Study of the Therapeutic Use of Language in Patients With Metastatic Colorectal Cancer

Critical Negotiations: Narrative Agreement, Negotiation, and Register Use in Encounters Between Patients With Metastatic Colorectal Carcinoma and Their Oncologists

The purpose of this study is to determine if the degree of agreement between patients and their physicians regarding the "story" of the illness correlates with improved patient symptom control and quality of life. Another goal of the study is to examine the actual language used by patients and physicians in a specific clinical situation.

Study Overview

• Status: Completed
• Conditions: Colorectal Cancer

Detailed Description

The purpose of this study is to investigate the co-created therapeutic narrative in scheduled office visits between adult patients with metastatic colorectal carcinoma and their medical oncologists in a community practice setting. The study will focus on the negotiation of the illness narrative and the semiotic (primarily linguistic) tools employed. The study will involve patients from a large community cancer center from Northeastern Pennsylvania (this center sees about 3,000 new patients each year). About 85% of patients with cancer in the United States are treated in this type of setting (National Cancer Institute, 2007), and so many results from this population are applicable to most cancer patients in the United States. The location of this study makes it very different from the majority of medical anthropological studies that are usually performed in urban academic medical centers or in sites outside of the United States or Western Europe. Although community cancer centers are the location of most of the treatment of patients with cancer in the United States, there are few to no studies published studying this patient population.

• Study Type: Observational
• Enrollment (Actual): 5

Contacts and Locations

Study Locations

• United States
  • Pennsylvania
    • Dunmore, Pennsylvania, United States, 18512
      • Hematology and Oncology Associates of Northeastern Pennsylvania, PC

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 18 years and older (Adult, Older Adult)
• Accepts Healthy Volunteers: No
• Genders Eligible for Study: All

• Sampling Method: Non-Probability Sample

Study Population

Patients with metastatic colorectal carcinoma and their physicians at a large community cancer center in Northeastern Pennsylvania.

Description

Inclusion Criteria:

• Patients and Physicians at Hematology and Oncology Associates of NE Pennsylvania
• Patients must have metastatic (stage IV) colorectal carcinoma
• Patients must be on treatment for their disease
• Patients must be scheduled for re-staging CT scans
• Patients must be older than 18 years old

Exclusion Criteria:

• Patients with a diagnosis other than metastatic colorectal carcinoma
• Patients not receiving active treatment or not having re-staging CT scans
• Patients younger than 18 years old

Study Plan

How is the study designed?

Number of groups / cohorts

2

Cohorts and Interventions

Group / Cohort
1; Medical Oncologists treating patients with metastatic colorectal cancer
2; Patients with metastatic colorectal cancer receiving re-staging CT scans

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Time Frame
Correlation of degree of "narrative agreement" with validated quality of life measures	6-8 weeks

Collaborators and Investigators

• Sponsor: Hematology and Oncology Associates of NE Pennsylvania
• Investigators: Principal Investigator: Christian S Adonizio, MD, Hematology and Oncology Associates of NE Pennsylvania

Publications and helpful links

General Publications

• Agha, A. (2007). Language and Social Relations. Studies in the Social and Cultural Foundations of Language. Cambridge, Cambridge University Press. 24: 242-244.
• Ainsworth-Vaughn, N. (1998). Claiming Power in Doctor-Patient Talk. New York, Oxford University Press.
• Austin, J.L. (1975) How to do things with Words. Ed. J.O. Urmson and Marina Sbisa. Cambridge, MA, Harvard University Press.
• Briggs, C. (1986) Learning How to Ask:A sociolinguistic appraisal of the role of the interview in social science research. Cambridge, Cambridge University Press.
• Cassel EJ. The nature of suffering and the goals of medicine. N Engl J Med. 1982 Mar 18;306(11):639-45. doi: 10.1056/NEJM198203183061104.
• Cassell, E. J. (1991). The Nature of Suffering and the Goals of Medicine. New York, Oxford University Press: 37-43.
• Charon, R. (2006). Narrative Medicine: Honoring the Stories of Illness. New York, Oxford.
• Csordas, T. J. ed. (1994). Embodiment and experience: The existential ground of culture and self. Cambridge Studies in Medical Anthropology. Cambridge: Cambridge University Press.
• Gee, J.P. (2005) An Introduction to Discourse Analysis: Theory and Method, 2nd ed. New York, Routledge.
• Eggly S. Physician-patient co-construction of illness narratives in the medical interview. Health Commun. 2002;14(3):339-60. doi: 10.1207/S15327027HC1403_3.
• Ferrell BR, Dow KH, Grant M. Measurement of the quality of life in cancer survivors. Qual Life Res. 1995 Dec;4(6):523-31. doi: 10.1007/BF00634747.
• Foucault, M. (1994). The Birth of the Clinic: An Archaeology of Medical Perception. New York, NY, Vintage Books.
• Frank, A. W. (1995). The Wounded Storyteller: Body, Illness, and Ethics. Chicago, Chicago University Press.
• Goffman, E. (1963) Stigma: Notes on the Management of Spoiled Identity. Englewood Cliffs, Prentice Hall.
• Good, B. J. (1994). Medicine, Rationality, and Experience: an anthropological perspective. Cambridge, Cambridge University Press.
• Laderman, C. and M, Roseman eds (1996) The Performance of Healing. London, Routledge.
• Linde, C. (1993) Life Stories: The Creation of Coherence. New York, Oxford University Press.
• Lock, M. and N. Scheper-Hughes (1996). A Critical-Interpretive Approach in Medical Anthropology: Rituals and Routines of Discipline and Dissent. Medical Anthropology: Contemporary Theory and Method. C. F. Sargent and T. M. Johnson. Westport, CT, Praeger Publishers: 47.
• Lyotard, J.-F. (1984). The Postmodern Condition: A Report on Knowledge. Minneapolis, University of Minnesota Press.
• Mattingly, C. (1998). Healing dramas and clinical plots: the narrative structure of experience. Cambridge, Cambridge University Press
• Mehan, H. (1996). The Construction of an LD student: A case study in the politics of Representation. Natural Histories of Discourse. M. Silverstein and G. Urban. Chicago, The University of Chicago Press: 253-276.
• Mishler, E. G. (1984). The Discourse of Medicine: Dialectics of Medical Interviews. Norwood, NJ, Ablex Publishing Corporation.
• National Cancer Institute (2007). "NCI Community Cancer Centers Program Pilot 2007-2010." from http://ncccp.cancer.gov/Media/FactSheet.htm.
• Riessman, Catherine Kohler. (1993) Narrative Analysis. Newbury Park, Sage University Paperback
• Ross, N. (2004). Culture and Cognition: Implications for Theory and Method. Thousand Oaks, CA, Sage
• Sontag, S. (2002). Illness as Metaphor and AIDS and Its Metaphors. New York, Penguin Books.
• The University of Texas--M.D.Anderson Cancer Center. (1999) "MDASI, M.D. Anderson Symptom Inventory Core Items", University of Texas.
• Webb, M. (1999). The Good Death: The New American Search to Reshape the End of Life. New York, Bantam.

Study record dates

Study Major Dates

• Study Start: July 1, 2008
• Primary Completion (Actual): October 1, 2009
• Study Completion (Actual): October 1, 2009

Study Registration Dates

• First Submitted: July 7, 2008
• First Submitted That Met QC Criteria: July 7, 2008
• First Posted (Estimate): July 9, 2008

Study Record Updates

• Last Update Posted (Estimate): June 3, 2015
• Last Update Submitted That Met QC Criteria: June 2, 2015
• Last Verified: June 1, 2011

More Information

Terms related to this study

• Keywords: Personal Communication; Narrative Medicine; Doctor Patient Relations
• Additional Relevant MeSH Terms: Digestive System Diseases; Neoplasms; Neoplasms by Site; Gastrointestinal Neoplasms; Digestive System Neoplasms; Gastrointestinal Diseases; Colonic Diseases; Intestinal Diseases; Intestinal Neoplasms; Rectal Diseases; Colorectal Neoplasms
• Other Study ID Numbers: 808231