De discursieve constructie van emotionele problemen in het follow-up consult van hoofd-hals-kankerpatiënten

Cancer survivors often experience heightened emotional distress, resulting in reduced quality of life. However, previous research has shown that oncologists tend to avoid discussing emotional issues with these patients. In this paper we analyse doctor-patient interaction in follow-up head-and-neck cancer consultations in a major cancer centre in The Netherlands, comparing data from a Control group and a group that used the Distress Thermometer and Problem List (DT+PL) to stimulate the discussion of emotional concerns. We found that, although emotional problems were addressed in both conditions, the change in the doctors’ epistemic status occasioned by the DT+PL caused there to be a marked difference in who first nominated the concerns as topics. When and how which issues were discussed was mutually, discursively, negotiated by the participants in the situation. Doctors were seen to rely in these negotiations on their bio-medical knowledge, while patients and companions used their own lived experience and the experiences of third parties. Detailed analysis of the data shows that when there was a disjunct between the knowledge that patients and doctors relied upon, both doctors and patients were very diffident when expressing disagreement.