Cancer survivors often suffer from psycho-social problems as a consequence of side effects of treatment and fear of recurrence of the disease. Although there is wide consensus that this kind of distress has a negative effect on health and healing, the discussion of emotional problems does not routinely occur in follow-up cancer consultations.
This thesis investigates the interaction between doctors and patients in a corpus of scheduled head-and-neck cancer follow-up consultations in a cancer centre in The Netherlands, with a focus on the effects of the introduction of the Distress Thermometer and Problem List (DT+PL) as a tool to further the discussion of psychosocial distress.
The multi-method design of the study, including insights from ethnography of communication and discourse analysis (more specifically conversation analysis and linguistic pragmatics), combines interviews with doctors and patients reflecting on the follow-up head-and-neck cancer consultation with a qualitative analysis of video-recorded consultations and descriptive quantitative data on discursive patterns that surfaced in the interactions. This broad design made it possible to trace not just what issues are discussed in the consultation and how frequently they are discussed, but also how the participants co-construct the interaction, what contextual parameters influence this, how the DT+PL affects all this, and how doctors and patients view the follow-up consultation and the DT+PL.