Healthcare Professional-patient Relationship Research Articles

REFLEXOS DA COMUNICAÇÃO NO CUIDADO EM SAÚDE

This article aims to reflect on the communication process as a valuable tool for providing quality, ethical, and appropriate care as based on first-hand reports I have received throughout my career as a psychologist. From my experience working with patients diagnosed with chronic illnesses and irreversible conditions in a hospital specialized in long-term care in the city of Suzano, located in the State of São Paulo, Brazil, it became clear to me how communication in the healthcare setting can promote relief, minimize suffering, and favor the success of the proposed treatment. Likewise, depending on the way it is practiced, not only can it negatively interfere with the biopsychosocial and spiritual spheres of patients and their families, but also harm the healthcare professional-patient relationship.

Group-Based Interventions in Lifestyle Medicine

Group-based interventions in health care have demonstrated a positive influence on patient outcomes by strengthening patient-healthcare professional relationships and providing an avenue for patient empowerment through shared experiences and belongingness. Groups have been shown to enhance social and psychological support, improve self-management behaviors, and encourage peer-support. However group settings also present challenges, such as discomforts in sharing within a group context and managing diverse group dynamics. We outline the efficacy and dynamics of group-based activities in health care settings. This includes key behavioral components of groups, such as creating a safe, supportive, and cohesive environment in group activities where confidentiality is paramount. By recognizing principles for group and moderator behaviors, individuals are more likely to maximize the potential of these interventions.

A qualitative exploration of the barriers and facilitators to self-managing multiple long-term conditions amongst people experiencing socioeconomic deprivation.

Globally, it is estimated that one in three adults live with two or more long-term conditions (multiple long-term conditions, MLTCs), that require self-management. People who experience socioeconomic deprivation face significant health inequalities due to a range of interrelated characteristics that lead to a lack of resources and opportunities. Previous research with underserved populations indicate low levels of trust towards primary care providers and potential barriers for developing patient-healthcare professional relationships. The purpose of this paper is to explore the barriers and facilitators to self-managing MLTCs, amongst people who experience socioeconomic deprivation. Semistructured one-to-one interviews with adults (n = 28) living in London and Sheffield, United Kingdom with MLTCs who are experiencing socioeconomic deprivation. Participants were recruited through general practices, community channels and social media. Data were analysed in NVivo using reflexive thematic analysis methods. Four analytical themes were developed: (1) challenges in accessing healthcare services, financial assistance, and cultural awareness; (2) empowerment and disempowerment through technology, including digital exclusion, and use of technology; (3) impact and causes of exclusion on self-management, including social isolation, area-based and economic exclusion, and health-related stigma and (4) adapting self-management strategies, including cost-effective, and culturally/lifestyle appropriate strategies. Future health interventions and services need to be developed with consideration of the combined complexities of managing MLTCs while experiencing socioeconomic deprivation. Increased awareness in practitioners and commissioners of the complexities surrounding the lives of people experiencing socioeconomic deprivation, and the need for targeted strategies to promote self-management of MLTCs are of great importa. A patient advisory group contributed to all stages of the study, including providing important feedback on study documents (topic guides and recruitment materials), as well as providing critical insights surrounding the interpretation of interview data.

Assessment of Awareness, Perception, and Opinions Towards Artificial Intelligence among Health Care Professionals and Medical Students at Tertiary Care Teaching Hospital: A Cross-sectional Study

Background: Artificial intelligence (AI) in healthcare, including machine learning and deep learning, enhances diagnosis and treatment across specialties like cardiology, dermatology, and ophthalmology. Its applications extend to transcription, patient data organization, and remote healthcare, offering support to medical professionals and transforming medical education for students and trainees. Methods: A prospective cross-sectional study was conducted with consecutive sampling, and 90 medical students were included in the study. Data was collected using Questionnaire data forms and analysed. Results: The findings revealed that 73.9% of students were aware of AI, but a significant 80.0% reported a lack of formal education on the subject. Positive perceptions included the recognition of AI's efficacy in reducing errors (71.1%) and facilitating patient education (56.7%). However, concerns were raised regarding potential impacts on the healthcare professional-patient relationship. The majority (56.7%) advocated for the integration of AI knowledge and skills into the academic curriculum. The mean positive perception score of 29.8 showed associations with age, and year of study. Conclusion: This study underscores the need to address gaps in AI awareness and advocates for the integration of AI education into pharmacy curricula. The findings highlight nuanced perspectives among students and emphasize the potential benefits of tailored educational strategies to harness positive attitudes toward AI integration in healthcare.

Electronic health record : challenges and possibilities

Information systems have been driving technological advances in healthcare, especially over the past two decades. Digital health is transforming care by emphasizing efficiency, accessibility, and integrating technology at every stage of the patient journey. The Electronic Health Record (EHR), a software used in hospitals or clinics, emerges as a cornerstone in this transformation by consolidating medical data to facilitate care coordination. This integration promises to enhance the quality of care and the patient-healthcare professional relationship, while presenting practical challenges such as increased documentation. In this article, we explore various aspects of the EHR, addressing its challenges and potential adaptations in our practice.

User Perspectives of Geriatric German Patients on Smart Sensor Technology in Healthcare.

With consideration of the progressing aging of our societies, the introduction of smart sensor technology can contribute to the improvement of healthcare for older patients and to reductions of the costs of care. From the clinical and medico-ethical points of view, the advantages of smart sensor technology are copious. However, any ethical evaluation of an introduction of a new technology in medical practice requires an inclusion of patients' perspectives and their assessments. We have conducted qualitative, semi-structured, exploratory interviews with 11 older patients in order to gain their subjective opinions on the use of smart sensor devices for rehabilitation purposes. The interviews were analyzed using methods of qualitative content and thematic analyses. In our analysis, we have focused on ethical aspects of adoption of this technology in clinical practice. Most of the interviewees expressed their trust in this technology, foremost because of its accuracy. Several respondents stated apprehension that the use of smart sensors will lead to a change in the patient-healthcare professional relationship. Regarding costs of introduction of smart sensors into healthcare, interviewees were divided between health insurance bearing the costs and individual participation in corresponding costs. Most interviewees had no concerns about the protection of their privacy or personal information. Considering these results, improvement of users' technology literacy regarding possible threats connected with putting smart sensors into clinical practice is a precondition to any individual application of smart sensors. This should occur in the form of extended and well-designed patient information adapted to individual levels of understanding. Moreover, application of smart sensors needs to be accompanied with careful anamnesis of patient's needs, life goals, capabilities, and concerns.

Stroke Survivor's Satisfaction and Experience with Rehabilitation Services: A Qualitative Systematic Review.

Research in healthcare is increasingly focused on quality assurance and continuous quality improvement aiming to promote service quality. Satisfaction is a key endpoint in outcomes research and service benchmarking, along with "traditional" clinical outcomes. What controls stroke survivors' satisfaction differs among qualitative studies' conclusions, but there is general consensus on the importance of communication, improvement in activity, and engagement in goal setting. This review aims to collect and synthesise studies of the satisfaction of stroke survivors with rehabilitation services. A systematic search was conducted in seven electronic databases, including CINAHL, OVID, Pedro, Scopus Midline, Web of Science, and PubMed. The database search yielded 1339 studies, while one additional work was identified through hand searching. After removing duplicates, 74 studies were read in full, and after resultant exclusions, 12 qualitative studies were systematically reviewed, extracted, and appraised by two reviewers independently (HAS and RT) and the third reviewer (CS) was available for any disagreement. Five analytical themes were identified: Healthcare Professional-Patient Relationship (HCP), Delivery Service, Perceived Patient Autonomy (PPA), Expectations Shape Satisfaction, and Culture Influences Satisfaction. The studies of survivors' satisfaction, experiences, and their rehabilitative needs with the services they receive have provided different factors that influence their satisfaction during rehabilitation in different countries worldwide. However, the context in which the studies were conducted is quite limited, and more detailed studies are required for many underexplored contexts.

Patient Experiences of Communication with Healthcare Professionals on Their Healthcare Management around Chronic Respiratory Diseases.

Communication is an important clinical tool for the prevention and control of diseases, to advise and inform patients and the public, providing them with essential knowledge regarding healthcare and disease management. This study explored the experience of communication between healthcare professionals (HCPs) and people with long-term lung conditions, from the patient perspective. This qualitative study analyzed the experience of people with chronic lung disease, recruited via Asthma & Lung UK (A&LUK) and COPD research databases. A&LUK invited people who had expressed a desire to be involved in research associated with their condition via their Expert Patient Panel and associated patients' groups. Two focus group interviews (12 participants) and one individual interview (1 participant) were conducted. Thematic analysis was used for data analysis. Two main themes were identified and we named them 'involving communication' and 'communication needs to be improved. 'They included seven subthemes: community-led support increased the patients' social interaction with peers; allied-HCP-led support increased patients' satisfaction; disliking being repeatedly asked the same basic information; feeling communication was unengaging, lacking personal specifics and the use of medical terminology and jargon. The study has identified what most matters in the process of communication with HCPs in people with long-term respiratory diseases of their healthcare management. The findings of the study can be used to improve the patient-healthcare professional relationship and facilitate a better communication flow in long-term healthcare management.

Interdisciplinary collaboration in serious illness conversations in patients with multiple myeloma and caregivers – a qualitative study

BackgroundThere is growing evidence that conversations between healthcare professionals and patients with serious illness can improve the quality of end-of-life cancer care. Yet, there is lack of insight into how different healthcare professions collaborate to deliver serious illness communication, as well as patients’ and caregivers’ perceptions of this collaboration between the nurse and physician. This study explores the interdisciplinary collaboration between nurses and physicians in serious illness conversations with patients diagnosed with multiple myeloma and their caregivers.MethodsEleven dyadic interviews were conducted with 22 patients and caregivers, and two focus group interviews involving four nurses and the other with four physicians. Data analysis and reporting were conducted using reflexive thematic analysis within phenomenological epistemology.ResultsThe interdisciplinary collaboration was characterized by three main themes: (1) Importance of relationships, (2) Complementary perspectives, and (3) The common goal.ConclusionThis study highlights the importance of interdisciplinarity in serious illness conversations as it enhances the use of existential and descriptive language when addressing medical, holistic, and existential issues. The use of broader language also reflects that interdisciplinary interaction strengthens the expertise of each professional involved in patient care. Through interdisciplinary collaboration, the preferences, hopes, and values of the patient and caregiver can be integrated into the treatment plan, which is key in providing the delivery of optimal care. To promote cohesive and coordinated collaboration, organizational changes are recommended such as supporting continuity in patient–healthcare professional relationships, providing interdisciplinary training, and allocating time for pre-conversation preparation and post-conversation debriefing.

Body objectified? Phenomenological perspective on patient objectification in teleconsultation.

The global crisis of COVID-19 pandemic has considerably accelerated the use of teleconsultation (consultation between the patient and the doctor via video platforms). While it has some obvious benefits and drawbacks for both the patient and the doctor, it is important to consider-how teleconsultation impacts the quality of the patient-doctor relationship? I will approach this question through the lens of phenomenology of the body, focusing on the question-what happens to the patient objectification in teleconsultation? To answer this question I will adopt a phenomenological approach combining both insights drawn from the phenomenological tradition, i.e., the concepts of the lived body and the object body, and the results from the phenomenologically informed qualitative research study on the patient experience of teleconsultation. The theoretical background against which I have developed this study comprises discussions within the field of phenomenology of medicine regarding the different sources of patient objectification within clinical encounter and the arguments concerning the negative impact that objectification has on the quality of care. I will argue that a factor that has frequently been identified within phenomenology of medicine as the main source of patient objectification in clinical encounters, namely, the internalized gaze of the clinician, is diminished during teleconsultation, increasing patient's sense of agency, decreasing her sense of alienation and opening up the possibility for a closer relationship between the patient and the health care provider, all of which lead to the transformation of the hierarchical patient-health care professional relationship.

Effectiveness of a brief motivational intervention in the management of risky alcohol use in primary care: ALCO-AP20 study protocol.

Motivational interviewing (MI) could be a method for minimizing alcohol-related harm. The study aims to assess the effectiveness of a brief intervention, based on a MI, in patients with risky alcohol use attended in Primary Care (PC). A cluster-randomized, two-arm parallel, multicenter, open-label, controlled clinical trial. Fifty PC healthcare professionals from the province of Córdoba (Spain) will be randomized to one of the two study groups: (1) Experimental Group (EG): MI-based approach; (2) Control Group (CG): Usual care based on health advice. EG intervention: Professionals will receive a training program focused on MI, consisting of a training workshop and the use of pre- and post-workshop questionnaires to measure knowledge and skills acquired, as well as the degree of empathy, with a videotape of the health professionals with standardized patients, before and after the workshop, and subsequent training feedback. CG intervention: Workshop on the management of risky alcohol use based on health advice; participants will also complete the pre-and post-workshop questionnaires and be videotaped. Study population: Patients ≥ 14 years old with risky alcohol consumption (28 Standard Drink Units-SDU-/week in men and 17 SDU/week in women) or excessive alcohol use (≥ 6 SDU in men or ≥ 4 SDU in women, in less than 2 h). It would be necessary to include 110 subjects/group to find a difference of 20% between the percentage of patients in abstinence between EG (37%) and CG (20%), alpha error of 5%, and statistical power of 80%. Assuming a loss rate of 5% and the cluster design effect, the number of subjects to be recruited is estimated at 197/group. The follow-up period will be 12 months. The primary outcome variables will be the self-reported alcohol use level and the Alcohol Use Disorders Identification Test (AUDIT) questionnaire score. The study aims to demonstrate the effectiveness of the motivational approach in the comprehensive treatment of the patient with risky alcohol use, improving the empathy of the healthcare professionals and strengthening the healthcare professional-patient relationship to achieve the behavioral change of the patients with this problem in primary care consultations. ClinicalTrials.gov.

Experiences of COVID-19 patients in a Fangcang shelter hospital in China during the first wave of the COVID-19 pandemic: a qualitative descriptive study

ObjectivesThis study aimed to examine COVID-19 patients’ experiences in a Fangcang shelter hospital in China, to provide insights into the effectiveness of this centralised isolation strategy as a novel solution...

Models of comprehensive care for older persons with chronic diseases: a systematic review with a focus on effectiveness

IntroductionAgeing entails a variety of physiological changes that increase the risk of chronic non-communicable diseases. The prevalence of these diseases leads to an increase in the use of health services....

Patients' and informal carers' experience of living with mesothelioma: A systematic rapid review and synthesis of the literature.

Mesothelioma is a rare and incurable cancer linked to asbestos exposure. It primarily affects the pleura. This systematic rapid review aimed to identify what is known about the experience of living with mesothelioma, from the perspective of patients and their informal carers. Medline, PsycInfo, Scopus and the Cumulative Index to Nursing and Allied Health Literature were searched for empirical studies published between December 2008 and October 2020. Google Scholar was searched. The inclusion criteria stated that studies were peer-reviewed, reported the experience of living with mesothelioma from the perspective of patients and carers and written in English. The Mixed-Methods Appraisal Tool was used to assess quality. The review protocol is registered on PROSPERO: CRD42020204726. Twenty-five studies met the inclusion criteria. Following data extraction, a narrative synthesis identified three themes: the impact on the individual; the impact on informal carers and relationships; and interactions with professionals and systems. The physical and psychological symptom burden of mesothelioma on patients' lives was reported as high. Both the qualitative and quantitative literature highlighted that patients and carers may have different needs throughout the mesothelioma journey. Differences included psychological experiences and preferences regarding the timing of information and support provision. Patients and carers expected their health care professionals to be knowledgeable about mesothelioma or refer to those who were. Health care professionals that were compassionate, honest and supportive also positively influenced the experience of patients and carers living with mesothelioma. A lack of communication or misinformation was damaging to the patient-healthcare professional relationship. Continuity of care, coordinated care and good communication between treatment centres were widely reported as important in the literature. Fragmented care was identified as detrimental to the patient experience, increasing anxiety in patients. However, relationships with professionals were not only important in terms of co-ordinating care. There was also evidence that good relationships with healthcare professionals were beneficial to coping with the mesothelioma diagnosis. The volume of mesothelioma experience research has grown over the past decade. This has led to our growing understanding of the complex needs and experiences of mesothelioma patients and carers. However, this review identified several evidence gaps.

Knowledge, attitudes, and practices of primary healthcare providers with assessing and supporting older informal caregivers

A time burden, financial strain, and prioritizing care recipient needs over their own are key barriers preventing informal caregivers from engaging in health-promoting self-care. Primary healthcare providers are well positioned to assess and support informal caregivers. A cross sectional descriptive, correlational study was used to examine the knowledge, attitudes, and practices of healthcare providers regarding assessment and support of older informal caregivers. The Healthcare Professional Facilitated Health Promotion (HPFHP) Model guides this study by depicting the collaborative patient-healthcare professional relationship. The Caregiver Self-Care Survey for Healthcare Providers measured the knowledge, attitudes, and practices of 80 healthcare providers on assessing and supporting older informal caregivers. Descriptive and inferential statistics were calculated using IBM Statistical Package for the Social Sciences (SPSS) 28.0 software. Results indicated that despite positive attitudes, knowledge deficit and system level barriers prevented integration of caregiver assessment in practice. A caregiver identification process, user-friendly assessment tool, and system level changes are overdue.

Results of the ECHO (Eating habits CHanges in Oncologic patients) Survey: An Italian Cross-Sectional Multicentric Study to Explore Dietary Changes and Dietary Supplement Use, in Breast Cancer Survivors.

The role of a healthy diet in cancer prevention is well recognized. Recent data indicate that following the same advices can also improve cancer survivors’ quality of life. Breast cancer (BC) patients are commonly concerned about diet and nutrition and frequently express the need to obtain health-related information and the will to change their diet and lifestyle. Hence, be aware of survivors’ dietary changes and information needs is crucial for healthcare professionals to guide them toward optimal lifestyle choices. In order to investigate eating habits changes in a BC survivors’ population, we conceived the cross-sectional multicentric study ECHO (Eating habits CHanges in Oncologic patients) Survey. Data were collected from 684 patients, diagnosed with invasive breast cancer, in order to investigate their changes in food consumption, use of supplements, or the beginning of a specific diet, after BC diagnosis. We also examined the sources of information used and if any modification in their diets was reported to the oncologist. We primarily observed that patients increased their consumption of vegetables, pulses, nuts, fruits, wholemeal bread/pasta, grains and fish; while decreasing red and processed meat, refined bread/pasta, baked good and animal fat consumption. Survivors also reported the use of dietary supplements, mainly vitamins, aimed at counteracting therapies’ side effects. Changes in nutritional habits were often adopted without asking or informing the oncologist. Despite BC survivors made some positive changes in their nutritional habits, those modifications were mostly pursued by less than half of them, while the majority of patients consumed nutritional supplements after diagnosis. These results, as well as the failure to communicate with the physicians, reinforce the need to both improve the patient-healthcare professional relationship and to develop tailored nutrition counselling and intervention programs for cancer survivors.

6.G. Workshop: Developing a consent model for health information – challenges in a rapidly changing digital world

Abstract Advances in eHealth and digital technologies have the potential to improve the quality of patient care and promote efficiency across a health service. The potential benefits have often not been realised, however, due to a sometimes greater focus on organisational needs rather than pursuing a person-centred approach. There are some concerns from the public in relation to the privacy and security of data, issues in relation to digital literacy and inadequate digital infrastructure, and the potential erosion of the patient-healthcare professional relationship. The introduction of new information systems requires clarity around consent to align with good information governance practices and support people's rights and involvement in relation to health information decisions. Internationally, the successful introduction of digital technologies in healthcare have been informed by effective public engagement and involvement from the outset. Public engagement helps to build trust and confidence in relation to health information use, and gives insight into important considerations for the development of a consent model. As part of this workshop, we will share the experiences of three different European countries who are at varying stages of development and implementation of eHealth solutions. Ireland is at the early stages of transition to a more digital healthcare service. In England, there are a number of eHealth systems in place although difficulties have been experienced at stages; understanding public expectations and involving the public in decision-making has been an important component of their progress. Estonia is recognised as a leader in eHealth and has much to offer in relation to the fundamental principles of successful implementation. The objectives of this workshop are to: 1) share experiences in relation to the process of public engagement across different contexts; 2) examine the eHealth landscape in relation to health information sharing; and 3) lead a discussion on the opportunities and challenges faced for the future of health information in a digital world. This workshop will be comprised of three presentations, from each of the above country perspectives, followed by a panel discussion with contributions invited from the audience. Key messages Building public trust, via public engagement, is essential for successful implementation of digital health technologies. Digital health can transform future health systems but success requires strong national leadership, information governance, robust standards, consent management, and access rights.

Patient participation in shared decision-making in palliative care - an integrative review.

Shared decision-making is a process where the decisions regarding patients' care are done in collaboration with the patient, the patient's family and a healthcare professional or an interdisciplinary team. Shared decision-making is considered to be a part of patient centred care, and it enables patient autonomy which is a cornerstone of palliative care. In the past, research on the experiences of palliative care patients' participation in shared decision-making involving a nurse has been limited as the focus has mainly been on specific medical interventions, rather than holistic palliative care. To synthesise research findings on patient participation in shared decision-making in palliative care. An integrative literature review. The literature search was conducted by searching computerised databases (CINAHL, PubMed, PsychINFO and COCHRANE). The search resulted in 12 articles. The quality of the included articles was evaluated with JBI checklist, and the data analysis was done using inductive content analysis. Reporting was done according to a PRISMA checklist. Patients do participate in shared decision-making and desire to participate in everyday nursing care decisions, treatment-related medical decisions and end-of-life decisions. The prerequisites for patient participation in shared decision-making are interdisciplinary teamwork, open communication, good patient-healthcare professional relationship, a favourable environment and mutual information. Palliative care patients do participate and desire to participate in decisions that cover a much broader range of topics than just medical interventions and this should be addressed in future research and in practise. The main responsibility for successful patient participation in shared decision-making lies with the healthcare professionals and the organisations providing palliative care. There is a need to conduct more research from the patient's perspective and explore the meaning of participating in shared decision-making from the patient's point of view.

The impact of protective face masks and coverings on patient-health provider communication

IntroductionAmid the COVID-19 pandemic the trend points to universal use of protective face masks. The impact posed on verbal and non-verbal communication by masks is yet another challenge to be addressed in clinical care.ObjectivesTo reflect on the consequences of face mask and covering use on communication in the clinical setting, including mental health settings.MethodsPubmed and Google Scholar literature search using terms face mask / face covering and communication / emotion.ResultsThere is a lack of literature on the impact of protective face masks and coverings on communication in clinical settings. Face masks and coverings may have a significant impact on patient-healthcare professional relationship due to disruption of verbal (poorer quality of speech transmission) and non-verbal communication (emotional expression and recognition) with consequences on: 1) clarity of communication with potential for misunderstanding clinical information, advice and prescriptions posing safety issues, 2) emotion perception, expression and reciprocity, 4) perception of healthcare professionals’ empathy and therefore, 3) patient satisfaction, 4) quality of care, and 5) clinical outcomes. Difficulties in communication between the patients´family or other carers and healthcare providers and between healthcare professionals are likewise challenged. People with hearing impairment, children and people with mental illness may be especially vulnerable to these difficulties in communication.ConclusionsProtective face masks and coverings are undoubtedly important in preventing spread of COVID-19, nonetheless mental healthcare professionals should take into account their significant impact on verbal and non-verbal communication in clinical care. Alternative strategies to enhance communication and rapport may be warranted.

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).