LATE-BREAKING ABSTRACT: First experience of narrative medicine to improve the care of COPD

Abstract

Background: Lack of adherence to treatment accounts for up to 50% in Italian patients with COPD, being the possible cause the lack of efficacious understanding of illness, as already assessed in other countries (Leiva-Fernandez, J. et al. BMC Pulm Med 2014 25;14:70). The parallel chart is a narrative medicine tool that improves doctor–patient relationship (Charon R. Oxford University Press 2006), by asking physicians to write about patients9 life, bringing out reflective thoughts on care. Aims and Objectives: The aim of the project was to evaluate if the use of parallel chart could change the reciprocal relationship between physicians and patients with COPD and consequently the quality and the alliance of care. Methods: Between October 2015 and March 2016, 50 Italian pulmonologists were involved in the collection of parallel charts of anonymous patients with COPD. The narratives were analysed according to the Grounded Theory and using semantic software (NVivo 10). Results: In the 244 parallel charts collected, the patients (mean age 69 years, 68% men) are described as still active and as a resource for their families (71%). Doctor patient relationship started as difficult in 50% of cases, being young age (78%) and smoking (86%) main conditioning factors. The conversations turned positive in 78% of narratives, leveraging onto a deeper mutual knowledge, on the trust for the clinicians establishing the effective therapy (92%), or supporting in smoke quitting (63%), or restoring patients9 activities (78%). Conclusions: All physicians, on a consensus basis, stated the adoption of innovative parallel charts was useful to improve clinical care and worth to be included officially in protocols for COPD patients9 management.