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On Intertext in Chemotherapy: an Ethnography of Text in Medical Practice

Abstract

Building on literary theory and data from a field study of text in chemotherapy, this article introduces the concept of intertext and the associated concepts of corpus and intertextuality to CSCW. It shows that the ensemble of documents used and produced in practice can be said to form a corpus of written texts. On the basis of the corpus, or subsections thereof, the actors in cooperative work create intertext between relevant (complementary) texts in a particular situation, for a particular purpose. The intertext of a particular situation can be constituted by several kinds of intertextuality, including the complementary type, the intratextual type and the mediated type. In this manner the article aims to systematically conceptualise cooperative actors’ engagement with text in text-laden practices. The approach is arguably novel and beneficial to CSCW. The article also contributes with a discussion of computer enabling the activity of creating intertext. This is a key concern for cooperative work as intertext is central to text-centric work practices such as healthcare.

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Notes

  1. 1.

    Excluding the research protocol, these types of documents are all present in the standard treatment of cancer patients and as such has a bearing on cancer treatment in general, rather than only on clinical trial.

  2. 2.

    The latter criterion is an important one as the trial seeks to not only to establish a new standard treatment which is superior to the one in use at present, but also to provide an extra option in terms of treatment when the standard treatment has been exhausted.

  3. 3.

    A baseline, a starting point in physical terms, is established upon which to base any assessment of progress (improvement or decline) in the patient’s condition during the trial. The baseline is established using the treatment and examination form, stipulating examinations including PET-CT scans for the assessment of tumour size, blood samples, EKG, weight, and asking the patient for his/her subjective impression of his/her condition.

  4. 4.

    Neutrophils usually make up 50–70 % of circulating white blood cells in a healthy adult and serve as the primary defence against infections by destroying bacteria in the blood. Hence, patients with low neutrophils count are more susceptible to bacterial infections, and without medical intervention the condition may become life threatening.

  5. 5.

    One might say that the concept of assemblies runs the risk of including every phenomenon in the analysis from technical implementation to coordinative artifacts to organizational policy. But at the same time this is the strength of the notion of assemblies i.e., putting focus on the broad picture.

  6. 6.

    Watson is a computer system capable of answering an array of questions posed in natural language. Developed by IBM, Watson was named after IBM’s first CEO and industrialist Thomas J. Watson. The computer system was specifically developed to answer questions on the quiz show Jeopardy! Subsequently, Watson has been further developed with other applications areas in mind, including healthcare (https://en.wikipedia.org/wiki/Watson_(computer) -accessed 020915 14:18).

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Acknowledgements

I am indebted to the great staff at the hospital departments for letting me take up so much of their time. I especially appreciate their openness and patience with me. In addition, Erling Havn’s opinions and careful reading of drafts of the article is greatly appreciated - needless to say, the responsibility for any issues is mine alone. Furthermore, I acknowledge with gratitude the contributions made by the editor and the anonymous reviewers whom helped improve the article markedly through their continued constructive critique and helpful comments. Thank you. Lastly, Morten Visby once again did a great job with the final proof reading.

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Correspondence to Lars Rune Christensen.

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Christensen, L.R. On Intertext in Chemotherapy: an Ethnography of Text in Medical Practice. Comput Supported Coop Work 25, 1–38 (2016). https://doi.org/10.1007/s10606-015-9238-1

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Keywords

  • Text
  • Intertext
  • Documents
  • Healthcare
  • Literary theory
  • Computer technology