Use of metaphors enables patients and caregivers to communicate experiences of living with long-term conditions

It is estimated that 15 million people in England—a quarter of the population—live with a long-term condition and 14.2 million people (one in four adults) are face the presence of more than two long-term conditions. These can broadly be defined as illnesses that cannot be cured and which may require treatment and/or therapies to manage their symptoms and underlying disease processes that are co-occurring or ongoing conditions.

Enabling patients and caregivers to communicate their experience of illness in their own words is vital to delivering person-centered care and developing a shared understanding about the impact of a conditions on their lives. Studies of patient voiced experiences show how metaphors can provide insight into the physical and emotional world of the patient, but such studies are often limited by their focus on a single illness.

Published in Qualitative Research in Medicine and Health care, the study compared metaphors expressed by patients and parents of patients with five long-term conditions.

The 11 authors, led by Professor Heidi Lempp, undertook a supplementary and amplified secondary qualitative data analysis of past conducted 25 face-to-face interviews, comparing the metaphors used by patients and parents of patients with dementia, myositis, plural mesothelioma, neonatal surgery and fibromyalgia.

An overview of the main groupings show that the dominant metaphors found across the sample could be divided into two categories, journey metaphors and violence metaphors. These metaphors were used alongside and often in interaction with other metaphorical vehicles, such as weight, object, and movement in ways that reflected how a given illness manifests and how diagnosis, treatment, management, and self-care are experienced.

"During a Medical Sociology Conference five years ago I was struck how many participants included metaphors in their presentations of interviews with patients diagnosed with long-term conditions. I contacted them after the conference and we embarked together on this study in close collaboration with Dr. Chris Tang from the School of Education, an expert in applied linguist in health communication," says Professor Heidi Lempp.

"What our study highlighted was how metaphors vary within and between conditions and individuals and how these can be potentially empowering or disempowering to patients in their consultations with clinicians."

The study concludes with implications for clinical practice how metaphorical expressions can be attended to by health care professionals as part of shared care planning.

In future, an analysis of the purpose of metaphor in practice could be developed to include studies health professionals caring for patients with long term conditions, alongside a wider and more diverse sample for cross-condition comparison of metaphor use with the effects of ethnicity and language background.