The online use of Violence and Journey metaphors by patients with cancer, as compared with health professionals: a mixed methods study

OBJECTIVE To compare the frequencies with which patients with cancer and health professionals use Violence and Journey metaphors when writing online; and to investigate the use of these metaphors by patients with cancer, in view of critiques of war-related metaphors for cancer and the adoption of the notion of the 'cancer journey' in UK policy documents. DESIGN Computer-assisted quantitative and qualitative study of two data sets totalling 753 302 words. SETTING A UK-based online forum for patients with cancer (500 134 words) and a UK-based website for health professionals (253 168 words). PARTICIPANTS 56 patients with cancer writing online between 2007 and 2012; and 307 health professionals writing online between 2008 and 2013. RESULTS Patients with cancer use both Violence metaphors and Journey metaphors approximately 1.5 times per 1000 words to describe their illness experience. In similar online writing, health professionals use each type of metaphor significantly less frequently. Patients' Violence metaphors can express and reinforce negative feelings, but they can also be used in empowering ways. Journey metaphors can express and reinforce positive feelings, but can also be used in disempowering ways. CONCLUSIONS Violence metaphors are not by default negative and Journey metaphors are not by default a positive means of conceptualising cancer. A blanket rejection of Violence metaphors and an uncritical promotion of Journey metaphors would deprive patients of the positive functions of the former and ignore the potential pitfalls of the latter. Instead, greater awareness of the function (empowering or disempowering) of patients' metaphor use can lead to more effective communication about the experience of cancer.