Impressions of Recording a Brief Audio File Known as a TIMS (This is My Story) File

Abstract

TIMS (This is My Story) audio files are about 1.5 min long and provide a brief snapshot of the patient as a person. Previous research has shown TIMS files improve communication between medical teams, patients and loved ones, and increase empathy on the part of clinicians for the patient. This study aims to assess what the experience of recording a TIMS file is like for the patient or their loved one, if they record on the patient's behalf. The person who recorded the file was asked to agree or disagree with 7 adjectives to describe the TIMS recording process, with a single open-ended question where they were invited to use their own descriptors. The majority of participants found the process easy, thought-provoking, unique, and unusual. Some said it was uncomfortable and about a fifth said they didn’t think it was relevant to their care.

PLS Title and Summary

What is the Experience of Recording a TIMS (This is My Story) File Like?

TIMS stands for This is My Story, an audio file featuring a patient or their loved one answering 4 questions: How do you want to be addressed? What brings you joy? What does your medical team need to know about you to care for you best? What brings you peace? The TIMS file is placed in a patient's medical chart and is used by clinicians to know them better as a person, with studies showing it improves both communication with the medical team and increases their empathy for the patient. This study asked patients themselves if they recorded their file or their loved one who recorded on the patient's behalf about the experience of recording a TIMS file. The study found that the majority of participants found recording easy, unusual, unique, and thought-provoking. Some found it a bit uncomfortable and about a fifth doubted whether the TIMS file would help in their care. In summary patients and loved ones found recording a TIMS file acceptable.

Introduction

How do you want to be addressed? What brings you joy? What does your medical team need to know about you to care for you best? What brings you peace? These 4 questions comprise a TIMS or This is My Story audio recording, a brief snapshot of the patient as a person. The recording, which after editing is about one and a half minutes in length, is uploaded into the electronic medical record and all clinicians caring for a patient with a TIMS file have access to it. In both intensive care units (ICUs) and on a medical unit, TIMS recordings have been shown to improve communication between the medical team, patients and loved ones, and increase empathy on the part of the team for the patient.^1,2 This study aimed to assess the impressions of patients or their loved ones on recording a TIMS file.

Recordings were made using a recording app on a smart phone.^1–4 Recording is usually undertaken in the patient's room, although some recordings are done remotely over the telephone. The unedited recording averaged about 4 min in length. The TIMS recording was edited using Adobe Audition to first noise reduce it, then edit for length and clarity to an average finished length of 1.5 min. TIMS files are saved as mono mp3 recordings.

Members of the medical team were electronically and verbally advised of the availability of a TIMS file for their patient once the recording was posted.

Methods

Study Design

To evaluate the TIMS experience for patients or loved ones, we used a posttest single group design with a single open answer question, followed by a text message with a single query on whether any member of the clinical team mentioned information contained in the TIMS file during their discussions, answered by yes or no 10 days later.

The single open answer question was posed to the person who recorded the audio file, patient or a loved one, and they were asked to agree or disagree with the applicability of 7 adjectives to describe the process. These questions were asked at the time point after the recording was made. The 7 descriptors, in reference to the recording of the audio file, were: recording was easy, thought-provoking, uncomfortable, relevant, unique, unusual, and helpful. Additionally, the person being recorded was then given the opportunity to describe the experience in their own words.

Approximately 10 days after discharge, the person who recorded the file was sent a single query by text message on whether anyone involved in their treatment mentioned any of the information in the TIMS file.

Two critical care units at the Johns Hopkins Hospital were included in this study, the medical ICU (MICU) and the neurosciences critical care unit (NCCU). Medical staff on these units were able to access the recorded interviews and were advised that a TIMS file was available on a patient using a highlighted banner on the summary page of the electronic health record as well as verbally when the chaplain was on the unit. ¹

Results

Fifty-six participants were included in this study. Seven adjectives were presented verbally to the person who recorded the TIMS file: easy, thought-provoking, uncomfortable, relevant, unique, unusual, and helpful. These adjectives were chosen based on previous experiences recording TIMS files. Ninety-one percent found recording the interview easy, 95% said it was thought-provoking, 93% said it was unique, and 95% said it was unusual. Almost one-fourth (23% of respondents) said recording was uncomfortable, while about one-fifth (21%) did not think recording was relevant to the provision of care for them or their loved one.

When asked to describe their experience of recording a TIMS file using their own adjectives, participants said “humanizing,” “touching,” “enables me to feel I am helping,” and “I see you are trying to make me into a human.” Some participants said recording “makes me think of things I normally don’t think about much” or “I don’t usually talk about this.” Some participants confided that they really didn’t know what brought them peace, or would need to think about it a bit more. A total of 11 participants provided additional adjectives or comments (Tables 1 and 2).

Table 1.

Demographic Details.

	Individual count (out of 56)	Percentage of total (out of 100%)
Individual being interviewed/recorded
Legally authorized representative	35	63
Patient (themselves)	21	38
Race/ethnicity (of person being recorded)
Black or African American	25	45
Caucasian	24	43
Asian	5	9
Prefer to not answer	1	2
Multiracial	1	2

Table 2.

Recording Impressions.

	Individual count (out of 56)	Percentage of total (out of 100%)
Was recording the interview easy? (as compared to a discussion with a new acquaintance)
Yes	51	91
No	4	7
Declined response	1	2
Was recording the thought provoking?
Yes	53	95
No	2	4
Declined response	1	2
Was recording the interview uncomfortable?
Yes	13	23
No	43	77
Declined response	0	0
Was recording the interview relevant to providing care for you or your loved one?
Yes	44	79
No	12	21
Declined response	0	0
Was recording the interview unique when compared to other interventions you have experienced?
Yes	52	93
No	4	7
Declined response	0	0
Was recording the interview unusual when compared to other interventions you have experienced?
Yes	53	95
No	3	5
Declined response	0	0
Was recording the interview helpful to providing care for you or your loved one?
Yes	38	68
No	18	32
Declined response	0	0

Because this study was conducted on 2 critical care units at the Johns Hopkins Hospital, the majority of those recorded were loved ones of the patient rather than the patient him or herself, since they were frequently intubated or otherwise incapacitated.

No one declined to be interviewed or recorded. All participants were advised that recording a TIMS file is voluntary, and declining would not impact their care or the care of their loved one. Quantitative analysis was performed by REDCap research support software. No qualitative analysis was attempted as few participants provided additional comments.

Follow up by text message approximately 10 days postdischarge of the patient with the person who recorded the TIMS file yielded 15 responses, with 4 participants answering “yes,” to whether any member of the medical team had asked them about information in the TIMS recording.

Discussion

In asking the participants questions the majority of participants identified the process as easy, unique, unusual, and thought-provoking. It was likely these engaging qualities that led to about a quarter of participants saying the recording was somewhat uncomfortable, since these types of questions are rarely asked in the healthcare environment, or even in other social interactions. This coupled with the 4 questions that were asked as part of the recorded interview (address, joy, knowledge, and peace) lead to discomfort due to this being a new experience. The fact that some participants doubted the helpfulness of the TIMS file in care provision may also reflect these perceptions or inability to link it to something they have previously experienced.

Overall, this points to the need to “normalize” this type of discussion in healthcare settings where information that may not be fit neatly into a qualitative category in the electronic medical chart. Some studies point to this type of discussion as crucial to treatment adherence and the patient sharing additional pertinent details. ⁵ The next discoveries and investigations for this project could also center around how physicians use the information that has been captured in the recorded interview to better connect with the patient or their loved one. As some physicians have expressed their desire to not take on additional tasks (eg, listening to a recorded interview), knowing more pointed information about the patient allows them to direct open ended questions in a more targeted manner rather than seeking a direction initially.

There are arguments opposed to knowing more about the patient, as defense mechanisms to reduce burnout, stress, and emotional fatigue ⁶ among medical care providers. This was reported in a previous study on these recorded interviews where a small minority reported increased distress ¹ and it was hypothesized that this was due to an additional burden of knowing the patient better during the height of a world-wide pandemic. While this is true in some instances, the overwhelming benefit of a patient “feeling valued” ⁶ outweighs a potential side effect of physician increased distress. As mentioned above, learning what to do, or not to do, with the information gleaned from the recorded interview is a next vital target.

Our ability to get a text response from participants after discharge was quite low. Other studies attempting such follow up have also reported difficulty. ⁷ This may be because the patient died, or participants did not want to revisit the hospitalization by responding to the text or their uncertainly of efficacy didn’t motivate them to response. Clearly this is an area where more investigation would be warranted to understand what occurred.

Limitations

Our study is limited in the number of respondents, the limited number of participants who gave greater detail on their experience of recording a TIMS file and the small number of participants who responded to a follow-up text. This was a single site study in 2 ICUs, and does not investigate why participants agreed or disagreed with adjectives used to describe the TIMS recording process.

Additionally, the questions (adjectives and follow-up text) were only administered to those who prospectively agreed to participate in the recorded interview. Included in this investigation were not measures to capture data from those who, although none did, declined to participate.

Conclusion

In summary patients and loved ones found recording a TIMS file to be predominantly positive and clinically useful. Against the background of previous findings demonstrating the ability of TIMS file to improve interactions with the medical team as well as provide support for them,^8,9 this practical and replicable intervention should be employed more widely.

Supplemental Material

sj-docx-1-jpx-10.1177_23743735251346585 - Supplemental material for Impressions of Recording a Brief Audio File Known as a TIMS (This is My Story) File

Supplemental material, sj-docx-1-jpx-10.1177_23743735251346585 for Impressions of Recording a Brief Audio File Known as a TIMS (This is My Story) File by Elizabeth Tracey, Jason Wilson, Rohan Mathur and David Hager in Journal of Patient Experience