Contesting illness: communicative (dis)enfranchisement in patient–provider conversations about chronic overlapping pain conditions

Abstract

Guided by the theory of communicative (dis)enfranchisement (TCD), this study analyzes 738 narratives describing negative (n = 381) and positive (n = 357) patient–provider interactions recounted by 399 female-identifying patients residing in 22 countries who are living with poorly understood chronic overlapping pain conditions (COPCs) such as fibromyalgia, vulvodynia, and endometriosis. Using thematic co-occurrence analysis (TCA), a novel method that builds on the identification of themes to map and visualize conceptual interrelationships, we identify nine enactments of (dis)enfranchising talk (DT) across three functions (discrediting, silencing, and stereotyping), four domains of consequences of DT (perceptual, emotional, physical, and material), and two patterns of co-occurrence between functions and consequences of DT (discrediting and physical, silencing and emotional). We illustrate how three MAXQDA software features can facilitate multi-coder TCA in large qualitative datasets. We offer theoretical implications and practical implications for communication researchers, patients, and medical providers toward improving difficult conversations concerning chronic pain.