title: The interweaving of pharmaceutical and medical expectations as dynamics of micro-pharmaceuticalisation: advanced-stage cancer patients' hope in medicines alongside trust in professionals.
abstract: Existing pharmaceuticalisation research denotes the salience of expectations in novel medicines and in the medical contexts through which these may be accessed. Specific processes of expectation such as hope and trust, alongside their shaping of patients' lifeworlds around pharmaceutical use, remain neglected however. Considering data from in-depth interviews and observations involving thirteen patients with advanced-stage cancer diagnoses who were or had recently been involved in clinical trials, we develop an interpretative phenomenological analysis of the influence of hope and trust upon the accessing of novel medicines through trials, illuminating the depth and texture of pharmaceuticalisation at the micro-level. Trust in clinicians and hope in trial medicines, for self and future patients, were important in the reconfiguring of patients' horizon of possibilities when accessing new medicines. Interwoven processes of trust and hope, embedded within heightened vulnerability, sustained the bracketing out of doubts regarding medicines, trials and professionals. The need to maintain hopes, and trusting relations with professionals who facilitated these hopes, generated meaning and momentum of medicines use which inhibited disengagement from trials. Findings indicate the taken-for-granted, as well as more reflexive, pursuit of solutions through medicines, which in this case-study enabled the generation of evidence through trial involvement. Analyses of micro-level dynamics within both downstream-consumption and upstream-substantiation of pharmaceutical solutions assist more nuanced accounts of interests, agency and expectations within pharmaceuticalisation.
authors.affiliation: Department of Sociology and Anthropology, University of Amsterdam, The Netherlands. Electronic address: p.r.brown@uva.nl.
authors.forename: Patrick
authors.initials: P
authors.lastname: Brown
authors.affiliation: Department of Sociology and Anthropology, University of Amsterdam, The Netherlands.
authors.forename: Sabine
authors.initials: S
authors.lastname: de Graaf
authors.affiliation: Department of Medical Psychology, Academic Medical Centre, University of Amsterdam, The Netherlands.
authors.forename: Marij
authors.initials: M
authors.lastname: Hillen
authors.affiliation: Department of Medical Psychology, Academic Medical Centre, University of Amsterdam, The Netherlands.
authors.forename: Ellen
authors.initials: E
authors.lastname: Smets
authors.affiliation: Medical Oncology, Academic Medical Centre, University of Amsterdam, The Netherlands.
authors.forename: Hanneke
authors.initials: H
authors.lastname: van Laarhoven
mesh_terms: D000328:Adult; D000368:Aged; D000970:Antineoplastic Agents / Q000009:adverse effects / Q000627:therapeutic use*; D001294:Attitude to Health; D004345:Drug Industry; D005260:Female; D065026:Hope; D006801:Humans; D007406:Interview, Psychological; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D009369:Neoplasms / Q000188:drug therapy* / Q000473:pathology* / Q000523:psychology; D010342:Patient Acceptance of Health Care; D018579:Patient Selection; D000067490:Prescription Drug Overuse; D011379:Prognosis; D036301:Qualitative Research; D011788:Quality of Life; D035502:Trust; D035501:Uncertainty
chemical_list: D000970:Antineoplastic Agents
keywords: Hope; Pharmaceuticalisation; Trials; Trust; Vulnerability