Metaphor in End-of-Life Care

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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.