title: From personal challenge to technical fix: the risks of depersonalised care.
abstract: Our research focuses on the complexity of needs associated with distress in people with advanced cancer. We have recently completed a large longitudinal survey exploring the interplay between a number of components of distress, including depression, demoralisation, debility and spirituality, amongst a cohort of people living with terminal cancer. Participants were recruited from 25 hospices across the Northwest of England between 2007-2009. A purposive subsample of 27 people was invited to take part in a qualitative interview to explore in greater depth their personal experiences of living with illness and related distress. Holistic-content analysis revealed two emerging themes: 'personal or personalised care' and 'expectations of truth and certainty'. We discuss these themes in the light of Illich's critique of health care as a 'technical response to a personal challenge'. We highlight the need for further work to explore the impact of organisation of care on personalised need and suggest looking to the chronic illness self-management literature for help in developing future palliative care approaches.
authors.affiliation: Institute of Psychology, Health and Society, University of Liverpool, Liverpool, UK. joanne.reeve@liv.ac.uk
authors.forename: Joanne
authors.initials: J
authors.lastname: Reeve
authors.forename: Tom
authors.initials: T
authors.lastname: Lynch
authors.forename: Mari
authors.initials: M
authors.lastname: Lloyd-Williams
authors.forename: Sheila
authors.initials: S
authors.lastname: Payne
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004739:England; D005260:Female; D017051:Hospice Care; D006801:Humans; D007407:Interviews as Topic; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000523:psychology*; D017060:Patient Satisfaction; D013727:Terminal Care / Q000523:psychology*