During the beginning of the COVID-19 pandemic, Nicole Ramer found herself navigating graduate school, isolation and a cancer diagnosis all at once.
Looking for support, she turned to online cancer support groups, spaces she initially approached with hesitation. What she found there not only helped her through treatment but ultimately reshaped the trajectory of her academic career. Now, a doctoral researcher in rhetoric and composition, Ramer studies how patients communicate within these online cancer support groups.
Ramer grew up in small-town Ste. Genevieve, Missouri–about 60 miles away from St. Louis–and there, public service was central to her childhood and upbringing.
“I came from a family of elected officials, my grandpa was a state representative. Community and public service was a big thing since I was a little girl.”
Those values and background led her to the University of Missouri-Columbia where she studied political science, planning for a career in law or politics. As graduation approached, however, she realized that wasn’t the path for her.
Instead, she dove into rhetoric and composition, studying how language shapes civic life and public understanding.
“When I found rhetoric and composition, I found that you could do so much with public service and language in that,” she says.
Her academic journey didn’t end there. She went on to earn two more master’s degrees and then spent almost a decade teaching at colleges in the St. Louis area. Ramer taught English 100, business writing, technical writing, writing for engineering and any type of writing class you could think of.
From there, she earned a third master’s degree in English from the University of Missouri–St. Louis. While there, she researched the Ferguson Commission report after the killing of Michael Brown, studying how language circulated throughout communities and shaped conversations on race.
This research path shifted dramatically after she began her PhD at UW–Madison. During her second semester, Ramer was diagnosed with cancer, all while the pandemic was isolating people from traditional forms of support.
“I really wanted support, and the only support that I could find was online, and usually on Facebook,” she says.
Initially, she was hesitant to join these digital communities, especially during a time where misinformation ran rampant, particularly regarding medicine and public health. Instead, she found something unexpected.
“I was pleasantly surprised by what was going on there,” she says. “People were generous and supportive in a non persuasive way.”
These communities reflected a rhetorical theory called invitational rhetoric, prioritizing listening and understanding over persuasion, something Ramer admits she had only encountered in theory. She had “always liked this concept” but had never actually seen it materialize in real life, describing it as “very utopian.”
However, seeing these support groups in action changed that perception, showing that it can exist in practice, not just as an ideal.
It was this realization that then became the foundation for her research. Instead of studying communication regarding doctors or institutions, Ramer is taking a community approach, centering the voices of patients themselves, exploring how digital communities provide emotional support, shared knowledge, and forms of advocacy that often fall outside traditional medical conversations.
Through surveys, interviews and focus groups with dozens of participants in online cancer communities, Ramer found that these groups challenge common assumptions about how health information circulates online.
“There’s a lot of dismissal about the information that’s going on in social media,” she says. “But I don’t think doctors give patients enough credit for the critical thinking that can be done in this community setting.”
These digital communities also provide support for parts of the illness that traditional settings fail to address.
“There’s so much with cancer besides the diagnosis and the sickness,” Ramer says. “Mental health, relationships, friendships … it affects so many different levels that aren’t always discussed.”
These communities are a place for information, connection and healing, their impact expanding beyond the digital forum, as well. Some members began writing books about their experiences, documenting their journey. Others expressed their experience through art and tattoos to commemorate what they’ve been through.
Ramer’s own experience navigating cancer during graduate school also reshaped how she views academic institutions and support systems. Her department allowed her to take leave and continue her studies while receiving treatment, an opportunity she says many graduate students elsewhere do not have. Now, she is continuing her research and also teaching English 100, UW’s freshman composition class.
On top of this, she works as a community engagement graduate hourly at the Morgridge Center for Public Service, helping build and lead workshops which introduce students to community-engaged learning and public service.
For Ramer, whether public service appears in classrooms, research or digital forums, it all comes back to reciprocal relationships and listening.
“I think it’s all about building relationships with the communities that you’re in, coming from a place of understanding and asset sharing,” she says.
As she prepares for graduation and plans to join the faculty at University of Arkansas at Little Rock, she wants her research to leave a legacy of understanding, hoping it will encourage academics and professionals to take patients seriously and learn more about their stories.
By Sammie Garrity