A hermeneutic understanding of the meaning of cancer for Hong Kong Chinese cancer patients

Abstract

This is a study using hermeneutic perspectives to understand how patients interpret their illness experiences of cancer. Dominant in the context of medical care is the biomedical view of cancer. This view regards cancer as a disease of the body of a person. It attempts to reduce cancer into discrete biomedical findings in mathematical terms. Respective medical intervention is concentrated in the body parts of patients. Complementary to the dominant view of medical care practices is the biopsychosocial view of illness. In this latter model, a wider perspective is used, taking the biological, psychological, and socio-cultural factors into account while the significance of patients' interpretation of illness is noted for effective interventions. Founding its roots in psychosomatics and behavioral medicine, the biopsychosocial approach is still reductionist; its methodological constraints are similar to those of the biomedical understanding of illness experiences, especially in the realm of the meaning of illness for patients. In Hong Kong, different intervention approaches have recently flourished in the context of social work intervention for cancer patients. Among these, understanding in terms of a "causal model of explanation" of patients' behaviors, as in the cognitive-behavioral approach which grounds itself in the biopsychosocial perspective, still prevails in the context of social work intervention. In such a way, the deeper level of meaning of cancer for cancer patients is concealed. The present research basically has been developed against such a background in contrast to the "causal model of explanation", this research emphasizes the notion of "deep understanding" in studying the meaning of cancer for cancer patients. This study begins with a meta-theoretical reflection on the limitations of the biomedical approach, the biopsychosocial approach, and the cognitive-behavioral approaches in understanding the meaning of cancer. Three related hermeneutic concepts, "constitutive nature of meaning", "language", and "self-interpretation", together with the concept of embodiment will be used as the main theoretical framework for the present study. This study adopts the method of semi-structured in-depths interviews for collecting data. Twelve patients were interviewed. Two levels of data presentation will be presented in the thesis. At the first level of data presentation, some crucial features of the informants' illness experience of cancer will be presented under the guideline "the traumatic experiences of cancer patients". Then, the data that focus on "issues of self-recognition in cancer" will be presented in the form of case narratives from five core cases, whereas the remaining cases will be used as supplementary data to the core cases. At the second level of data presentation, data will be further presented in light of three discussion guidelines, namely, "cancer as an existential situation of cancer patients", "the self-interpretive meanings of cancer in contexts: issues of patients' negative self-evaluations" and "the problems in sustaining patients' self-recognition".