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Metaphor in End-of-Life Care

临终关怀中的隐喻

基本信息

批准号：
ES/J007927/1
负责人：
Elena Semino
金额：
$ 22.31万
依托单位：
Lancaster University
依托单位国家：
英国
项目类别：
Research Grant
财政年份：
2012
资助国家：
英国
起止时间：
2012 至无数据
项目状态：
已结题

来源：
https://gtr.ukri.org/projects?ref=ES%2FJ007927%2F1
关键词：
Metaphor End Life Care

项目摘要

This project is concerned with how different groups of people talk about their experiences with end-of-life care. The care and support needs of people approaching the end of life are potentially relevant to every member of society, and have recently received considerable attention on the part of healthcare policy makers and clinicians in the UK. The way in which the experience of end-of-life care is talked about can shed light on people's views, needs, experiences and challenges, and identify areas where increased anxiety and/or misunderstanding can occur, for example, in communication between patients and health professionals. We will investigate the language use of members of three stakeholder groups in end-of-life care: patients, unpaid family carers and senior healthcare professionals. We will analyse a large collection of data (1.5 million words) consisting of interviews with members of each group (approximately 100,000 words per group) and contributions to online fora by members of each group (approximately 400,000 words per group). The specific aspect of language use we will focus on is metaphor, which is recognised in many different areas of study as an important tool we use to communicate and think, especially about topics that are impalpable, complex, sensitive or taboo. Illness and death are among these topics. For example, we conventionally talk metaphorically about people 'battling cancer' or needing a 'fighting spirit' to survive cancer. Different metaphors highlight some aspects of the topic and background others. The 'war' metaphor for illness highlights the way in which being ill may involve strength, perseverance, endurance and heroism, and facilitates an understanding of recovering health as a victory and of not recovering or dying as a defeat. On the other hand, this metaphor backgrounds the way in which one may, for example, accept and live with an illness, and may make patients feel as though their body is a battlefield on which a war is being fought. However, the shortcomings of a particular metaphor may be overcome by replacing it or using it alongside an alternative metaphor. For example, seeing the experience of illness as a journey can highlight both progress and lack of progress, as well as routine, companionship, and so on. Indeed, recent policy documents on cancer in particular suggest a deliberate shift away from military metaphors towards 'journey' metaphors, such as the 'cancer journey' and clinical 'pathways'. By analysing systematically the metaphors used by different stakeholder groups to talk about end-of-life care, we will gain a better understanding of their views, experiences, and needs. By exploring both the differences and similarities in the use of metaphor within and across each group, we will be able to draw conclusions about potential opportunities and difficulties in relationships among members of the three different groups. Our findings will have implications for practice and training in the provision of end-of-life care. We will therefore share our results with a range of groups and organisations involved with end-of-life care, in order to make a positive impact on the experience of patients approaching the end of life. Our project will also result in a better understanding of the phenomenon of metaphor itself, which will be relevant to researchers in the humanities and social sciences.The method we will employ to identify and analyse metaphor in our data involves both 'manual' analysis based on well-established techniques and computational analysis. The most innovative aspect of our method is the exploitation of a software tool that was developed by a member of our team for linguistic analysis. In a previous project, we have adapted this tool for the analysis of metaphors in large amounts of data. This will enable us to identify metaphorical language more systematically and comprehensively than is currently possible with other methods.

这个项目关注的是不同群体的人如何谈论他们在临终关怀方面的经历。接近生命尽头的人的护理和支持需求可能与社会的每个成员都相关，最近受到了英国医疗保健政策制定者和临床医生的高度关注。谈论临终关怀经历的方式可以揭示人们的观点、需求、经历和挑战，并确定可能出现更多焦虑和/或误解的领域，例如，在患者与卫生专业人员之间的沟通中。我们将调查三个利益相关者群体的成员在临终关怀的语言使用：病人，无偿家庭照顾者和高级医疗保健专业人员。我们将分析大量数据（150万字），包括对每个小组成员的采访（每组约10万字）和每个小组成员对在线论坛的贡献（每组约40万字）。我们将重点关注语言使用的具体方面是隐喻，这在许多不同的研究领域都被认为是我们用来交流和思考的重要工具，特别是关于那些无法触及的，复杂的，敏感的或禁忌的话题。疾病和死亡是其中的一个主题。例如，我们习惯性地比喻人们“与癌症作斗争”或需要“战斗精神”来战胜癌症。不同的隐喻突出主题的某些方面和背景的其他方面。疾病的“战争”隐喻强调了生病可能涉及力量，毅力，耐力和英雄主义的方式，并促进了对恢复健康作为胜利的理解，而不是恢复或死亡作为失败。另一方面，这个比喻的背景，其中一个可能，例如，接受和生活的疾病，并可能使病人觉得好像他们的身体是一个战场上的战争正在进行。然而，特定隐喻的缺点可以通过替换它或与另一种隐喻一起使用来克服。例如，将疾病的经历视为一段旅程，可以突出进展和缺乏进展，以及常规，陪伴等。事实上，最近关于癌症的政策文件特别建议从军事隐喻转向“旅程”隐喻，例如“癌症之旅”和临床“路径”。通过系统地分析不同利益相关者群体在谈论临终关怀时所使用的隐喻，我们将更好地了解他们的观点，经验和需求。通过探讨每个群体内部和跨群体使用隐喻的差异和相似之处，我们将能够得出关于三个不同群体成员之间关系的潜在机会和困难的结论。我们的研究结果将对提供临终关怀的实践和培训产生影响。因此，我们将与一系列参与临终关怀的团体和组织分享我们的研究结果，以便对接近生命尽头的患者的体验产生积极的影响。我们的项目也将导致更好地理解隐喻现象本身，这将是相关的研究人员在人文和社会科学。我们将采用的方法来识别和分析隐喻在我们的数据涉及两个'手动'分析基于成熟的技术和计算分析。我们的方法最具创新性的方面是利用我们团队的一名成员开发的软件工具进行语言分析。在以前的一个项目中，我们已经调整了这个工具，用于分析大量数据中的隐喻。这将使我们能够识别隐喻语言更系统和全面比目前可能与其他方法。