“We can talk about it. We can joke about it, you know, which is nice”: Tensions surrounding (in)directness in talk about death and dying involving women with ovarian cancer

Abstract

Ovarian cancer been described as the ‘silent killer’ due to the lack of specific notable symptoms experienced by women in the early stages of the disease. It is often diagnosed at an advanced stage and the five year survival rate is low (Cancer Research UK). Almost twenty years ago Lutfey and Maynard (1998) described the interactional caution exhibited by physicians and patients in talk about death and dying. They highlight the collaborative and social nature of the unpackaging of the bad news and how allusive and euphemistic stances are maintained. In a systematic review (Parry, Land and Seymour, 2014) of CA and DA studies in illness progression and end-of-life across various contexts there were common themes of indirectness, allusive language, distancing techniques, shifting to the positive and non-verbal behaviours interpreted as conveying sensitivity to the seriousness of the situation. Allusiveness and being indirect appear to be stable features of such talk, despite shifts in healthcare cultures to promote increasing openness about end-of-life and related matters. In this paper we report on data from interviews undertaken with twelve women with ovarian cancer, following their participation in the Genetic Testing in Epithelial Ovarian Cancer (GTEOC) Study. Drawing on relevant discourse and conversation analytic methods we examine how talk about death and dying is accomplished by participants (the interviewer and the women) in a moment-by moment unfolding of an interaction. The purpose of these interviews was to discuss the women’s diagnoses of cancer and genetic testing. Thus, in the data, death-related talk is not solicited by the interviewer, but is rather self-initiated by the women in response to questions about their treatment or family history of cancer. Minimal responses from the interviewer are observed in the ongoing interaction. We explore discourse and interactional strategies that the women employ to avoid direct reference to their own deaths and to index it indirectly (Lutfey and Maynard, 1998). These strategies include reference to death as it relates to third parties or oneself hypothetically, and extended formulations focusing on actions and activities related to the management of the diseases rather than self-disclosure about the terminal nature of the disease. We also consider metaphoric formulations as indirect ways of indexing death and dying. Furthermore, we examine laughter is a mitigating action in ‘serious’ and sensitive talk related to one’s death (Glenn, 2003). In response to women’s distancing and indirect language the interviewer produces generalized or ambiguous utterances, which promote ongoing implicit nature of the talk about death. Thus, we highlight the interactional tentativeness and avoidance that seems pervasive in talk about death and dying and the strategies the speakers in our data use in managing this.