Narrative-based Medicine Research Articles

The potential of narrative-based medicine interventions targeting hospital practitioner burnout: findings from a scoping review

ABSTRACT Purpose To map the empirical literature with regards to narrative-based medicine interventions targeting burnout in hospital-based practitioners. Methods A systematic search of electronic databases (n = 6) and manual searches was conducted informed by the Joanna Briggs Institute scoping review guidelines. Papers were independently screened for quality. Semi-structured interviews were held with practitioners to further explore the acceptability and feasibility of the interventions from the review. Results The searches yielded 4,439 articles. Following screening by title and abstract, 73 papers remained for full-text review. Six papers were included in the final analysis. Gaps were noted in relation to reporting of intervention details, and of implementation considerations across the dataset. Narrative interventions were considered acceptable by stakeholders but significant issues of compatibility and feasibility were identified. Conclusions Narrative-based interventions are complex and warrant a systematic research approach. Addressing factors related to implementation in addition to mechanisms of action is essential to progress this promising interdisciplinary knowledge base.

Patient-Physician Relationship in Irritable Bowel Syndrome: Review on Empathy and Stigma.

Irritable bowel syndrome (IBS) lacks a clear understanding of the disease's pathogenesis and effective treatments thus producing frustration among providers and patients, leading to the stigmatization of the disease and the patients with the syndrome. A literature search was performed to make a hermeneutical review on empathic patient-provider communication and IBS. The relationship is defined by partners being dependent on one another in the pursuit of obtaining good outcomes. It is a unique interaction depending not only on the individual qualities of each partner but also on the specific patterns of the patient-physician synergy. Empathy is crucial for any relationship. It helps to recognize the other as the other of myself, a person like me. Meanwhile, stigmatization results from identifying and labelling human differences and stereotyping persons who are linked to undesirable characteristics. IBS is at high risk of stigmatization in various contexts and settings including health care, causing patients and physicians misconceptions and distress, which in turn leads to the worsening of the disease in patients and burnout in physicians. Narrative-based medicine helps create a holistic perspective of a patient's problems and health, thus providing a tool for an empathic doctor-patient relationship that fosters mutual understanding and helps patients with IBS make sense of symptoms, increases their ability to manage their IBS in a psychologically flexible manner, subsequently helping them maintain their quality of life.

Perspectives on Neuromyelitis Optica Spectrum Disorders, the Narrative Medicine contribution to care

BackgroundThis research aimed to investigate the experience of Neuromyelitis Optica Spectrum Disorders (NMOSD) by integrating the perspectives of patients, caregivers and clinicians through narrative-based medicine to provide new insights to improve care relationships.MethodsThe research was conducted in the second half of 2022 and involved six Italian centres treating NMOSD and targeted adult patients, their caregivers and healthcare providers to collect the three points of view of living with or caring for this rare disease, still difficult to treat despite the pharmacological options. Narratives followed a structured outline according to the time: yesterday-today-tomorrow, to capture all disease phases.ResultsTwenty-five patients diagnosed with NMOSD, ten caregivers and 13 healthcare providers participated in the research. Patients reported symptoms limiting their daily activities and strongly impacting their social dimension. We noticed improvements across disease duration, whilst the persistence of limitations was recurrent in patients with longer diagnoses.Caregivers’ narratives mainly share experiences of their daily life changes, the burden of the caregiving role and the solutions identified, if any. Healthcare providers defined their role as a guide.ConclusionLimitations in activities are prominent in the lives of people with NMOSD, along with fatigue. Family members are the weakest link in the chain and need information and support. Healthcare professionals are attentive to the helping dimension.

Narratives in the medicolegal field from the perspective of physicians involved in medical dispute mediation meetings in Taiwan

Medical treatment and narratives are interrelated. We examined this interrelation by evaluating the medical dispute mediation system in Taiwan. We conducted 16 semi-structured interviews with legal and administrative specialists in medical mediation and physicians involved in mediation meetings. The interview data were reproduced into almost verbatim text for coding and analysis. We examined how narratives were discussed in the field of medicine and identified two approaches to narratives. One was the narrative from a patient's storytelling, that is, narrative-based medicine. The other was the narrative of medical staff, which included shared decision-making and decision aids. Discussions of these approaches revolved around the avoidance of conflicts during medical treatment. However, knowing how to handle unsuccessful medical treatment is crucial. By applying polyphony in narratives, physicians can comprehend the role of narratives in unsuccessful medical treatment, helping themselves to practice how to develop narratives to communicate with patients and their surrogates when encountering any difficulty in different stages of medical treatment.

Elaborar, compartilhar, narrar: uma análise narrativa de três abordagens de comunicação em Saúde

Abstract Communication, despite being considered a key aspect in medical practice, has not received the corresponding attention both on literature and medical training as has the technological and biomedical aspects. As a reaction to this context emerged fields of knowledge proposing to reflect and strengthen aspects of communication between the physician and the patient. In this article, we perform a narrative analysis of the literature of three of such approaches to communication in health: the Balint Groups, the Patient Centered Care and Narrative-Based Medicine. The study highlights the approximations and distances between these approaches, along with the recognition of the potency of each of them in the different contexts of medical practice.

Exploring patient’s experience and unmet needs on pregnancy and family planning in rare and complex connective tissue diseases: a narrative medicine approach

ObjectiveThe aim of this work is to explore patient’ unmet needs of rare and complex rheumatic tissue diseases (rCTDs) patients during pregnancy and its planning by means of the narrative-based...

Multicentre narrative research on major depression to integrate the experiences of patients, their caregivers and healthcare providers in Italy

ObjectiveThis research aimed to investigate the experience of major depression by integrating the perspectives of patients, caregivers and healthcare providers through narrative-based medicine (NBM) to provide new insights to improve...

Thematic analysis of illness narratives as an example of an approach to better understand the lived experience of women diagnosed with breast cancer in Spain

ObjectiveTo explore the lived experience of women diagnosed with breast cancer through the analysis of illness narratives, as an example of a narrative-based medicine approach.SettingSpain.ParticipantsNine narratives stemming from non-fiction books,...

Narrative-based medicine in headache disorders

In this editorial we aim to provide an overview of Narrative-based Medicine (NBM) and highlight what it may offer to the care of individuals with headache disorders.

The effectiveness of postgraduate education on narrative-based medicine for physical therapists

The effectiveness of postgraduate education on narrative-based medicine for physical therapists

Narrative medicine in the cancer care: implementation and impact

Abstract Issue National and international health authorities have described Narrative-based medicine (NBM) in clinical practice as a fundamental tool for acquiring, understanding and integrating the different points of view of those involved in the disease and its treatment, promoting more effective and appropriate care. Description of the problem The use of NBM is part of the strategic project to improve patient-engagement in San Raffaele Hospital in Milan. Its implementation started, using the 'DNM-Digital Narrative Medicine' web-based platform, with the pilot prostate cancer path in March 2019. Results A 10-item questionnaire was sent to all 47 patients and 45 doctors involved, to evaluate: benefits perceived by the care team in terms of communication support, personalization of therapy, observation of cognitive elements not otherwise evident; benefits perceived by the patient (support, communication, self-management, identification of emotional, relational, social elements of daily life); patient and medical staff opinions in terms of compliance, accessibility, ease of use. The overall rating was 4.3/5 for doctors and 4.2/5 for patients. Patients valued the most the platform supporting them in the decision on what treatment to undergo (4.8/5), for the doctor the platform has been important in considering unknown aspects of the patient and understanding the patient's point of view (4.4/5). Patients, more than doctors, perceived platform usability positively. 43% of the patients who decided not to participate reported to prefer a direct approach with the doctor. Lessons The oncologic field represents an optimal setting for the implementation of methods aimed at strengthening communication and relationship of care. NBM offers the possibility of exploring elements as adherence to treatment, perception of illness, socio-psychological impact, sometimes missed during the visit, enhancing the conversation between patient and care team and stimulating the co-construction of care. Key messages NBM has proven to be a useful tool and a good communication channel in the oncologic setting. The NBM platform demonstrated good acceptability and ease of use by doctors and patients.

Medical Progress from Bio-Psycho-Social Points of View Associated with Happiness of People

For the inaugural issue of the “Biomedical Science Journal (BSJ)” in Ciencia Scientific Publisher group, Ciencia in Spanish means science, learning, and knowledge. BSJ covers wider fields of biomedical science. Medical practice has bio-psycho-social aspects. This is characteristic of primary care (PC), integrative medicine (IM), and psychosomatic medicine (PSM). Among them, important concepts include ACCCC of PC, Hinohara-ism, and New Elderly Association (NEA) by Dr. Shigeaki Hinohara, patient-oriented medicine, evidence-based medicine (EBM), narrative-based medicine (NBM). The goal of the medicine would be the health of the body and soul with happiness. Subjective well-being can be evaluated by the Subjective Happiness Scale (SHS). Significant and meaningful reports in BSJ would be expected to contribute much to the happiness of people across the world.

Narrative Based Medicine for healthcare professionals and cancer patients

Unlike the Evidence Based Medicine (EBM) approach, which tends not to consider the particularity of the subject, understood as unicum, in recent years a new “sensitivity” has spread in the Medical Faculties of many countries - European and non-European - and a different way of understanding medical-health practice: Narrative Based Medicine (NBM). This supports the need for social and health workers to learn to pay attention to patient stories and understand their emotional experience, but also to reflect on themselves, their emotions in confronting the disease and how they affect perceptions and on clinical practice.

Application of narrative medicine in oncological clinical practice: impact on health care professional.

Narrative medicine makes explicit the experience of disease and enhances the subjective view in the cure. In addition, the narrative approach involves personal experience and emotional resonances of the health care professional leading him to redefine the values in terms of health and disease. The IMPERO study aims to explore the personal "life experience" of health care professionals involved in studies exploring a new methodological clinical approach: the use of a digital narrative diary in collecting and integrating theme-oriented narration in clinical practice. Qualitative study based on the interviews of three health care professionals (two oncologists and one nurse) involved in the AMENO study. The main topic of the interviews was the "perceived" and the intimate experience of each health care professional, particularly on the meaning and the role regarding their personal and professional experience while coping with patients narration. The analysis of data focuses on three aspects: a) the health care professionals' point of view using the diary as a tool for narrative-based medicine; b) the work environment as a framework for the use of the digital diary; c) the mental construction concerning the meaning of the tool and its preliminary use in clinical practice. The diary is appreciate as a tool for the application of narrative-based medicine; the reading/writing format is considered of high quality and suitable for clinical practice processes. The narration drives a change in the patient-health care professional relationship: the patient is valued as an "individual". An atmosphere of empathy and greater intimacy is created. The perceptions developed over the years of clinical practice, which reflect personal and professional concepts (knowledge and individual believes in illness, health, healing, etc.), influence the perception of the narrative instrument and its clinical use. The work context influences the use of the diary, limiting its potential. Narrative medicine is a way of reorganizing the criteria that contribute in defining the quality of patient care by focusing on the patient-health care professional relationship. The approach of narrative medicine must be reviewed in the light of the relational systemic theory which allows us to understand several aspects: the training in narrative medicine itself, the acquisition of professional skills by practitioners, and the organizational development of the institutions (the organizational structures but also the values and professional culture of work).

Deeper inside the Experience of Pediatric Headache: A Narrative Study

Objective: To explore meanings, perspectives and points of view of the subjective experience of paediatric patients with headache (PPwH) and create a first-person narrative for clinical practice. Methods: We conducted a qualitative, narrative research study with PPwH, 11 - 17 years old. Data were collected through narratives interviews and a twofold narrative analysis was performed: a narrative and a thematic analysis. Results: Twenty-three patients (14 girls; mean age 14.5; median duration of illness of 5.8 years) were recruited. Through narrative analysis and close reading, narratives revealed different ways to organize illness experience: PPwH can use 1) narrative sequences of recurrent events in order a) to describe the continuing living-through of the experience of headache, b) to define operative script or c) to characterize the illness experience generally as a “controlled” routine; or 2) a storied account of events, with well-defined characters, plot and evaluation of contingency and correlation between events to express a personal point of view and a moral standpoint about the illness experience. Through thematic analysis 5 main themes and 22 subthemes about the significance of being a PPwH emerged: a) disease dimension (description of pain), b) illness dimension, c) sickness, d) causality, e) coping and f) future perception. Then, a first-person narrative story was created as a tool enabling reflection and conversation during clinical consultation. Conclusions: Results suggest that promoting narrative dialogue can be an opportunity for the neurologist: the prototypical narrative developed from story analysis might be a tool to apply for the narrative-based medicine in the clinical setting.

Healing Power of The Narrative in Medical Education

ÖZ Hastalık öyküleri tıbbı olguları tanımlamakla kalmaz; özelde, bir insanın yaşam ve ölümünün en “asıl” gerçekliğini de anlatır. Tıpta “öyküleştirme” ya da “anlatısallık” (narrative medicine); bireyin kendini, hastalığını ve yaşamı nasıl algıladığını anlayarak, yaşadığı acı veren deneyimle baş etmesini kolaylaştırmak amacında olan bir yaklaşımdır. Hasta oluş ve çare aramanın öyküleştirilmesi; hekim, hasta ve hasta yakınlarına karşılıklı anlamayı güçlendiren önemli bir içgörü kazandırır. “Yapılandırılmış” öyküler, yaşanılan olumsuz deneyimden uzaklaşarak farklı bir bakış açısıyla görmeyi sağlar. Hastalıkların tanı ve sağaltımını yönlendiren, kanıtlanabilen ve sonuca götüren uygulamalar tıbbın temelidir. Ancak bireyin “eşsiz”liği ve “öznel” unsurların anlaşılması da tanı ve sağaltıma, göz ardı edilemeyecek denli katkı sağlamaktadır. Kanıta dayalı tıbbın, “öyküye dayalı tıp” yaklaşımı ile bütünleştirilebilmesi için, “hasta merkezli” modelin benimsenmesi gerekir. Hekim-hasta ilişkisinde hasta merkezli yaklaşımın özünü öyküler oluşturur. Öyküler nedenselliği aydınlatan araçlardır. “Olgu” öyküleri, patolojik durumların tanımlanmasının yanı sıra, belli bir bireyde, bir hastalığın “nasıl” yaşandığını da gösterir. Hastalıkları, yalnız biyolojik ve patolojik nedenlerle açıklayan biyomedikal yaklaşımın, süreç içinde evrildiği “biyo-psiko-sosyal” model, hastalıkların ruhsal ve sosyal unsurlar da içerdiği gerçeğiyle, “hastalık yok, hasta var” bilincini geliştirmiştir. Biliminin kanıta dayalı olması gerektiği gerçeği, tıbbın öznel yanının yok sayılmasını gerektirmemektedir. Çünkü öznellik, tanısal durumlarda karar vermeyi kolaylaştıran ve sağaltımı, “o” birey için yapılandırabilen bir unsurdur. “Hastayı dinlerseniz size tanısını söyler” öğretisi ve “hümanizma”, tıbbı uygulamada giderek yok olmaktadır. Bu çalışmanın amacı; öyküleştirmenin tıp eğitimi ve uygulamalarında neden ve nasıl var olması gerektiğini incelemektir.

Is ignorance bliss, or is knowledge power? When cancer healthcare professionals become cancer patients

Cancer healthcare professionals who are diagnosed with cancer enter the patient journey with considerable illness-specific and healthcare expertise, which may influence the nature of their experience. Insights gained from having personal cancer experience may also lead to changes in professionals' subsequent clinical practice. This study explored cancer professional-patients' experiences of their own cancer diagnosis, changes in practice, and recommendations for cancer care improvements. Participants were current or former cancer healthcare professionals who had ever received a cancer diagnosis. Semi-structured interviews were conducted with 26 participants. Thematic analysis with an inductive approach was used for data analysis. Cancer professional-patients faced unique needs, benefits and disadvantages due to their professional background, which both aided and marred their personal cancer experience. Individuals reported subjective practical and emotional-related improvements in their clinical practice, although adverse emotional consequences upon returning to work were also prevalent. Care recommendations highlighted the importance of communication skills training for professionals, integrating psychological support, and providing patient-centred care. In order to provide optimal care for cancer professional-patients, providers must acknowledge their distinct challenges. Findings may help to foster improvements in cancer care practices through developing guidelines for treating cancer professional-patients, and as part of narrative-based medicine.

Narrative Medicine – the methodology of doctor-patient communication analysis

AbstractThe present paper aims at presenting a non-exhaustive list of methodology instruments for narrative analysis in medical communication. Patient narratives became of more and more importance while evidence-based medicine has created a gap between patients, their illness and their doctors. While being investigated through high-technology instruments used in medicine, the patient vanishes behind the computer screen where his body is analysed based on the biomedical factors. Narrative medicine is defined by one of its founders as the interaction between a health practitioner who doesn’t simply look at diseases, but treats the person who’s suffering from an illness by listening closely to his story (Charon 2001). Therefore, as mentioned by Rita Charon in her works, the doctor-patient interactions are measured considering the effectiveness of medical care. The patient is empowered with medical knowledge related to his illness, transposed into an accessible language. On the other side of the communication spectrum, the doctor reconnects with his patient, manifesting interest on how the patient’s life is affected by illness, not only on how it can be effectively treated. ‘Now, in recent years medical narrative is changing—from the stories about patients and their illnesses, patient narratives and the unfolding and interwoven story between healthcare professionals and patients are both gaining momentum, leading to the creation or defining of narrative-based medicine (NBM).’ (Kalitzkus and Matthiessen 2009). Narrative based medicine is presented to counteract the pitfalls of evidence-based medicine (EBM). NBM can foster a better care while taking into account the patient’s story on the way illness is affecting the quality of his everyday life. The final objective of effective medical care is to alleviate, if not to dismiss completely the illness and the suffering of the patients.

Strategie ed efficacia della medicina narrativa nei pazienti nefrologici: una revisione della letteratura. Parte 1

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Strategies and effectiveness of narrative medicine in renal patients: a literature review. Part 1

IntroductionThis paper on narrative-based medicine (NBM) is divided into two articles. The concept of NBM has been developed over the last decades to bring the biomedical aspects of illness and tre...