Research program
The communication of knowledge.
Ethnography of knowledge in diverse institutional and organizational settings
University Co-ordinator
Università degli Studi di BERGAMO -
SCIENZE DEI LINGUAGGI, DELLA COMUNICAZIONE E DEGLI STUDI CULTURALI - BERGAMO(BG)
Research Unit Leader
Marco MARZANO
Description
A first area of research will be the social processes of communicating bad news in healthcare settings (in particular that of oncological diseases in which this type of communication is very frequent). In these settings news concerning the patient’s health is bad when it corresponds to a poor prognosis – that is, the presence of clinical indices which suggest that death is close. The task of managing this information, of deciding if and when to disclose it to the patient, pertains essentially to the doctor.The communication of bad news may have numerous harmful consequences on the stability of the social order.The patient's reactions are unpredictable and potentially destabilizing: a sick person may react to a negative prognosis by immediately withdrawing from social life, by committing suicide, by becoming angry and aggressive, disturbing with violent and uncontrolled behaviour the everyday routine of the hospital and refusing to undergo the therapies prescribed by the doctor to prolong the life remaining to him/her and/or to control the painful symptoms of the disease.Also personal and family relations may be upset by the communication to the patient of a grim prognosis. More than the doctors, for whom illness and death are everyday occurrences, the family members do not know how the patient will react to the news of his/her imminent death, and are therefore often terrified of the effects that communication of the prognosis will have on their relative. As a consequence, their strategies are characterized by less reflexive awareness and greater uncertainty, and their judgments and behaviour are bound to mature over time. The uncertainty is mainly due to the fact that the relatives are unable to foresee many of the consequences of their choices and unable - largely because of inexperience - to imagine future situations beforehand. A high level of ambiguity also surrounds the objectives of actions to assist the dying person, which are very often redefined in the course of the illness, shifting from the mere prolongation of biological life to its overall quality, from trust in more aggressive pharmacological therapies to discovery of the importance of reducing pain and controlling symptoms. For relatives and patients, mortal illness is an emotional and cognitive shock, an unprecedented situation which requires them swiftly and desperately to find a frame of meaning which explains the situation's sudden onset and dramatic development.Moreover, bad news is a message difficult to comprehend. A number of recent studies have shown that there is no strong correlation between the sincere communication of the diagnosis and its understanding by the patient. That is to say, the work of sensemaking, adjustment and meaning-construction present in all human communication is particularly visible and substantive in this situation. It frequently happens, in fact, that patients repress the bad news, or at least behave as if they are unaware of the consequences of what the doctors have told them.For all these reasons, in many cultural settings the doctors refrain from disclosing poor prognoses, equating their sincere communication with pointless (for the patient) and damaging (for both the patient and the rest of society) further torment besides that already inflicted by the disease.The research will seek to shed light on these communicative policies, on how they are transmitted to new members of the healthcare team, on the problems of intraorganizational communication (especially between doctors and nurses) that they generate, on the resources that they require to conserve their credibility, etc. This will be made possible by ethnographic observation of some dozens of cases - of patients - whose "trajectories of dying" will be followed by our research unit from the moment of diagnosis until death. The interactions among all the actors involved in the process (doctors, nurses, patients and relatives) will be observed in a variety of settings, including clinical examination rooms, the waiting rooms of day hospitals and surgeries, and hospital wards. The observation will take place within the oncology department (ward, day hospitals and surgeries) of a large hospital in northern Italy. Access will be guaranteed by contacts already established during previous research by the coordinator of the research unit. Before every contact with patients, we will inform the latter in general terms of the nature and purpose of our research and obtain the consent indispensable for observation can begin. The participant observation will be supplemented by some dozens of discursive interviews conducted with healthcare personnel, relatives and patients.The results of the research will finally be compared with those already obtained by similar projects in other countries.A second area of research will be analysis of the representations of disease and health furnished by the mass media. Subject to study will be a) the messages that the most influential members of the medical community produce on particular public occasions (for example, during the annual fund-raising campaigns for cancer research); b) the communication by the press and other media of news about cancer, dying from the disease, and scientific discoveries in its regard. Frame analysis will be the main theoretical and methodological basis for the research. A frame confers a particular type of sense on media messages by providing a particular "metacommunicative" context for their interpretation, where the reference is to the process by which the media define reality (the framing process). This will require analysis of medial texts and their discourse strategies: in other words, identification of the media frames most frequently used. Examination will be made of the medial texts appearing in the daily press in the course of twelve months. The work will be carried out on four newspapers, two national and two local.The aim will be to reconstruct, on the basis of the media frames, the image of medicine that these help to make credible and the most widespread expectations concerning the effects of surgery and pharmacological therapies.
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