'Breast cancer won't kill ya in the breast': Broaching a rationale for chemotherapy during the surgical consultation for early-stage breast cancer.

Abstract

To examine how, and for what interactional purpose, a surgeon raises the risk of death with an early-stage breast cancer patient. Single-case analysis of a recorded surgical consultation, using conversation analysis. The surgeon not only negotiates the surgical treatment decision with the patient, she provides an overview of what her non-surgical treatment is likely to entail. Analysis reveals how the surgeon addresses interactional challenges when providing this overview, including how to broach the rationale for administering chemotherapy, the possibility that cancer could spread to vital organs and prove fatal. To do this, the surgeon orients to the possibility that the patient has misconceptions about her risk of dying from breast cancer. She uses negatively-formulated assertions to invoke these possible misconceptions, making correction relevant and providing a point of entry into delicate interactional territory. The surgeon draws upon possible patient misconceptions to broach the rationale for administering adjuvant chemotherapy. The surgical consultation is typically the first treatment-related consultation newly-diagnosed breast cancer patients have and represents an opportunity to educate patients and prepare them for future treatment decisions. The challenges of providing and receiving such overviews, and how they may influence future treatment decisions, merit consideration.