The online use of Violence and Journey metaphors by patients with cancer, as compared with health professionals: a mixed methods study

TLDR

Cancer metaphors such as violence and journey can convey both positive and negative emotions, challenging the assumption that violence is always negative and journey always positive. The study compares how often cancer patients and health professionals use violence and journey metaphors online, examining their implications amid critiques of war metaphors and the rise of the cancer journey narrative. Using text mining on 753,302 words from UK patient forums and professional websites, the authors quantified metaphor usage, finding patients used violence and journey metaphors about 1.5 times per 1,000 words. Patients use violence and journey metaphors more often than professionals; both metaphor types can be empowering or disempowering, so rejecting violence metaphors or uncritically endorsing journey metaphors would limit communication, and awareness of metaphor function can improve patient‑provider dialogue.

Abstract

To compare the frequencies with which patients with cancer and health professionals use Violence and Journey metaphors when writing online; and to investigate the use of these metaphors by patients with cancer, in view of critiques of war-related metaphors for cancer and the adoption of the notion of the 'cancer journey' in UK policy documents.Computer-assisted quantitative and qualitative study of two data sets totalling 753 302 words.A UK-based online forum for patients with cancer (500 134 words) and a UK-based website for health professionals (253 168 words).56 patients with cancer writing online between 2007 and 2012; and 307 health professionals writing online between 2008 and 2013.Patients with cancer use both Violence metaphors and Journey metaphors approximately 1.5 times per 1000 words to describe their illness experience. In similar online writing, health professionals use each type of metaphor significantly less frequently. Patients' Violence metaphors can express and reinforce negative feelings, but they can also be used in empowering ways. Journey metaphors can express and reinforce positive feelings, but can also be used in disempowering ways.Violence metaphors are not by default negative and Journey metaphors are not by default a positive means of conceptualising cancer. A blanket rejection of Violence metaphors and an uncritical promotion of Journey metaphors would deprive patients of the positive functions of the former and ignore the potential pitfalls of the latter. Instead, greater awareness of the function (empowering or disempowering) of patients' metaphor use can lead to more effective communication about the experience of cancer.