Interacción con otras proteínas

Many women talked about contact with their breast care nurses (outside of clinical appointments) as only possible through telephone contact. Women spoke of the

restrictiveness of this type of contact: - ‘It’s always on the phone and I don’t like phones so

46 _{The definition of ‘healthcare professional’ provided by the World Health Organisation and cited by}

Smailhodzic et al., (2016) is utilised within this thesis; that is :- ‘those who study, advise on or provide preventative, curative, rehabilitative and promotional health services based on an extensive body of theoretical and factual knowledge in diagnosis and treatment of conditions and other health problems’ (p. 3).

110 much’(Jayne);‘I hate ringing up and mithering the nurses’ (Sarah M);‘I’ve only rang twice. They must have lots of other people; women, men, children who need their time and

experience, you know, as well’ (Denise D). Sarah J voiced concern about not wanting to ‘be bothering them with phone calls when they are in clinic’. The notions of ‘mithering’, ‘bothering’ and ‘lots of other people who need their time and experience’ demonstrate women negotiating entitlement to care (Sulik, 2007) positioning themselves and their health within a wider cultural framework of publicly funded healthcare provision. Breast care nurses were portrayed as stretched with limited opportunity to support patients. This view was supported by Mandy – a chemotherapy nurse:

‘it’s so fast-paced, that um, you know, it’s all so clinical, it’s like ‘in, assessment, get the chemo up, next person, in, out, in, out’ that’s how it is 135 patients a day we have’ (Photo-elicitation: Mandy).

Often women only brought their breast care nurses into the conversation after looking at the photo-elicitation photographs (Figure 7-3), they nevertheless expressed strong feelings about the nature of the relationship they had with them.

Women framed their interactions with breast care nurses as limited by time. ‘They never have enough time’ (Jayne); ‘they are rushed off their feet’ (Jojo); ‘they are really busy; (Jayne); ‘they were there to do their job and go’ (Jojo); ‘they didn’t have time to talk to you’ (Jojo). Jojo and Millie voiced their experiences of changes in the provision of care within the health service. Jojo drew on personal experience of being an NHS employee to express a view that care provision was universally different ‘back in the day’. Millie supports Jojo’s claim. She tracks the changes in her care provision between the time of her primary diagnosis and second diagnosis, eleven years apart:

Figure 7-3 Images of healthcare professionals used in the photo-elicitation study which women responded and 'spoke' to.

111 ‘I had more contact with my breast cancer nurse then, than I’ve had this

time’;

‘she used to ring me quite regular to make sure that I was alright. Whereas, the contact has not been the same this time’;

‘I’ve just rung when I’ve got a query, whereas before she rang me’ (Photo- elicitation: Millie).

Across the interviews, women were careful to voice support for their breast care nurses despite describing limiting their contact with them outside of the clinical setting:

‘Breast care nurses are great, but they never have enough time’(Photo- elicitation: Jayne);

‘you’ve got to understand they are doing their best so I have a lot of time for people like that’ (Photo-elicitation: Denise G);

‘the breast care nurses but they have a lot…they’ve got a lot of patients. I didn’t like to request too much of them or ask too much of them’ (Photo- production: Delphi).

This carefully constructed criticism implicates structural factors as affecting the support provided rather than personal factors. Women therefore take a protective stance towards the breast care nurses employed to support them. By limiting their ‘demands’ for care by not ‘mithering’ or ‘bothering’ and attributing the limited opportunities for interaction to

structural constraints, women put others needs including the needs of the breast care nurses before their own. At the same time, there is notable media reporting on ‘rationing’ or

reductions in access to NHS healthcare (Charles, 2017). This includes restrictions to access to drugs, equipment, surgery and other procedures, as well as increased waiting times for

treatment. Explicit public messages of pressure on health services frame patients’ stories of cautious healthcare use in the primary setting (Llanwarne, Newbould, Burt, Campbell & Roland, 2017). These findings demonstrate women LwBBC as cautious users of secondary47 healthcare resources when not physically in the secondary healthcare setting and point to social media as a resource to supplement conversations with healthcare professionals. Rupert et al., (2014) reported that users of online health communities (n = 89) also described

healthcare professionals as “too busy for detailed discussions” (p.320). To what extent the wider social and cultural focus on perceived pressures on the NHS influence women’s

47 _{Secondary healthcare is sometimes referred to as 'hospital and community care' ("The NHS provider sector",}

112 choices as to where they source support is not known. Similarly, it is unknown to what extent patient’s decisions to access support from elsewhere relieve demands on clinical service provision or how alternative channels of support, via social media, mediates this decision- making. Women’s accounts however do suggest that their use of social media platforms is changing aspects of their relationships with primary and secondary healthcare providers:

‘I mean I’ve tried to make appointments with my GP, but you know the way things are going with the NHS and all that, it’s like three weeks until my next appointment. I don’t need to now I just go on the group and think ‘oh, OK, alright yeah’ (Photo-elicitation: Jojo).

7.1.3 Photography limits the significance of support from healthcare professionals