https://doi.org/10.1177/1049732320930699
Qualitative Health Research
1–13
© The Author(s) 2020
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DOI: 10.1177/1049732320930699
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Research Article
Introduction
In the current climate of national and global migration,
the potential for challenges to emerge around place, iden-
tity, race, and belonging is palpable (Delanty et al., 2019).
In the context of cancer care, it has been repeatedly shown
how cultural difference inflects care (Burke et al., 2012;
Goldstein et al., 2014; Kleinman et al., 1978; van Eechoud
et al., 2016). Cancer patients who report as “migrants”
have poorer outcomes across virtually every measure,
and this holds across national contexts (e.g., Butow et al.,
2013; Kai et al., 2011; Light, 2012). It is within this con-
text, and with regard to the enduring concern over the
care for people who identify as migrants
1
in cancer care
settings (Shaw et al., 2015), that we embarked on this
study involving patients and professionals, which aimed
to gain a more sophisticated understanding of difference
as a relational and coproduced feature of care.
In focusing on “difference” in cancer care, we were
acutely aware of the plenitude of existing “culturally and
linguistically diverse” (CALD) research already in exis-
tence across the health and medical spheres. Yet, as has
been argued elsewhere (e.g., Jeffery & Nelson, 2011;
Muaygil, 2018), much of this work slips into either cul-
tural categorization (reductivism) or models wherein
“difference” is largely about the person’s characteristics
(reification). Such simplicities have also been shown to
exist in many of the interventions targeting migrant com-
munities in cancer care settings (Jenks, 2011; Thackrah &
930699QHR XX X 10.1177/1049732320930699Qualitative Health ResearchBroom et al.
research-article 2020
1
The University of Sydney, Sydney, New South Wales, Australia
2
The University of New South Wales, Sydney, New South Wales,
Australia
3
RMIT University, Melbourne, Victoria, Australia
4
Monash University, Melbourne, Victoria, Australia
5
University of Technology Sydney, Sydney, New South Wales,
Australia
6
Liverpool Hospital, Sydney, New South Wales, Australia
7
South Eastern Sydney Local Health District, Sydney, New South
Wales, Australia
8
Royal Brisbane and Women’s Hospital, Brisbane, Queensland,
Australia
9
University of Queensland, Brisbane, Queensland, Australia
Corresponding Author:
Alex Broom, Department of Sociology and Social Policy, The
University of Sydney, Sydney, NSW 2006, Australia.
Email: alex.broom@sydney.edu.au
The (Co)Production of Difference in
the Care of Patients With Cancer
From Migrant Backgrounds
Alex Broom
1
, Rhiannon Parker
1
, Stephanie Raymond
1
,
Emma Kirby
2
, Sophie Lewis
2
, Renata Kokanović
3,4
,
Jonathan Adams
5
, Paul de Souza
6
, Lisa Woodland
7
,
David Wyld
8,9
, Zarnie Lwin
8,9
, and Eng-Siew Koh
2,6
Abstract
An extensive body of scholarship focuses on cultural diversity in health care, and this has resulted in a plethora of
strategies to “manage” cultural difference. This work has often been patient-oriented (i.e., focused on the differences
of the person being cared for), rather than relational in character. In this study, we aimed to explore how the
difference was relational and coproduced in the accounts of cancer care professionals and patients with cancer who
were from migrant backgrounds. Drawing on eight focus groups with 57 cancer care professionals and one-on-one
interviews with 43 cancer patients from migrant backgrounds, we explore social relations, including intrusion and
feelings of discomfort, moral logics of rights and obligation, and the practice of defaulting to difference. We argue, on
the basis of these accounts, for the importance of approaching difference as relational and that this could lead to a
more reflexive means for overcoming “differences” in therapeutic settings.
Keywords
cancer; culture; cultural competence; lived experience; health; focus groups; interviews; Australia