Metaphor in End-of-Life Care

这个项目关注的是不同群体的人如何谈论他们的临终关怀经历。接近生命末期的人的护理和支持需求与社会的每个成员都有潜在的关系，最近在英国的医疗保健政策制定者和临床医生中受到了相当大的关注。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，并确定可能发生焦虑和/或误解增加的领域，例如，在患者与卫生专业人员之间的沟通中。我们将调查临终关怀中三个利益相关者群体成员的语言使用情况：患者、无薪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（每个小组约10万字）和每个小组成员对在线论坛的贡献（每个小组约40万字）。我们将重点关注语言使用的具体方面是隐喻，隐喻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，尤其是在那些难以捉摸的、复杂的、敏感的或禁忌的话题上。疾病和死亡是这些话题之一。例如，我们通常会比喻人们“与癌症作斗争”，或者需要一种“战斗精神”来战胜癌症。不同的隐喻突出了主题的某些方面，并为其他方面提供了背景。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，并有助于理解恢复健康是一种胜利，不恢复或死亡是一种失败。另一方面，这个隐喻为人们接受疾病并与疾病共存的方式提供了背景，也可能让病人觉得他们的身体是一个正在进行战争的战场。然而，一个特定的隐喻的缺点可以通过替换它或与另一个隐喻一起使用来克服。例如，将疾病的经历视为一段旅程，可以突出进步和缺乏进步，以及常规，陪伴等等。事实上，最近关于癌症的政策文件特别表明，有意从军事隐喻转向“旅程”隐喻，例如“癌症之旅”和临床“途径”。通过系统地分析不同利益相关者群体在谈论临终关怀时使用的隐喻，我们将更好地了解他们的观点、经历和需求。通过探索每个群体内部和不同群体之间隐喻使用的异同，我们将能够得出关于三个不同群体成员之间关系中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，我们将与一系列涉及临终关怀的团体和组织分享我们的结果，以便对接近生命尽头的患者的经历产生积极的影响。我们的项目也将有助于更好地理解隐喻本身的现象，这将与人文和社会科学的研究人员有关。我们将采用的方法来识别和分析数据中的隐喻，包括基于成熟技术的“手动”分析和计算分析。我们的方法中最具创新性的方面是利用了一个软件工具，这个工具是由我们团队的一名成员开发的，用于语言分析。在之前的一个项目中，我们将该工具用于分析大量数据中的隐喻。这将使我们能够比目前其他方法更系统、更全面地识别隐喻语言。

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.