Case PhD Studentship, University of Liverpool and University Hospital Aintree NHS Foundation Trust

Social Anthropology Pathway
Case PhD Studentship in collaboration with University Hospital Aintree NHS Foundation Trust
Diagnosing the ‘Cancer-Patient-In-Liverpool’: A Cultural Excavation of the Classificatory Moment

The Position

The Department of Public Health and Policy at the University of Liverpool is looking for a full-time +3 PhD candidate to undertake a CASE studentship funded through the Social Anthropology Pathway of the Northwest Doctoral Training Centre in collaboration with University Hospital Aintree and the Department of Anthropology, The University of Manchester.

The student will be based in the Department of Public Health and Policy, University of Liverpool, undertaking research on the classificatory practices of cancer diagnosis in Liverpool. The student will be supervised by Dr. Ciara Kierans (medical anthropologist, University of Liverpool), Professor Jeanette Edwards (Department of Anthropology, University of Manchester) and Prof Terry Jones (University Hospital Aintree).

The studentship is available to cover UK/EU fees and an annual Research Council maintenance grant. Rates for the academic year 2015-16 will be as follows (subject to confirmation from the ESRC): Maintenance Grant £14,210, plus access to a Research Training Support Grant.

Person Specification

The studentship provides funding on a +3 basis, so in addition to a 1^st or 2:1 in (social anthropology) or a related social science subject (e.g., sociology, science and technology studies), applicants must have a Masters degree (or be close to completion) which has sufficient research methods training to enable PhD study. The project will be ethnographic in character and will require the student to have experience in ethnographic methods and approaches alongside an understanding of related ethical and theoretical concerns. As the focus of this research centres on biomedical practices and contexts, experience of and an interest in studies of science, technology and medicine would be desirable.

Further details on eligibility are available here

TO APPLY: To apply, please send your CV, the names of two referees and a supporting letter detailing how your education, training, experience and interests prepare you for this studentship. For more information, please contact Dr. Ciara Kierans [email protected]). The deadline for applications is Friday 16^th of February. Interviews will be held on the week of the 23rd February 2015.

Details of the Studentship

Within anthropology, studies of cancer, considered the ‘Emperor of all Maladies’ (Mukherjee, 2010), have generated a range of interconnecting heuristics for thinking through the relationship between culture, biology and political economy. Developments in cancer care, prevention and diagnostics have produced new types of biosocial identity: the cancer survivor and previvor (Jain, 2013); new forms of genetic kinship (Gibbon and Novas, 2008; Franklin, 2003); new forms of citizenship (Heath et al., 2008); and new markets in health and healthcare (Biehl, 2011). Cancer has emerged as a ‘total social fact’ within contemporary life. Its legal, bureaucratic, economic, religious, and morphological effects are ones which individualise, while simultaneously making visible the consequences of racial, class and gender cleavages. In mediating between the individual and the collective, cancer embodies social relations as it connects and fissures distinct areas of life across different sites and settings. In so doing, it is profoundly a disease of place, which gains very different registers of meaning across nations and cultures (Livingstone, 2013).

This study takes the diagnosis of cancer as a particular medical and cultural problem. It will examine the ways in which specific places – i.e., Liverpool – have become bound up with the production of new socio-diagnostic categories – i.e., the Cancer-Patient-In-Liverpool. Late in 2013, various news media ran a series of reports designating Liverpool as ‘the capital of cancer in the UK’. The underpinning statistics, generated by Cancer Research UK, have shown the city and region to have an overall rate of cancer incidence 25% above the national average. This figure, when disaggregated, shows profound socio-economic disparities in both morbidity and mortality terms. Of central importance is a particular diagnostic problem, relating, inter alia, to cancer of the Head and Neck, which involves the late presentation of cancer patients and the associated problems of the need for more extensive treatments which result in greater detriment to patient and carer quality of life. The Cancer-Patient-In-Liverpool is one which has been exemplified as an inherently cultural and political-economic category, one which positions the diagnostic encounter – that between doctor and patient – as a critical site of understanding, interpretation and action.

Aim

Drawing on ethnographic work on the diagnostic category and its social and political consequences (Bowker and Star, 2000; Buscher et al; 2009 Hacking, 2013), this project will examine in detail the diagnostic encounter in a Liverpool cancer clinical setting. To do this, it will take diagnosis not as a cognitive skill, but as a set of practices, tools, infrastructures, and social relations (Buscher et al, 2009). Its aim is to show how the Cancer-Patient-In-Liverpool operates as a culturally situated and transformative category, one which allows us to understand how patient biographies, routes to medical care and treatment decisions are brought together to shape outcomes for health, recovery and wellbeing on an individual and societal level.

Study sites and methodology

The Mersey Regional Head and Neck Cancer Units, in particular, St Helen’s & Knowsley Teaching Hospitals NHS Trust and Aintree University Hospital NHS Foundation Trust, will operate as starting sites for this ethnographic project. The research will focus on patients who have been diagnosed with cancer of the upper aero-digestive tract. Grouped as ‘Head and Neck cancer’, this heterogeneous constellation of malignant tumours exhibit, in Merseyside, an incidence and mortality rate more than twice the national UK average as a direct consequence of social, environmental and individual actions.

The PhD student, with support from her supervisory team and a specified research nurse, will recruit between 15 and 20 diagnostic cases, and conduct clinical observations, biographical/narrative and informal interviews with clinical staff, patients and their families, in addition to the analysis of case-notes, cancer policies, protocols and patient care guidelines. The student will specifically:

1. examine the production of the Cancer-Patient-In-Liverpool as an ethnographic object of inquiry, paying particular attention to the political-economic, infrastructural, technological and institutional contexts within which it is made. In so doing, this study asks, what holds this category in place so as to make it meaningful?
2. map out the particular socio-medical trajectories bound up with diagnostic classifications, taking into consideration what Hacking refers to as their ‘looping effects’ (Hacking, 2013 ) – the complex prospective and retrospective (re)fashioning that is done as diagnosis reshapes the past events and the future possibilities around itself.
3. examine (i) the ways in which patient biographies can be understood as a function of this particular cancer category, and re-routed and distorted through it; and (ii) the interpretive and practical accomplishments of clinical staff as they form agreement around care-pathways, interventions, prognostic hope and so on.
4. document the policy and political-economic changes which frame the organisation and delivery of cancer services.