When Even Hope Can Silence: An Analysis of How the Meaning of Cancer Progression is Constructed During Clinical Interactions

Cancer progression can represent a significant turning point in patients’ expectations for the future. However, little observational research exists on how the meaning of progression is negotiated during cancer clinical interactions. Through a discourse analysis of transcripts from thirty clinical interactions, this article argues that physicians often encourage patients to view progression as solely a biomedical event with an established treatment response. This measured hope for the continuation of the status quo can foreclose patients’ ability to express concerns and participate fully in shared decision-making. The article closes by proposing physician- and patient-oriented interventions, including a question prompt list focused on problem definition in clinical interactions, that could open space for a wider range of meanings for progression.