According to King's College London researchers, patients can provide a unique insight into their own physical and emotional world through their own words with intentional or unintentional metaphors.

It is estimated that 15m people in England—a quarter of the population—live with a long-term condition, and 14.2m people (one in four adults) face the presence of more than two long-term conditions. These can broadly be defined as illnesses that cannot be cured and may require treatment and/or therapies to manage their symptoms and underlying disease processes that are co-occurring or ongoing.

Enabling patients and caregivers to communicate their experience of illness in their own words is vital to delivering person-centred care and developing a shared understanding of the impact of conditions on their lives. Studies of patient-voiced experiences show how metaphors can provide insight into the physical and emotional world of the patient, but such studies are often limited by their focus on a single illness.

Recently published in Qualitative Research in Medicine and Healthcare, the study compared metaphors expressed by patients and parents of patients with five long-term conditions. The eleven authors, led by Heidi Lempp, undertook a supplementary and amplified secondary qualitative data analysis of past conducted 25 face-to-face interviews, comparing the metaphors used by patients and parents of patients with dementia, myositis, plural mesothelioma, neonatal surgery and fibromyalgia.

An overview of the main groupings shows that the dominant metaphors found across the sample could be divided into two categories: journey metaphors and violence metaphors. These metaphors were used alongside and often in interaction with other metaphorical vehicles, such as weight, object, and movement, in ways that reflected how a given illness manifests and how diagnosis, treatment, management, and self-care are experienced.

Heidi said, “During a Medical Sociology Conference five years ago I was struck how many participants included metaphors in their presentations of interviews with patients diagnosed with long-term conditions. I contacted them after the conference, and we embarked together on this study in close collaboration with Chris Tang from the School of Education, an expert in applied linguistics in health communication. What our study highlighted was how metaphors vary within and between conditions and individuals and how these can be potentially empowering or disempowering to patients in their consultations with clinicians.”

The study concludes with implications for clinical practice on how metaphorical expressions can be attended to by healthcare professionals as part of shared care planning.

In future, an analysis of the purpose of metaphor in practice could be developed to include studies of health professionals caring for patients with long-term conditions alongside a wider and more diverse sample for cross-condition comparison of metaphor use with the effects of ethnicity and language background.

Access the full article here: https://doi.org/10.4081/qrmh.2023.11336

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