Integration of Person-Centered Narratives Into the Electronic Health Record

Coats, Heather; Shive, Nadia; Doorenbos, Ardith Z.; Schmiege, Sarah J.

doi:10.1097/nnr.0000000000000463

Cited by 6 publications

(30 citation statements)

References 30 publications

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“…However, research on the effective integration of a patient's narrative into the EHR is limited. PCNIs that incorporate cultural values and beliefs are important components of person-centered care [14,31]. Person-centered care includes implementing shared decision-making, providing holistic patient care with respect for patients' preferences and goals, paying attention to nonmedical aspects of care, facilitating communication, knowing the patient as a person, and understanding culture, which influences health behaviors and the meaning of illness [3,14,[22][23][24][25][26].…”

Section: Background and Rationalementioning

confidence: 99%

“…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 [ 30 , 31 ]. However, research on the effective integration of a patient’s narrative into the EHR is limited.…”

Section: Introductionmentioning

confidence: 99%

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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%

Section: Introductionmentioning

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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Integration of Person-Centered Narratives Into the Electronic Health Record

Coats,

Shive,

Adrian

et al. 2023

Nursing Research

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Background Care delivery that is not person-centered has been called “discordant care.” There has been a shift to incorporate more of a person’s narrative into their individual health care treatment plan to reduce discordant care. Aligning with this shift in health care delivery, we developed a person-centered narrative intervention (PCNI) to address existing gaps in delivery of person-centered care. Objectives This study aimed to evaluate the feasibility of conducting a randomized study and describe the outcomes of PCNI to usual care on the following person (patient) reported outcomes: perceptions of the quality of communication with their nurses and their psychosocial and existential well-being. Methods This study’s design was an Obesity-Related Behavioral Intervention Trials (ORBIT) model Phase II proof-of-concept randomized study. The participants were people admitted to an acute care hospital diagnosed with heart failure and/or end-stage renal disease. Results Despite COVID-19 challenges, the PCNI was feasible in an acute care setting; it showed a moderate positive difference between conditions in the person’s perception of their quality of communication and a small positive difference in their perception of feeling heard and understood. For our secondary outcomes of anxiety, depression, and psychosocial illness effect, there were small or no effects in the acute care setting. Discussion Using a person-centered narrative, such as the PCNI, can help inform delivery of care that incorporates a person’s (patient’s) beliefs, values, and preferences into their health care. This study used a pragmatic approach to evaluate the PCNI in real time in an acute care setting to assess patient-reported outcomes. These positive results in a small sample indicate the need for continued testing of the PCNI. These promising effects require further testing in a Phase III efficacy study within a larger randomized controlled clinical trial.

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Integration of Person-Centered Narratives Into the Electronic Health Record

Cited by 6 publications

References 30 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

Integration of Person-Centered Narratives Into the Electronic Health Record

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