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Open Access Publications from the University of California

The Interactional Negotiation of Complex Treatment: Physician Authority and Patient Agency in Cancer Care

  • Author(s): Tate, Alexandra
  • Advisor(s): Stivers, Tanya
  • et al.

Situated in the domain of the cancer clinic, this dissertation uses conversation analytic and ethnographic approaches to explore the ways in which patient involvement and physician expertise are negotiated in an age of evidence-based medicine, decreased medical authority, and increased patient agency and autonomy under the tenants of shared decision-making. Although cancer care is a major site for clinician-patient treatment negotiation requiring a careful balance of potentially competing viewpoints, little is known about how clinicians promote their treatment recommendations to patients, what the manner of promotion tells us about the oncologist-patient relationship, and how clinicians respond when patients resist their treatment recommendations. Drawing on video-recorded encounters between oncologists and their patients, this analysis examines treatment decision-making in oncology and investigates how physicians balance asserting their authority while at the same time attending to patient agency and involvement in decision-making. Taking this one step further, this work explores how physicians negotiate decision-making with patients given that they occupy a liminal state between obligations to policy imperatives and commitments to their professional knowledge and technical expertise. This dissertation first investigates the ways in which oncologists present treatment recommendations and the treatment contexts in which they are made. Subsequently, it identifies moments of patient resistance to those recommendations and how oncologists address patient resistance through modes of persuasion to secure treatment acceptance. Taken together, the following chapters establish that oncologists and their patients orient to cancer treatment as negotiable and that cancer treatment can—and should—be treated at all stages of disease. Investigating the interactional practices which contribute to these orientations uncovers physicians’ and patients’ collective sensemaking of how complex diagnoses get addressed in the structural environment of the cancer clinic.

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