The Influence of Sociality in Cancer Treatment Decision-Making

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Carolyn Sargent of Washington University will research how transnational communications about disease generate therapy management group decision-making. The research will contribute to scientific understandings of how disease shapes social interaction and how meanings of illness acquire legitimacy and influence treatment decisions. Medical anthropologists have long emphasized the ways in which many treatment decisions are influenced not just by communications between doctor and patient, but also by a range of larger social networks. The research focuses on meanings and strategies about breast cancer among immigrants from the Senegal River Valley (Mali, Mauritania, Senegal) in Paris, France, an appropriate research context because of the robust and complex transnational decision-making networks that have emerged. Migrant communities such as these have proven to be an ideal social laboratory for exploring the formation of decision-making networks as these are typically spaces where a range of social relationships are observably emergent. Three central questions are posed: (1) how sufferers, families, interpreters and clinicians collectively and progressively define and manage cancer; (2) how social relations are restructured around the collective experience of cancer and how the symbolic importance of cancer figures into these reconfigurations; (3) how transnational meanings and strategies are continuously generated by means of cell phone and other communications. To investigate these questions, the researchers have designed a two-year study, to follow 40 women with breast cancer, as well as caretakers, clinicians and interpreters. Regular home visits will be conducted to assess kinship obligations, social hierarchies, and moral conventions, using semi-structured interviews and a mix of qualitative methods. Participant observation in women's immigrant associations will allow the researchers to assess popular representations of breast cancer and treatment modalities.The broader impact of this research lies in its implications for public health policy and clinical practice. The research explores the impacts to medical treatment that arise when biomedical practitioners, patients, and families do not share a common language or core illness constructs and treatment expectations. It points to areas that merit attention to ensure that policies acknowledge the potential for serious disruptions in the provision of care to gravely ill patients when these issues remain unaddressed. The researchers' connections with clinicians and public health officials will facilitate the dissemination of research findings and produce relevant workshops, working papers, and publications.