Based on the principles of Narrative Medicine, this study explored a narrative-based workshop for multi-level interdisciplinary clinicians who have EOL conversations.
Methods
Fifty-two clinicians participated in narrative-based interactive workshops. Participants engaged narrative in three forms: viewing narratives, writing/sharing narratives, and co-constructing narratives. Post workshop interviews were conducted and thematically analyzed.
Results
Five themes characterized how the workshop shaped learning and subsequent care experiences: (1) learning to enter/respond to the patient stories, (2) communicating across professions and disciplines, (3) practicing self-care. Additional themes emphasized (4) barriers to narrative learning and (5) obstacles to applying narrative to practice.
Discussion
Results highlight the function/utility of narrative forms such as the value of processing emotions via reflective writing, feeling vulnerable while sharing narratives, and appreciating colleagues’ obstacles while observing patient-clinician simulations. Challenges associated with narrative such as writing anxiety and barriers to implementation such as time constraints are detailed to inform future initiatives.
Al-ImariL.YangJ.PimlottN. (2016). Peer-support writing group in a community family medicine teaching unit: Facilitating professional development. Canadian Family Physician, 62, E724–E730.
2.
BarberS.Moreno-LeguizamonC. J. (2017). Can narrative medicine education contribute to the delivery of compassionate care? A review of the literature.Medical Humanities, 43(3), 199–203. https://doi.org/10.1136/medhum-2017-011242
3.
BolasC. (1987). The shadow of the object: Psychoanalysis of the unthought known. Columbia University Press.
4.
BoyatzisR. E. (1998). Transforming qualitative information: Thematic analysis and code development. Sage.
5.
BraverS. L.BayR. C. (1992). Assessing and compensating for self-selection bias (non-representativeness) of the family research sample. Journal of Marriage and the Family, 54(4), 925. https://doi.org/10.2307/353173
6.
ButterfieldL. D.BorgenW. A.AmundsonN. E.MaglioA. T. (2005). Fifty years of the critical incident technique: 1954-2004 and beyond. Qualitative Research, 5(4), 475–497.
7.
BylundC. L.BrownR. F.Di CicconeB. L.LevinT. T.GueguenJ. A.HillC.KissaneD. W. (2008). Training faculty to facilitate communication skills training: Development and evaluation of a workshop.Patient Education and Counseling, 70(3), 430–436. https://doi.org/10.1016/j.pec.2007.11.024
8.
CanzonaM. R.LoveD.BarrettR.HenleyJ.BridgesS.KoontzA.NelsonS.DayaS. (2018). “Operating in the dark”: Nurses’ attempts to help patients and families manage the transition from oncology to comfort care.Journal of Clinical Nursing, 27(21–22), 4158–4167. https://doi.org/10.1111/jocn.14603
9.
CharonR. (2001). Narrative medicine: A model for empathy, reflection, profession, and trust.The Journal of the American Medical Association, 286, 1897–1902.
10.
CharonR. (2008). Narrative medicine: Honoring the stories of illness. Oxford University Press.
11.
ChretienK. C.SwensonR.YoonB.JulianR.KeenanJ.CroffootJ.KheirbekR. (2015). Tell me your story: A pilot narrative medicine curriculum during the medicine clerkship.Journal of General Internal Medicine, 30(7), 1025–1028. https://doi.org/10.1007/s11606-015-3211-z
12.
ChungH.OczkowskiS. J. W.HanveyL.MbuagbawL.YouJ. J. (2016). Educational interventions to train healthcare professionals in end-of-life communication: A systematic review and meta-analysis. BMC Medical Education, 16, 13.
13.
CovinskyK. E.FullerJ. D.YaffeK.JohnstonC. B.HamelM. B.LynnJ.TenoJ. M.PhillipsR. S. (2000). Communication and decision-making in seriously ill patients: Findings of the support project. Journal of the American Geriatrics Society, 48(S1), S187–S193. https://doi.org/10.1111/j.1532-5415.2000.tb03131.x
14.
CreswellJ. W. (2007). Qualitative inquiry & research design: Choosing among the five approaches (2nd ed.). Sage Publications, Inc.
15.
DaceyM.ArnsteinF.KennedyM. A.WolfeJ.PhillipsE. M. (2013). The impact of lifestyle medicine continuing education on provider knowledge, attitudes, and counseling behaviors.Medical Teacher, 35, e1149–e1156.
16.
DalyK. J. (2007). Qualitative methods for family studies and human development. SAGE.
DavisonS. (2010). End-of-life care preferences and needs: Perceptions of patients with chronic kidney disease. Clinical Journal of the American Society of Nephrology, 5, 196–204.
19.
DavisonS. N.SimpsonC. (2006). Hope and advance care planning in patients with end stage renal disease: Qualitative interview study.British Medical Journal, 333(886): 886–889.
20.
EpnerD. E.BaileW. F. (2014). Difficult conversations: Teaching medical oncology trainees communication skills one hour at a time. Academic Medicine, 89, 578–584.
21.
Fernandes-TaylorS. (2010). Provider communication, self-reported health, and post-treatment regret among young breast cancer survivors [ProQuest Dissertations and Theses, 86]. University of California, Berkeley.
22.
FulmerT.EscobedoM.BermanA.KorenM. J.HernándezS.HultA. (2018). Physicians' views on advance care planning and end-of-life care conversations. Journal of the American Geriatrics Society, 66(6), 1201–1205.
23.
GlaserB.StraussA. (1967). The discovery of grounded theory. Weidenfield & Nicolson.
24.
GogoA.OstaA.McclaffertyH.RanaD. T. (2019). Cultivating a way of being and doing: Individual strategies for physician well-being and resilience.Current Problems in Pediatric and Adolescent Health Care, 49(12), 100663.
25.
GordonE. J.DaughertyC. K. (2003). ‘Hitting you over the head': Oncologists' disclosure of prognosis to advanced cancer patients.Bioethics, 17(2), 142–168. https://doi.org/10.1111/1467-8519.00330
26.
GowdaD.CurranT.KhedagiA.MangoldM.JiwaniF.DesaiU.CharonR.BalmerD. (2019). Implementing an interprofessional narrative medicine program in academic clinics: Feasibility and program evaluation.Perspectives on Medical Education, 8(1),52–59.
27.
GrayN. A.LeBlancT. W. (2018). The study to understand prognoses and preferences for outcomes and risks of treatments (Support). Advance online publication. https://doi.org/10.1093/med/9780190658618.003.0030
28.
GreenhalghT.HurwitzB. (1999). Why study narrative?British Medical Journal, 18 (7175), 48–50.
29.
HarterP. M.JappB.BeckC. S. (Eds.) (2005). Narratives, health, and healing: Communication theory, research and practice. Erlbaum.
30.
HawkinsN. E. (1991). Bravery training: an approach to desensitizing young children to fears encountered in the hospital setting. Archives of Physical Medicine and Rehabilitation, 72, 697–700.
31.
HoA.JamesonK.PavlishC. (2016). An exploratory study of interprofessional collaboration in end-of-life decision-making beyond palliative care settings.Journal of Interprofessional Care, 30, 795–803.
32.
HuddsonP. L.ArandaS.KristjansonL. J. (2004). Meeting the supportive needs of family caregivers in palliative care: Challenges for health professionals. Journal of Palliative Medicine, 7(1), 19–25.
33.
KeatingeD. (2002). Versatility and flexibility: Attributes of the critical incident technique in nursing research.Nursing and Health Sciences, 4(1–2), 33–39.
34.
KolbD. A.FryR. (1975). Toward an applied theory of experiential learning. Theories of Group Process. John Wiley.
LibenS.ChinK.BoudreauJ. D.BoillatM.SteinertY. (2012). Assessing a faculty development workshop in narrative medicine. Medical Teacher, 34(12): e813-e819. https://doi.org/10.3109/0142159x.2012.714876
37.
MackJ. W.SmithT. J. (2012). Why physicians do not have discussions about poor prognosis, why it matters, and what can be improved. Journal of Clinical Oncology, 30(22), 2715–2717.
38.
MackJ. W.WolfeJ.CookE. F. (2007.) Hope and prognostic disclosure. Journal of Clinical Oncology, 25, 5636–5642.
39.
McClementS. E.ChochinovH. M. (2008). Hope in advanced cancer patients.European Journal of Cancer, 44, 1169–1174.
MilotaM. M.Van ThielG. J.Van DeldenJ. J. (2019). Narrative medicine as a medical education tool: A systematic review.Medical Teacher, 41(7), 802–810. https://doi.org/10.1080/0142159x.2019.1584274
42.
MorrisD. (2008). Narrative medicines: Challenge and resistance. The Permanente Journal, 12(1): 88–96.
43.
MorseJ. M.BarrettM.MayanM.Olson.K.SpiersJ. (2002). Verification strategies for establishing reliability and validity in qualitative research. International Journal of Qualitative Methods, 1(2), 13–22 (Article 2).
44.
National Academy of Medicine. (2003). When children die: Improving palliative and end-of-life care for children and their families. The National Academies Press.
45.
National Academy of Medicine. (2015). Addressing key end of life issues; Dying in America: Improving quality and honoring individual preferences near the end of life. National Academies Press. https://www.ncbi.nlm.nih.gov/books/NBK285681/
46.
NestelD.TierneyT. (2007). Role-play for medical students learning about communication: Guidelines for maximising benefits. BMC Medical Education, 7(1). https://doi.org/10.1186/1472-6920-7-3
47.
OwenW. F. (1984). Interpretive themes in relational communication. Quarterly Journal of Speech, 70, 274–287.
48.
ParkerS. M.ClaytonJ. M.HancockK.WalderS.ButowP. N.CarrickS.CurrowD.GhersiD.GlareP.HagertyR.TattersallM. H. (2007). A systematic review of prognostic/end-of-life communication with adults in the advanced stages of a life-limiting illness: Patient/caregiver preferences for the content, style, and timing of information.Journal of Pain and Symptom Management, 34(1), 81–93. https://doi.org/10.1016/j.jpainsymman.2006.09.035
49.
PehrsonC.BanerjeeS. C.MannaR.ShenM. J.HammondsS.CoyleN.KruegerC. A.MaloneyE.ZaiderT.BylundC. L. (2016). Responding empathically to patients: Development, implementation, and evaluation of a communication skills training module for oncology nurses.Patient Education and Counseling, 99(4), 610–616. https://doi.org/10.1016/j.pec.2015.11.021
50.
PennebakerJ. W. (1997). Opening up: The healing power of expressing emotions(Rev. ed.).The Guilford Press.
51.
PennebakerJ. W. (2018). Expressive writing in psychological science.Perspectives on Psychological Science, 13, 226–229.
52.
PennebakerJ. W.SeagalJ. D. (1999). Forming a story: The health benefits of narrative. Journal of Clinical Psychology, 55(10), 1243–1254.
53.
RaynerM.HawleyE. (2019). Response to: Persistent influence of a narrative educational program on physician attitudes regarding patient care.Medical Teacher, 42(2), 239–240. https://doi.org/10.1080/0142159x.2019.1620928
54.
SandelowskiM.LeemanJ. (2012). Writing usable qualitative health research findings. Qualitative Health Research, 22, 1404–1413. http://doi.org/10.1177/1049732312450368
55.
SchankR. C.BermanT. R. (2002). The pervasive role of stories in knowledge and action. In GreenM. C.StrangeJ. J.BrockT. C. (Eds.), Narrative impact: Social and cognitive foundations (pp. 287–313). Lawrence Erlbaum.
56.
ShannonS. E.Long‐SutehallT. (2011). Coombs M. conversations in end‐of‐life care: Communication tools for critical care practitioners. Nursing in Critical Care, 16, 124–130.
57.
Tavakoly SanyS. B.PeymanN.BehzhadF.EsmaeilyH.TaghipoorA.FernsG. (2018). Health providers' communication skills training affects hypertension outcomes. Medical Teacher, 40, 54–163.
58.
TenoJ. M.FisherE. S.HamelM. B.CoppolaK.DawsonN. V. (2002). Medical care inconsistent with patients' treatment goals: Association with 1-year Medicare resource use and survival. Journal of the American Geriatrics Society, 50(3), 496–500.
59.
TsaiS.HoM. (2012). Can narrative medicine training improve OSCE performance?Medical Education, 46(11), 1112–1113. https://doi.org/10.1111/medu.12029
60.
WaldH. S.HaramatiA.BachnerY. G.UrkinJ. (2016). Promoting resiliency for interprofessional faculty and senior medical students: Outcomes of a workshop using mind-body medicine and interactive reflective writing.Medical Teacher, 38(5), 525–528.
61.
WaldH. S.ReisS. P. (2010). Beyond the margins: Reflective writing and development of reflective capacity in medical education.Journal of General Internal Medicine, 25(7), 746–749. https://doi.org/10.1007/s11606-010-1347-4
62.
WeeksJ. C. (2008). Patients’ expectations about effects of chemotherapy for advanced cancer. New England Journal of Medicine, 149(12), 861–868.
63.
Wittenberg-LylesE.GoldsmithJ.FerrellB.BurchettM. (2014). Assessment of an interprofessional online curriculum for palliative care communication training. Journal of Palliative Medicine, 17, 4–406.
64.
Wittenberg-LylesE.GoldsmithJ.RaganS. L.Sanchez-ReillyS. (2010). Dying with comfort: Family illness narratives and early palliative care. Journal of Social Work in End-of-Life & Palliative Care, 8(2), 202–203.
65.
WrightA. A. (2008). Associations between end-of-life discussions, patient mental health, medical care near death, and caregiver bereavement adjustment.Journal of the American Medical Association, 300(14), 1665.
66.
WuD. S.KernD. E.DyS. M.WrightS. M. (2019). Narrative approach to goals of care discussions: A novel curriculum.Journal of Pain and Symptom Management, 58, 1033.e1–1039.e1.
