Seeking certainty through narrative closure: men's stories of prostate cancer treatments in a state of liminality

Abstract

Radical treatments of prostate cancer often lead to a pervasive liminal state that is characterised by multiple uncertainties that relate both to a possible recurrence of cancer and recovery from side effects, such as erectile and urinary dysfunctions. Liminality can make it difficult for cancer patients to narrate their experiences, as their stories lack a definite ending. After interviews with 22 Finnish men who had undergone radical prostatectomy, we analysed how men produce closure in their illness narratives. Focusing on the timelines of control visits or their anticipated recovery from side effects, these interviewees sought provisional certainty within a seemingly chaotic future. By locating erectile dysfunction in the wider context of a life-course and interpreting their fading sexuality as a 'natural' consequence of ageing, these men were adjusting to their post-operative lives. Our study further shows that the inability to adjust personal experiences to positive culturally available storylines that provide a chance for the narrative reconstruction of life, can cause materialised negative consequences, such as relationship breakdowns.

Factors related to self‐rated health and life satisfaction one year after radical prostatectomy for localised prostate cancer: a cross‐sectional survey

“…Apparently, men do not interpret problems with sexual function as a health issue in the same way that they do urinary incontinence. It is known that men tend to normalise erectile dysfunction caused by cancer treatment by interpreting the symptoms as part of the normal ageing process and by stating that sexual activity is mainly part of a younger man's life . This view may also explain why the participants of this study did not necessarily take erectile dysfunction into account when answering the general questions about their health .…”

Understanding and managing uncertainty in health care: revisiting and advancing sociological contributions

“…A substantial body of sociological work has emphasised the importance of studying uncertainty in health care, and responses to it, with studies exploring the training needed to prepare doctors for uncertainties associated with diagnosis, treatment and patient response (Calnan 1984, Delamont and Atkinson 2001, Fox 1957, Light 1979, Mesman 2008, Parsons 1951) and the uncertainties experienced by patients (Gillespie 2012, Pietilä et al . 2018). The organisational demands for accurate prediction and effective screening (Warner and Gabe 2004) and the tensions faced by healthcare professionals working with a range of tests and interventions in the face of uncertainty have also been studied (Armstrong and Hilton 2014, Brown and Calnan 2010, Gale et al .…”

“…Sociological contributions to the field include notions of ‘provisional certainty’ within a chaotic future for prostate cancer (Pietilä et al . 2018) and the development of technoscientific identity (TSI) to enable patients to manage the biomedical and personal uncertainty of breast cancer (Sulik 2009). Identity management is also foregrounded in reactions to physiological risks and social changes accompanying organ transplantation (Cormier et al .…”

The healthcare experience of prostate cancer patients: exploring the intersection of age and gender

“…The repercussions of prostate cancer on sexuality are also very often seen as an inevitability that is relatively well accepted because of ageing (Pietilä et al 2018). "Had I been younger, perhaps it would have been more of a problem", as Léon put it (aged 78, retired postmaster.…”