Constructing narratives in a cancer journey

Across the world, an estimated 18.1 million people received a cancer diagnosis in 2018 [1]. A diagnosis marks the beginning of a journey through the medical system that touches every aspect of the individual’s life - how do you even begin to make sense of such a journey? Dr. Lez Trujillo Torres (ESSEC Business School) and Dr. Benét DeBerry-Spence (University of Chicago at Illinois) examined the question in their recent research[2], applying marketing concepts of consumer journeys to understand how people construct narratives about their experience with cancer and the implications for those with cancer and their networks of loved ones and service providers. Their article was a finalist for the 2019 Sheth Foundation Best Paper of the Year Award in the Journal of Academy of Marketing Sciences.

In a typical consumer journey, said consumer will assign value to the product or entity in question, in a process called “valorization”. Value can be monetary or non-monetary (for example, evaluations of its quality or meaning). The process of valorization is ongoing and fluid and ongoing, impacting how people approach their consumer journey. They use the word “journey” as a consumer’s relationship to a product is often not a one-off encounter and instead can involve an extended experience. For example, consider the example of students acquiring a master’s degree. Students will interact with the counselors, professors, support staff, and other students over an extended period of time from the moment they start their program, to providing a social media review after graduation, to remaining an engaged alumni. The university or school will plan and deliver an experience and nurture relationships with students along the way, finishing by delivering an intense emotional experience that can be transformative for the individuals. After all, a college degree is intended to be a positive experience. However, much of the research on valorization has focused on recreational and hedonic service experiences like brand fests, river rafting, mountain climbing, canoeing, etc.

How, then, does this apply in a traumatic context, like that of a grave illness such as cancer? Dr. Trujillo Torres and Dr. DeBerry-Spence turned their focus here, recognizing that people with cancer will encounter a wide variety of products and services that are both medical and non-medical and that are often unconnected (for example, physicians and patient support organizations). Since these service providers have the potential to play an important role in treating and supporting the physical and emotional wellbeing of cancer patients, it’s important to understand how exactly their influence plays out.

The researchers took a multi-pronged approach to explore valorization during the cancer journey. They studied blog posts, field notes from cancer-related events, interviews with patients, clinicians, caregivers, and representatives from nonprofit cancer support organizations, and background information (such as pamphlets and institutional websites). To gather the field notes, the researchers volunteered with patient support organizations and attended events such as patient information workshops, conferences, and informational fairs, which had a wide range of attendees. This approach allowed the researchers to get a sense of different perspectives on customer valorization, including perceptions of the cancer journey, successes and obstacles, and how people interacted with service providers, as well as contextual information.

Dr. Trujillo Torres and Dr. DeBerry-Spence found that people typically take one of three approaches along their journey with cancer: metaphorical framing, flesh-witnessing, or commemorating. Metaphorical framing means using metaphors available in public discourse to structure and make sense of their journey. For example, people often think illness as a battle, with an identifiable enemy (the cancer), the battlefield (treatment) and the ultimate goal of vanquishing the enemy. Others think of themselves as “survivors” once they’ve defeated their foe and achieved NED status (no evidence of disease). This use of metaphors can be socially reinforced or contested given that this conceptualization is not for everyone, with some feeling uncomfortable with the terms and metaphors used or with how it differentiates people by their health outcomes.

Another approach is flesh-witnessing: claiming authority and/or expertise based on personal experience. It typically takes one of three forms: transformational, translational, or transcendent flesh-witnessing. People who engage in flesh-witnessing may become advocates for patient care, drawing on their personal experience and knowledge acquired during their journey. In other words, they become experts as a result of their experiences. In translational flesh witnessing, people draw from their newfound knowledge and experiences to handle the everyday difficulties of their illness, such as managing health insurance claims or service interruptions. Finally, those who employ transcendent flesh-witnessing place their experiences as part of a broader context, embedding their personal experiences in larger social and cultural environments. In other words, they learn to see the personal and macro aspects of their experiences, such as correcting medical errors and providing social spaces for individuals impacted by cancer.

The third approach is commemorating. This means that people recognize and pay tribute to memories from their journey, in particular to milestones and social support. Commemorating milestones involves a recognition and sometimes a celebration of key events during their experience, like the end of chemotherapy or radiation. For example, the M.D. Anderson system has patients ring a bell at the end of their chemotherapy treatments to mark the end. In commemorating social support, people will honor the social ties that have been developed or nurtured throughout their illness, to acknowledge the value of those ties. One example of this is cancer support groups, which can help with a feeling of solidarity reducing the social isolation often experienced by those with cancer. It also provides a safe space for discussion, such that people can work through experiences and discuss difficult topics with those experiencing similar circumstances.

These three strategies highlight the stability and change of consumer journeys in a service context characterized by trauma. They show that people valorize certain aspects of their journey more than others (e.g., sharing their experiences as experts, commemorating events or people). These aspects have important implications for service providers, who can support individuals’ valorization by providing spaces where individuals can commemorate key events and people, like websites, forums, booklets, and physical spaces. Service providers can also support individuals’ development and deployment of expertise. For example, service providers can engage “expert” individuals in mentoring, troubleshooting, and advocacy. The study has also implications for families and friends of individuals impacted by cancer, in that it can help them to better understand the changes facing their loved ones and their desire to recognize and celebrate key memories (the good, the bad, and the ugly). By applying marketing principles in a new context, that of a cancer diagnosis and illness, Dr. Trujillo Torres and Dr. Spence lay the groundwork for additional research on consumer valorization in complex consumer journeys and service settings.

References

Bray, F., Ferlay, J., Soerjomataram, I., Siegel, R.L., Torre, L.A. and Jemal, A. (2018), Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA: A Cancer Journal for Clinicians, 68: 394-424. doi:10.3322/caac.21492
Torres, L. T., & DeBerry-Spence, B. (2019). Consumer valorization strategies in traumatic extraordinary experiences. Journal of the Academy of Marketing Science, 47(3), 516-531.