider relationship, prognostic conversations, and treatment and end-of-life decision-making for Black women. First, I examine the impact of financial security or insecurity on the way Black women approach and understand their disease and treatment. I go beyond questions of income and insurance status to illuminate the ways in which class intersects with race and gender for women undergoing treatment for advanced cancer and the implications those intersections hold for how the women view and understand their disease. Next, I expand upon previous research on the role of religion in oncology care to explore how Black women’s faith impacts not only medical-decision making but also their view of self and illness. Finally, I trouble the notion of what counts as an intersectional identity. I posit that cancer patienthood, one’s identity as a cancer patient post-diagnosis, is itself an important identity in studying the experience of health and illness. I describe the way the intersections of race, gender and patient identity impact experiences of patienthood, relationships with providers and understanding of disease and prognosis.