Session 5b: Seeking Care
Chair: Margo Milne

Can Medical and Lay Logic Meet? Enhancing Colorectal Cancer (CRC) Early Detection, Mortality Reduction
Lea Hagoel
Department of Community Medicine and Epidemiology, Faculty of Medicine, Technion & CHS National Israeli Cancer Control Center at Lady Davis Carmel Medical Center, Haifa, Israel

Screening for the early detection of colorectal cancer (CRC) is a health policy recommendation in many countries. The medical logic involved relies on disease related knowledge. There is a suitable technology for mass screening; and the results of randomized clinical trials, show a decrease in CRC mortality with annual performance of FOBT. This medical logic is in a different realm from that of lay logic. Individuals in the target population do not have access to the meanings embedded in the medical vocabulary. The 'well' person is rarely attuned to the development of latent health problems.
Cancer screening is a relatively recent innovation. Individuals in Israel are eligible for free, yearly, FOBT, but relatively few adhere; however, screening programs rely on high adherence rates for success in mortality reduction. Can the meanings behind medical considerations be translated? Part of this is medical professionals’ use of new categories, neither ‘well’ nor‘sick’: being “at risk”, a “carrier”. Conveying their meaning, supporting adherence to CRC screening, may be the key to a diffusion, comprehension and absorption, as well as enhanced adherence and mortality reduction.

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Sorry For Any Delays
Jennifer Yiallouros and Nicki Thorogood
PEHRU, London School of Hygiene and Tropical Medicine, United Kingdom

Any journey can be beset by delays, how these delays are understood and viewed depends very much on the individual’s circumstances. Someone who has had a diagnosis of cancer is often thought of as going on a journey; yet some of this journey only happens in retrospect, when people look back to the time and events leading up to their diagnosis. There have been many epidemiological studies looking at issues such as ‘Why people with a cancer diagnosis delay going to their GP’, but in these ‘delay’ is usually defined by some arbitrary period and the respondents divided into ‘delayers’ and ‘non-delayers’. However this assumes a shared understanding of ‘delay’ and assigns it a purely temporal definition. In this research I became interested in investigating ‘delay’ from the perspective of people diagnosed with cancer. My findings are based on in-depth interviews with a small sample of people who had been diagnosed with either bladder or kidney cancer. I am using Frank’s framework of three narrative types; restitution, chaos and quest, to explore the potential relationship between how a person diagnosed with cancer experiences ‘the time it took for things to happen’ and the style of illness narrative they use.

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