Narrative medicine to improve the management and quality of life of patients with COPD: the first experience applying parallel chart in Italy

Abstract

PurposePoor adherence to therapy and the failure of current smoking cessation programs demonstrate that the current management of COPD can be improved, and it is necessary to educate physicians about new approaches for taking care of patients. Parallel chart is a narrative medicine tool that improves the doctor–patient relationship by asking physicians to write about their patients’ lives, thereby encouraging reflective thoughts on care.Patients and methodsBetween October 2015 and March 2016, 50 Italian pulmonologists were involved in the collection of parallel charts of anonymous patients with COPD. The narratives were analyzed according to the Grounded Theory methodology.ResultsIn the 243 parallel charts collected, the patients (mean age 69 years, 68% men) are described as still active and as a resource for their families (71%). The doctor–patient relationship started as difficult in 50% of cases, and younger age and smoking were the main risk factors. The conversations turned positive in 78% of narratives, displaying deeper mutual knowledge, trust for the clinicians’ ability to establish effective therapy (92%), support efforts to quit smoking (63%), or restore patients’ activities (78%).ConclusionAll the physicians concurred that the adoption of innovative parallel charts was useful for improving clinical care and worthy of official inclusion in protocols for the management of COPD.

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“…The positive effect of narrative medicine on a patient's physical and mental health has been confirmed by previous studies. For example, the narrative medical intervention helped to improve the self-management and quality of life of COPD patients, 18 reduced the depressive emotion level in patients with Parkinson's disease, 19 reduced pain and improved well-being in cancer patients, 20 and reduced polypharmacy. 21…”

The Burden of Heart Failure: Physicians’, Patients’, and Caregivers’ Perspectives Using Narrative Medicine

“…The main tools of this methodology are parallel charts and illness plots, dedicated to healthcare professionals and patients-caregivers, respectively [14,15]. Recent studies have demonstrated advantages of applying the parallel chart in exploring a healthcare professional's point of view about the pathway of care for chronic conditions (i.e., chronic obstructive pulmonary disease [COPD]) and doctor-patient relationships [16,17]. Similarly, patient and caregiver illness plots were recently shown to be a source of information on personal coping with the disease, and on how patients and their families rearrange their lives after a diagnosis in studies in other chronic diseases [18][19][20].…”

Perspectives on narrative medicine

“…We read the article on the relationship between narrative medicine and the positive outcomes reflected in COPD management, by Banfi et al 1 with great interest. We were particularly intrigued by how the simple documentation of parallel charts could improve the patient–doctor relationship and patient adherence to treatment.…”

“…The article 1 highlights that narrative medicine improves the patient–doctor relationship and hence patient outcomes. Graffigna et al 2 suggested a multidimensional association between the patient–doctor relationship, patient engagement, and medical adherence for patients with chronic conditions.…”

“…Banfi et al 1 briefly explored ways narrative medicine can benefit doctors, allowing them to reflect upon their emotions, in addition to those of their patients. We were interested to find further evidence of this outside the realm of COPD.…”