Reinforcing social expectations

This section describes how during consultations participants say certain phrases or fill conversational space in a way that helps to keep the interaction running smoothly. These utterances were present in all consultations and usually displayed a certain ‘human’ quality of warmth or humour. All doctors, patients and companions conformed to some extent to the social expectations of their role within medical consultations (see table 13).

Table 13: Summary of participants’ comments in social expectation theme

Theme: Social expectations Doctor total (n=14) % Patient total (n=14) % Companion total (n=13) % Social mores 12 86% 14 100% 9 63% Reassurance 8 57% - - 3 28% Comments on doctors role - - 4 29% 0 0% Encourages patient - - - - 5 38%

The item social mores was present in most consultations, examples of doctors social mores include:

“He’s thinking ‘I’ve been given too much information today’ [laughs].” (Doc 11)

“I think you know especially in a situation where there isn’t anything to blame it’s just bad luck.” (Doc 8)

“well, you know, that’s ermm [laughter] well, oh my word, I’m going to have to get my crystal ball out know aren’t I?” (Doc 3)

“we’re never going to give you the lungs of a 21 year old you know. so we just take things step by step.” (Doc 3)

Patients expressed social mores in all consultations. They used the ordinary language that surrounds cancer; talking about being positive, having a fighting spirit and a sense of control over their disease, for example:

“…even the neighbours have been fantastic so I’m very lucky in that respect so I’m going to be positive, it’s the only way I can do it.” (Pat 8) “no I think you’ve, I mean basically, I’d like lot live a lot longer and if I have my way I’ll try my best.” (Pat 10)

“I mean I’ll fight it that’s not the problem.” (Pat 9)

“I’m a strong positive person, you know, we know people that have been said to them they’ve got weeks to live and they’ve lived for a long time.” (Pat 14)

Companions’ usually stated social mores, these comments were containing and supporting of both themselves and the patient, examples include:

“my mum is not your average 80 year old no.” (Com 2)

“there’s a lot to take in and you feel that you’ve understood it and I’ll walk out of here and I won’t remember a word you’ve said, but I know what’s going to happen, I’ve got the leaflet.” (Com 6)

“Well we have to wait and see how things turn out.” (Com 5)

Companions also encouraged patients, sometimes this was encouraging them to be active in the consultation or sometimes this was in terms of being encouraging about their attitude towards the disease, for example:

“What do you know of it mum, do you want to say what you do know?” (Com 5)

“if you’re going to give it a damn good fight then you give it a damn good fight.” (Com 10)

On occasion companions also reassured patients, for example:

“But I suppose everything’s here that’s anywhere in the world I think…you can’t get better treatment anywhere else.” (Com 6)

“when your chest is a bit better and you’re in a better frame of mind it might not seem as daunting, I don’t know.” (Com 4)

Doctors offered patients some form of reassurance more than companions did, this was usually regarding aspects related to treatment and remembering all the

facts the doctor was providing, information leaflets were often given at this stage. Examples include:

“I’ll do it for you (re: taking down info) don’t worry, at the end. I’ll do it don’t worry about that.” (Doc 6)

“Well try to put your mind at rest you know in terms of starting the treatment there’s a few cancers we need to start treatment within a week and that’s particularly small cell, the other times that we tend to do is more about you know if you waited 2 weeks it’s not going to make any difference.” (Doc 8)

Patents commented on the doctor’s role and/or asked the doctors advice in around a third of consultations. Patients’ utterances were around their confidence that the doctor was a skilled and informed expert, for example:

“I can’t deal with it myself now obviously can I? I need somebody like you whose got knowledge about this stuff and you, you’re there to direct me in the right direction, what you think’s the right direction. I don’t know what’s the right direction, only by what you’ve just said.” (Pat 3) “Listen to them cos they know what they are doing.” (Pat 2)

“No, no, obviously it’s a very specialist…this is why you have to listen to the experts don’t you.” (Pat 6)

The above results illustrate that there are a range of themes talked about by participants in lung cancer treatment decision making consultations. Differences between how much certain themes are discussed and whether these conversations involve SDM is explored in the following chapter.