Catherine Hughes

Cultural Meaning-making in the Journey from Diagnosis to End of Life

Abstract This article is based on an ethnographic study undertaken to explore whether eight people diagnosed with terminal cancer and their families drew on aspects of their cultural identities to make sense of their journey towards death, and if so, how. Ethnographic methods were supplemented by semistructured interviews. Most participants received medical treatments until close to death and invested much effort, time, and hope in these. Consequently, they made little sense of their palliative referrals. Instead, they accommodated the biomedical cultures of treatment-oriented services, thus delaying their own and their familys preparation for death. Only three participants appeared well prepared one month prior to death. An ecological perspective helped to explain the systemic factors involved in this prioritisation. The authors make recommendations for greater involvement of social workers in palliative care, and for more attention to supporting dying people and their families to make culturally meaningful decisions in the journey toward death.

Being-in-the-Chemotherapy-Suite versus Being-in-the-Oncology-Ward: An Analytical View of Two Hospital Sites Occupied by People Experiencing Cancer

How do people with cancer occupy places within the health system during their journey through palliative care? The answer to this question was explored by the authors as part of a wider ethnographic study of eight people’s journeys from referral to palliative care services to the end of life. This article reports on findings that have emerged from ongoing analysis that has been completed in the years proceeding data collection. An ethnographic research design was used to collect data about the participants and their family members over a three-year period. Data was collected using participant observation and semi-structured interviews. Over 380 transcripts based on field note entries and taped interviews were produced during the 1121 h of contact with participants and family members that made up the research period. Analysis of these texts identified two focal sites within Christchurch Hospital that were occupied by the participants. These were the Chemotherapy Suite and the Oncology Ward. Drawing on literature concerning previous anthropological analysis, research was conducted to understand how places affect people and how people affect places. The researchers have used a model outlined by the American ethnographer Miles Richardson to analyse two distinct sites within one hospital. As explained in Richardson’s article, whose title is used to model the title of this article, a sense of place becomes apparent when comparing and contrasting two sites within the same location. Richardson’s article is highly interpretative and relies not only on pre-existing theoretical frameworks but also on personal interpretation. The same approach has been used in the current article. Here, ethnographic methods require the researcher’s interpretation of how participants occupied these sites. Following this approach, the Chemotherapy Suite is presented as a place where medicine dominates illness, and appears as distinct from the Oncology Ward, where disease predominates and death is secreted away.