WHAT DOES TALK ABOUT PSYCHOSEXUAL HEALTH LOOK LIKE IN THE BREAST CANCER CLINIC?

Abstract

ABSTRACT Introduction: Breast cancer is the most commonly diagnosed malignancy in women worldwide, presenting significant psychosexual consequences that impact a woman’s sexuality, body image, confidence, intimate relationships, and gender identity. Communication guidelines specify that patients should receive adequate, tailored information about the psychosexual risks and consequences of treatment. However, research suggests such discussions may not happen effectively in practice. Existing research has primarily relied on retrospective accounts of experience, offering limited insight into how such sensitive topics are negotiated within real-time clinical interactions. This thesis addresses that gap through a Conversation Analytic (CA) study of video-recorded breast cancer consultations. Methods: The dataset consists of 73 video-recorded consultations involving forty-seven patients with primary breast cancer and sixteen clinicians at an NHS breast cancer unit in the north of England. Analysis draws on a corpus totalling over 30 hours of footage. Employing Conversation Analysis, the data were examined through a systematic process of repeated viewing, detailed transcription, and sequential analysis. An initial data trawl was conducted to identify instances where talk about psychosexual health was made relevant by participants in interaction. These sequences were then analysed to reveal the interactional practices through which such talk was occasioned, managed, and responded to in the breast cancer clinic. Results: This thesis comprises three interrelated studies examining how psychosexual concerns are interactionally managed in breast cancer consultations. Each paper focuses on a distinct yet overlapping domain. The first analyses how concerns about postoperative appearance are raised, legitimised, or resisted, and considers how clinical talk may inadvertently reproduce culturally embedded norms. The second examines patients’ use of ‘bright side’ talk following expressions of dissatisfaction or bad news, showing how this practice functions as in-the-moment identity work that mitigates distress and deflects potential inferences of complaint about life-saving treatment. The third explores weight-related discussions, demonstrating the delicacy of such talk and the interactional management of face: clinician-initiated sequences are typically hedged and more likely to encounter resistance, whereas patient-initiated talk fosters greater affiliation and collaboration. Collectively, the findings show how psychosexual issues become ‘safely sayable’ through interactional practices that allow sensitive or face-threatening matters to be voiced, softened, or deferred. Conclusion: This study produces new insights concerning the ways in which psychosexual health features in clinical interaction in breast cancer care. Findings illustrate the intricate and nuanced ways psychosexual concerns are raised and managed in talk between patient and clinician, revealing the delicate negotiation of patient identity, agency, as well as cultural and institutional norms in the breast cancer clinic. The implications for practice, training, and future research are also discussed.

Date of Award	15 Sept 2025
Original language	English
Awarding Institution	The University of Manchester
Supervisor	Anja Wittkowski (Co Supervisor) & Susan Speer (Main Supervisor)