“Connection”: The Integration of a Person-Centered Narrative Intervention into the Electronic Health Record: An Implementation Study

Coats, Heather; Meek, Paula; Schilling, Lisa M.; Akard, Terrah Foster; Doorenbos, Ardith Z.

doi:10.1089/jpm.2019.0376

Cited by 23 publications

(43 citation statements)

References 21 publications

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“…A comprehensive palliative care approach improves communication, leading to better quality of life (QoL) for patients [4][5][6]; however, discordant care continues in part because of knowledge gaps about patients' psychological, social, and spiritual needs [7][8][9][10]. Person-centered narrative interventions (PCNIs) can fill these knowledge gaps [11][12][13][14][15][16][17][18][19][20], yielding an increased understanding of patients' psychological, social, and spiritual needs, which will help clinicians develop tailored palliative care interventions.…”

Section: Background and Rationalementioning

confidence: 99%

An Electronically Delivered Person-Centered Narrative Intervention for Persons Receiving Palliative Care: Protocol for a Mixed Methods Study

Coats¹,

Shive²,

Adrian³

et al. 2023

JMIR Res Protoc

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Background In the health care setting, electronic health records (EHRs) are one of the primary modes of communication about patients, but most of this information is clinician centered. There is a need to consider the patient as a person and integrate their perspectives into their health record. Incorporating a patient’s narrative into the EHR provides an opportunity to communicate patients’ cultural values and beliefs to the health care team and has the potential to improve patient-clinician communication. This paper describes the protocol to evaluate the integration of an adapted person-centered narrative intervention (PCNI). This adaptation builds on our previous research centered on the implementation of PCNIs. The adaptation for this study includes an all-electronic delivery of a PCNI in an outpatient clinical setting. Objective This research protocol aims to evaluate the feasibility, usability, and effects of the all-electronic delivery of a PCNI in an outpatient setting on patient-reported outcomes. The first objective of this study is to identify the barriers and facilitators of an internet-based–delivered PCNI from the perspectives of persons living with serious illness and their clinicians. The second objective is to conduct acceptability, usability, and intervention fidelity testing to determine the essential requirements for the EHR integration of an internet-based–delivered PCNI. The third objective is to test the feasibility of the PCNI in an outpatient clinic setting. Methods Using a mixed method design, this single-arm intervention feasibility study was delivered over approximately 3 to 4 weeks. Patient participant recruitment was conducted via screening outpatient palliative care clinic schedules weekly for upcoming new palliative care patient visits and then emailing potential patient participants to notify them about the study. The PCNI was delivered via email and Zoom app. Patient-reported outcome measures were completed by patient participants at baseline, 24 to 48 hours after PCNI, and after the initial palliative care clinic visit, approximately 1 month after baseline. Inclusion criteria included having the capacity to give consent and having an upcoming initial outpatient palliative care clinic visit. Results The recruitment of participants began in April 2021. A total of 189 potential patient participants were approached via email, and 20 patient participants were enrolled, with data having been collected from May 2021 to September 2022. A total of 7 clinician participants were enrolled, with a total of 3 clinician exit interviews and 1 focus group (n=5), which was conducted in October 2022. Data analysis is expected to be completed by the end of June 2023. Conclusions The findings from this study, combined with those from other PCNI studies conducted in acute care settings, have the potential to influence clinical practices and policies and provide innovative avenues to integrate more person-centered care delivery. International Registered Report Identifier (IRRID) DERR1-10.2196/41787

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Section: Background and Rationalementioning

confidence: 99%

An Electronically Delivered Person-Centered Narrative Intervention for Persons Receiving Palliative Care: Protocol for a Mixed Methods Study

Coats¹,

Shive²,

Adrian³

et al. 2023

JMIR Res Protoc

Self Cite

View full text Add to dashboard Cite

show abstract

“…The outcomes being tested in this trial are the patient participant's perception of quality of communication with their nurses and the patient participant's biopsychosocial well-being. 7 , 8 All patient participants complete a 65-item survey conducted at 3 time points. Patient participants randomized to the intervention group complete the PCNI—an audio-recorded, semistructured interview.…”

Section: Covid-19 Initial Impactmentioning

confidence: 99%

“…The research team then creates a person-centered narrative written in the voice of the patient participant, the person living with the serious illness. 7 , 8 The patient participant is allowed to make changes, and the research team uploads the narrative to the electronic health record, subsequently alerting the bedside nurse that the narrative is in the chart and providing education on how to access it. Nurse participants are also recruited to provide feedback on their experience with the PCNI.…”

Section: Covid-19 Initial Impactmentioning

confidence: 99%

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Essential Versus Nonessential

Shive

Doorenbos

Schmiege

et al. 2021

J Hosp Palliat Nurs

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The COVID-19 pandemic has created disruptions and ethical tensions in palliative care research; however, ethical principles must continue to be applied for evaluating the safety of conducting research with seriously ill patient participants and nurse participants in an acute care setting. This randomized controlled trial is conducted in the acute care hospital and tests the effects of a narrative intervention versus usual care on the primary outcome of patients' perception of quality of communication with their nurses and the secondary outcome of biopsychosocial well-being. In accordance with local and institutional COVID-19 guidance, research activities were temporarily suspended in March 2020, and when allowed to resume, some aspects of the protocol were adapted to maximize safety for all stakeholders: patients/families, nurses, and the research team. This article ( a ) considers case perspectives of all stakeholders involved in a randomized controlled trial conducted in the acute care hospital setting during the COVID-19 pandemic, ( b ) describes the ethical dilemma and ethical principles in the context of the case, ( c ) discusses lessons learned while resuming clinical research activities, and ( d ) provides an ethical framework for the decision-making processes around vulnerability and safety in conducting research during a pandemic with persons living with serious illness.

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“… 15 From a patient perspective, reminiscence interventions have demonstrated meaningful increases in mental health 16 and overall well-being outcomes 17 in numerous populations, including patients with dementia, 18 patients with cancer, 19 and geriatric patients. 20 From a provider perspective, including patient narratives in the electronic medical record has fostered improved communication and a feeling of increased connection, 21 and the majority of providers agree that reading these narratives allows them to take better care of their patients. 13…”

Section: Introductionmentioning

confidence: 99%

My Life, My Story: Integrating a Life Story Narrative Component Into Medical Student Curricula

et al. 2022

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Introduction Medical students experience burnout, depersonalization, and decreases in empathy throughout medical training. My Life, My Story (MLMS) is a narrative medicine project that aims to combat these adverse outcomes by teaching students to interview patients about their life story, with the goal of improving patient-centered care competencies, such as empathy. Methods The MLMS project was started in the Veterans Affairs (VA) system and has since spread to dozens of VA sites. We adapted and integrated this project into the Warren Alpert Medical School of Brown University curriculum. As part of the required curriculum, first- and third-year medical students participated in a life story interview with a community-based volunteer or a patient in the inpatient hospital setting, transcribed the story, and reviewed the written story with the patient. We assessed student perceptions of the project, changes in empathy, and changes in burnout symptoms. Results A total of 240 students participated in this project. Students spent an average of 70.7 minutes interviewing patients. A majority of the students believed MLMS was a good use of time (77%), fostered connection with patients (79%), and was effective in recognizing patients’ thoughts and feelings (69%). Discussion To our knowledge, this is one of the first life story interview interventions to be implemented into a required medical school curriculum and outside the VA setting. MLMS may assist students in improving clinical empathy skills and create a structure for medical trainees to better understand their patients.

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“Connection”: The Integration of a Person-Centered Narrative Intervention into the Electronic Health Record: An Implementation Study

Cited by 23 publications

References 21 publications

An Electronically Delivered Person-Centered Narrative Intervention for Persons Receiving Palliative Care: Protocol for a Mixed Methods Study

An Electronically Delivered Person-Centered Narrative Intervention for Persons Receiving Palliative Care: Protocol for a Mixed Methods Study

Essential Versus Nonessential

My Life, My Story: Integrating a Life Story Narrative Component Into Medical Student Curricula

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