We can discern young patient members’ resistance to cancer diagnosis based on the above discussion. However, their choice of making their cancer stories known to the public by participating in KDD cancer board indicates that they have already accepted the cancer diagnosis. Even though they still resist it subconsciously, they chose to make their cancer stories known to the public by posting self-introductions in KDD cancer board. In fact, it was patient members’ resistance that led them to participate in the cancer board and tell their stories. Kreitler (1999) reviewed the literature about cancer patient’s denial when diagnosed with cancer and further focused on its positive and negative effects. Its positive effect is that it helps to reduce patient’s anxiety in early stages of coping with cancer.
Because young patient members resisted the fact of getting cancer, they came to Bulletin Board System (BBS) to release their emotion by telling their stories through self-introduction posting. Their anxiety is then reduced through releasing their emotion.
Besides, the participation in the cancer board was also their way to divert the emotion caused by the receiving of the cancer diagnosis. This behavior is what Buckman (1992:
123) called ‘displacement.’ According to Buckman (1992), patients divert their emotion caused by the receiving of bad news into another action or activity. By this diversion, patients can release the emotion aroused from the receiving of bad news. Accordingly, patient members’ emotions were released through the participation and storytelling in the cancer board.
Moreover, in the process of telling their stories and releasing emotion, they can share their experiences and emotions with other patient members. By doing so, they further make cancer board a suitable place for young patients to get mutual support of what they seek.
The study by Høybye et al. (2005) also pointed out the advantages of getting mutual encouragement by participating in support groups. They researched the online interaction of cancer patients in a breast cancer online support group and pointed out that cancer patients can get a new identity different from the ones in medical contexts, where they are passively acted upon, through telling their stories. Moreover, they can get encouragement and know how to live with cancer through reading other cancer patients’ stories. Getting cancer diagnosis itself is not a usual topic people would discuss openly in social contexts.
It is even harder for people from the age group of 20 to 29 to talk about openly because they are not usually associated with cancer (cf. Table 5.1). Nonetheless, support and encouragement from others is what cancer patients need the most and they also need a place to vent their emotions. The cancer patients interviewed by Kyngäs et al. (2001) pointed out that they used social support as the main strategy to deal with cancer. The patient members in KDD cancer board also use the power of social support to deal with cancer. They get emotional and informational support by having interactions with other patient members through sharing their experiences. Virtual Internet forums like BBS provide a safe place for its members to release their emotions, give mutual encouragement or share information about fighting cancer without worrying about revealing personal privacy.
We have mentioned earlier that more than half (55%) of the patient members ended their self-introduction postings with words for encouragement, such as, ‘我們大家一起加 油吧!!!/we can do this!!!’ (Example 5 in Table 4.8). This linguistic feature is also beneficial for cancer members to get mutual support. Locher (2006) pointed out in her
study the discourse features and functions of advice-giving in an American Internet health advice column that the intention of providing supportive messages from the advice provider is to create connection and rapport with advice-seekers. According to this point of view, by providing words for encouragement, patient members in KDD cancer board are able to create connections and positive rapport with each other, which further makes cancer board a good place for cancer patients to create and maintain friendly sentiments. The friendly sentiment then promotes their exchange of mutual support.
Patient members in KDD cancer board provide emotional support by expressing concern and empathy to other members as was similarly done by the patients in the study by Mo and Coulson (2008). They analyzed the messages posted on an online HIV/AIDS support group and focused on the social support conveyed through those messages. One kind of social support they mentioned was emotional support. Patient members provided words for encouragement to give other patient members wishes, express support for each other and provide encouragement as well as power for positive thinking. According to Mo and Coulson (2008), words for encouragement provide message receivers with hope and confidence. One patient member said that ‘感謝有這個版 讓我一路受益不少 也更有準 備面對一切/thanks to this board that helps me a lot and helps me to have better preparation to face with everything.’ The saying by another patient member: ‘謝謝版友們 的鼓勵 我會加油的/thanks to other members’ encouragement. I will go for it,’ directly proves that words for encouragement can provide cancer patients with the power to fight cancer. Therefore, patient members in cancer board simultaneously get the confidence to fight and the hope to conquer cancer when they see the words for encouragement.
Kim et al. (2012) also conducted research on the obtainment of social support between cancer patients. They investigated the process and effect of social support exchanges in an online breast cancer support group. Their results show that the
exchange of social support is a reciprocal process. Support providers pass the power of support on to support receivers. Support receivers then become the ones to provide support after they have gotten support. As a result, social support is able to keep circulating inside the groups. Patient members in KDD cancer board also did the same thing. After they got help or support from other patient members, they also tended to become the ones to provide help and support as shown by the content posted by one patient member: ‘看到許 多版友分享了自身的經歷，也讓我想把自己的經驗給大家分享。希望對一起對抗病魔 的病友有幫助/After seeing that many members have shared their personal experiences, I also want to share my own. Hope it will be helpful for fellow patients who are fighting against illness together with me.’ In this way, the power of social support forms an advantageous circle among posters and readers and further makes cancer board a suitable place for cancer patients to get mutual support. We can also see patient members’ belief in getting mutual support through the board by the content they posted, such as, ‘大家互相鼓 勵 ， 一 起 樂 觀 的 面 對 病 魔 :)/everyone provides encouragement for each other and optimistically deals with illness together:)’ and ‘與大家共同努力 相互打氣/make efforts together with everybody and give mutual encouragement.’ These sayings also indicate that they come to cancer board with the hope to have communication with others and also to get social support from each other as evidenced by one patient member: ‘最重要的是來這 裡可以和眾多病友一起分享經驗，交流抗癌心得 這也是我來報道的原因/the most important thing for me to come here is being able to share experiences with numerous fellow patients and exchange what we have learned from fighting cancer. This is also the reason for me to come here.’
The two characteristics on the style of expression of words for encouragement (the use of smile emoticons and multiple exclamation marks, cf. 4.3) from patient members can also promote the obtainment of mutual support because they make the original words more
powerful and influential. Derks et al. (2008) examined the influence of using emoticons on the interpretation of messages among high school students. Their results show that a positive message with smile emoticons is evaluated as more positive than the same message without smile emoticons because smile emoticons convey much more sense of happiness. Therefore, the use of emoticons is able to strengthen the message. According to their argument, adding smile emoticons after words for encouragement as the patient members in KDD cancer board did (cf. Examples 1, 4 and 7 in Table 4.8) not only creates a warm and delightful atmosphere but also strengthens the encouragement from posters.
Moreover, it helps cancer members to get more power to make positive efforts.
The use of multiple exclamation marks can not only strengthens the effects of words for encouragement but also helps the creation of a friendly atmosphere. Waseleski (2006) examined the use of exclamation marks within computer-mediated communication. Its result shows that exclamation mark is used mostly to indicate friendliness and cordiality expressed within the content of the words, such as, ‘I hope this helps!’ (p.1018). Therefore, exclamation marks can be seen as a marker of friendly interaction. Colley et al. (2004) investigated gender differences in the style and content of emails and letters to friends.
They pointed out that the use of multiple exclamation marks not only emphasizes emotional aspects of the content used to share emotional reactions but also encourages email and letter receivers to respond with the same reaction. Based on the arguments pointed out by the above two studies, the use of one exclamation mark can show a friendly attitude toward the interaction and the use of multiple exclamation marks not only emphasizes the friendly feelings conveyed through the interaction but also induces message receivers to have the same response. By adding multiple exclamation marks after words for encouragement, patient members in KDD cancer board not only show their friendliness to other patient members but also involve their emotions in it. Their emotions
strengthen along with the number of exclamation marks. That is, the more exclamation marks they use, the heavier their emotions are involved. Apart from this, they also hope other patient members to have the same response. Through the saying ‘我們大家一起加油 吧!!!/we can do this!!!’ (cf. Example 5 in Table 4.8), patient members showed his/her friendliness and invited other patient members to make an extra effort together. This atmosphere of mutual encouragement makes cancer board a warm place for cancer patients.
CHAPTER SIX
CONCLUSION AND IMPLICATIONS
In this chapter, we first summarize the main findings of the present study. Then, implications and limitations of the present study are presented followed by our suggestions for further studies. Finally, this chapter ends with the contributions of the present study.