Locock Louise, Nettleton Sarah, Kirkpatrick Susan, Ryan Sara, Ziebland Sue
Health Experiences Research Group, Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Observatory Quarter, Woodstock Rd, Oxford OX2 6GG, United Kingdom; NIHR Oxford Biomedical Research Centre, John Radcliffe Hospital, Headley Way, Oxford OX3 9DU, United Kingdom.
Department of Sociology, Wentworth College, University of York, Heslington, York YO10 5DD, United Kingdom.
Soc Sci Med. 2016 Apr;154:85-92. doi: 10.1016/j.socscimed.2016.02.037. Epub 2016 Feb 26.
Diagnosis can be both a 'diagnostic moment', but also a process over time. This paper uses secondary analysis of narrative interviews on ovarian cancer, antenatal screening and motor neurone disease to explore how people relate assembling procedural, spatial and interactional evidence before the formal diagnostic moment. We offer the idea of a diagnostic assemblage to capture the ways in which individuals connect to and re-order signs and events that come to be associated with their bodies. Building on the empirical work of Poole and Lyne (2000) in the field of breast cancer diagnosis, we identify how patients describe being alerted to their diagnosis, either through 'clues' they report picking up (often inadvertently) or through 'cues', perceived as a more intentional prompt given by a health professional, or an organisational process. For patients, these clues frequently represent a breach in the expected order of their encounter with healthcare. Even seemingly mundane episodes or behaviours take on meanings which health professionals may not themselves anticipate. Our findings speak to an emergent body of work demonstrating that experiences of formal healthcare during the lead-up to diagnosis shape patients' expectations, degree of trust in professionals, and even health outcomes.
诊断既可以是一个“诊断时刻”，也可以是一个随时间推移的过程。本文通过对关于卵巢癌、产前筛查和运动神经元疾病的叙述性访谈进行二次分析，来探讨人们在正式诊断时刻之前如何将程序、空间和互动证据整合起来。我们提出“诊断组合”的概念，以捕捉个体如何与那些与他们身体相关的迹象和事件建立联系并重新排序。基于普尔和莱恩（2000年）在乳腺癌诊断领域的实证研究，我们确定了患者如何描述他们被诊断的过程，这要么是通过他们报告（通常是无意中）发现的“线索”，要么是通过被视为医疗专业人员或组织过程给出的更具意向性的提示“暗示”。对患者来说，这些线索常常代表着他们与医疗保健接触的预期顺序被打破。即使是看似平常的事件或行为也会具有医疗专业人员自己可能无法预料到的意义。我们的研究结果与一系列新出现的研究成果相符，这些研究表明在诊断前的准备阶段接受正规医疗保健的经历会塑造患者的期望、对专业人员的信任程度，甚至健康结果。
