Re-contextualising cancer: A qualitative interview study of patients’ responses to diagnosis

For individuals and their families, the cancer diagnosis represents one of the most profound and memorable experiences, and can be an emotive and challenging time. Lay-professional encounters which involve the delivery of a diagnosis of serious, life-limiting or terminal illness are complex and difficult for both patient and health professional, and this fundamental aspect of cancer care is reflected in a wealth of literature and medical education focused on best-practice and effective ways to approach such conversations and communication. Such a focus on communication, however, overlooks the broader context within which the patient (and clinicians) find themselves. Namely, the ways by which previous experiences, life events and relationships shape experiences of diagnosis. Relatively little is known about how patients’ broader life experiences shape perceptions of diagnosis, and how the lead-up to a diagnosis is experienced by patients. Here, drawing on qualitative interviews with 80 people living with cancer, I explore patient reflections on living with cancer, with the aim of better understanding experiences of receiving and responding to a cancer diagnosis. Sharing data from qualitative interviews with 80 patients living with cancer from two metropolitan hospitals on the east coast of Australia, I discuss the development of four typologies of responses to the cancer diagnosis: 1) the incongruent diagnosis; 2) the incidental diagnosis; 3) the validating diagnosis and, 4) the life context diagnosis. Through discussion of each of these typologies I will explore diagnosis of cancer as not always (or only) experienced by patients as ‘bad news’, and as perceived and experienced variably according to broader social context and life experiences.