Communicating "Evidence": Lifestyle, Cancer, and the Promise of a Disease-free Future.

In the era of evidence-based health care, conferences aimed at disseminating scientific knowledge perform an essential role in shaping policy and research agendas and transforming physician practice. Drawing on observations at two U.S. cancer prevention conferences aimed at knowledge translation, we examine the ways that evidence regarding the relationship between cancer and lifestyle is articulated and enacted. We show that characterizations of the evidence base at the conferences far outstripped what is presently known about the relationship between cancer and lifestyle. The messages presented to conference participants were also personalized and overtly moralistic, with attendees engaged not merely as practitioners but as members of the public at risk for cancer. We conclude that conferences seeking to bring together knowledge "makers" and knowledge "users" play a potentially important role in the production of scientific facts and are worthy of further study as distinct sites of knowledge production.

Rethinking assumptions about cancer survivorship.

A growing body of research informed by theories and methods in the social sciences and humanities indicates that certain problematic messages are commonly embedded in popular and oncological representations of cancer. Becoming more aware of these underlying messages has the potential to improve the ways clinicians think about and manage cancer. (Note: A written response to this article appears in Truant, Kohli, & Stephens (2014), Response to "Rethinking Assumptions about Cancer Survivorship": A Nursing Disciplinary Perspective, Canadian Oncology Nursing Journal, Vol. 24, Issue 3, p. 169).

Metastatic cancer and mothering: being a mother in the face of a contracted future.

For the majority of people diagnosed with metastatic cancer, there is little hope of a disease-free future. Drawing on ethnographic fieldwork at a support group for women with metastatic cancer, we examine the relationship between metastases and mothering. We argue that the experience of raising children while living with a terminal illness crystallizes cultural expectations about mothering based on an essentialist model of parenthood whereby the person best suited to raise children is their biological mother. These expectations create an irresolvable gap between discourse and experience that both increases the suffering of women raising children and generates an internal hierarchy of suffering among women with cancer metastases that hinges on the distinction between those who have dependent children and those who do not.

Being a 'good mother': Dietary governmentality in the family food practices of three ethnocultural groups in Canada.

In this qualitative study with three ethnocultural groups in two regions of Canada, we explore how official dietary guidelines provide particular standards concerning 'healthy eating' that marginalize other understandings of the relationship between food and health. In families where parents and youth held shared ways of understanding healthy eating, the role of 'good mother' was constructed so as to include healthy eating expertise. Mothers expressed a perceived need to be personally responsible for providing skills and knowledge about healthy eating as well as guarding children against negative nutritional influences. Governing of family eating practices to conform to official nutritional advice occurred through information provision, monitoring in shopping and meal preparation, restricting and guiding food purchases, and directly translating expert knowledges into family food practices. In families where parents and youth held differing understandings of healthy eating, primarily families from ethnocultural minority groups, mothers often did not employ the particular western-originating strategies of conveying healthy eating information, or mentoring healthy meal preparation, nor did they regulate or restrict children's food consumption. Western dietary guidelines entered into the family primarily through the youth, emphasizing the nutritional properties of food, often devaluing 'traditional' knowledge about healthy eating. These processes exemplify techniques of governmentality which simultaneously exercise control over people's behaviour through normalizing some family food practices and marginalizing others.

Perceptions of food and eating among Chinese patients with cancer: findings of an ethnographic study.

This article explores the ways that participants in a Chinese cancer support group talk about food, diet, and eating. An ethnographic research design was used, including participant observation at a Chinese cancer support group over an 8-month period and key informant interviews with 7 members of the group. Food, eating, and diet were a recurrent focus of discussion at support group meetings throughout the fieldwork period. The ways in which support group participants talked about food centered on 3 distinct but interconnected themes: the prevalence of eating issues as an adverse effect of cancer and its treatment, the importance of eating ability, and questions and concerns connected with the differing and often contradictory cultural models of diet that they were exposed to. Culturally specific understandings of the relationship between food and health informed Chinese patients' experience of eating issues during cancer treatments and their ongoing concern with food and nutrition after the completion of treatment. Health professionals need to pay more attention to the meanings and attributes of food and eating beyond their physiological properties, and further research needs to be conducted with other immigrant populations with culturally distinct understandings of food.

A cross-Canada survey of clinical programs for the care of survivors of cancer in childhood and adolescence.

BACKGROUND: More than 80% of children who have been recently diagnosed with cancer will survive for five years or more. A majority of these survivors are at risk for developing one or more long-term sequelae of their therapy. Thus, they all require specialized medical care that is focused on their specific risks. METHODS: A survey of informants from all 17 paediatric cancer programs in Canada was conducted to determine the care offered to survivors of childhood cancer, both during their paediatric and adolescent years, as well as after they transition to adulthood. RESULTS: Sixteen informants representing all 17 centres responded to the survey by telephone or e-mail. Twelve of the 17 centres (71%) had a formal program or clinic dedicated to the care of survivors during their paediatric and adolescent years, while the remaining centres cared for survivors in their acute care oncology clinics. However, only six of 17 centres (35%) had access to a formal program for survivors once they reach adulthood. Fifteen of the 17 centres (88%) adhered to published long-term follow-up guidelines, and 13 of 17 centres (76%) provided a treatment summary and/or a survivorship care plan to each survivor before their transfer out of paediatric care. CONCLUSION: Despite the centralization of paediatric oncology care within 17 specialist centres and the availability of universal health care, many Canadian survivors of childhood cancer do not have access to clinics specializing in long-term risk-based survivor care, and this access further decreases once they reach adulthood.

Engaging with healthy eating discourse(s): ways of knowing about food and health in three ethnocultural groups in Canada.

The aim of this study was to increase our understanding of how people make sense of healthy eating discourses by exploring the 'ways of knowing' about healthy eating among members of three different ethnocultural groups in Canada: African Nova Scotians, Punjabi British Columbians and Canadian-born European Nova Scotians and British Columbians. Data for this paper come from in-depth, individual interviews with 105 adults where they described their experiences, interpretations, and reasoning used in learning and deciding what to believe and/or reject about healthy eating. Between and within ethnocultural group differences in how people come to know and use practices about healthy eating were examined as they were represented through three broad healthy eating discourses: cultural/traditional, mainstream and complementary/ethical. The discourses represented different ways to interpret the food-health relationship and make sense of the evidence about healthy eating in the everyday experience. Engagement with different discourses led participants to undertake different practices upon themselves in the name of healthy eating. We suggest that each of the discourses has a significant contribution to make in a dialogue about how healthy eating, as part of health and well-being, should be conceptualized by a society.