The Patient’s Narrative Agenda as an assessment tool: the story of Robert, suffering from osteosarcoma
Keywords:
Patient’s Narrative Agenda,, interview, qualitative method, assessment, osteosarcoma, cancerAbstract
Background and aim of the work. To activate the participation of the person in his/her care path, the literature highlight the impact of the professional’s ability to show a genuine interest in the problems brought by the patient and to recognize him/her as ‘competent’. In these sense the narrative patient’s agenda could be a useful relational tool, because is focused on the perception of patient experiences of his/her illness. Thus this study aims to analyze the usefulness of patient’s narrative agenda during the assessment phase. Method. A semi-structured interview has been adopted to explore the agenda of Robert, 21 years old, suffering from osteosarcoma. A first level analysis identified the four functional areas of the agenda: ideas and beliefs; expectations and desires and context in which he lives and interacts. A second level analysis assessed the main Robert’s problems. Results. The narrative agenda has highlighted many central problems of Robert (e.g. therapeutic adherence, quality of life, mood, body image, existential problems related to experiences, hopes and expectations). Of course these results could be integrated with other tools: qualitative, to understanding difficulties and to formulate hypotheses, and quantitative, to measure the level of severity of problems reported. Discussion and conclusion. The narrative agenda has not only proved to be a valid instrument of assessment, allowing an adequate insight on the patient’s problems, as we exemplified, but it can be also used for monitoring the dynamic situation of the person’s history, lending itself to the re-exploration of its functional areas over time.
References
2. Leydon GM, Stuart B, Summers RH, Little P, Ekberg S, Stevenson F, Chew-Graham CA, Brindle L, Heritage J, Drew P, Moore MV. Findings from a feasibility study to improve GP elicitation of patient concerns in UK general practice consultations. Patient Educ Couns 2018, 101(8):1394-1402.
3. Dowell A, Morris C, Macdonald L, Stubbe M. “I can’t bend it and it hurts like mad”: direct observation of gout consultations in routine primary health care. BMC Fam Pract 2017, 18;18(1):91.
4. Arreskov AB, Graungaard AH, Kristensen MT, Søndergaard J, Davidsen AS. General practitioners’ perspectives on chronic care consultations for patients with a history of cancer: a qualitative interview study. BMC Fam Pract 2019, 20(1): 119.
5. Singh Ospina N, Phillips KA, Rodriguez-Gutierrez R, Castaneda-Guarderas A, Gionfriddo MR, Branda ME, Montori VM. Eliciting the patient’s agenda-secondary analysis of recorded clinical encounters. J Gen Intern Med 2019, 34(1):36-40.
6. Grassi L. Psychiatric and psychosocial implications in cancer care: the agenda of psycho-oncology. EPS 2020, 29, E89.
7. Houwen J, Lucassen PL, Stappers HW, Assendelft WJ, van Dulmen S, Olde Hartman TC. Improving GP communication in consultations on medically unexplained symptoms: a qualitative interview study with patients in primary care. Br J Gen Pract 2017, 67(663):e716-e723.
8. Gobat N, Kinnersley P,Gregory JW, Robling M.What is agenda setting in the clinical encounter? Consensus from literature review and expert consultation. Patient Educ Couns 2015, 98(7):822-9.
9. Larsson IE, Sahlsten MJ, Segesten K, Plos KA. Patients' perceptions of nurses' behaviour that influence patient participation in nursing care: a critical incident study. Nurs Res Pract 2011, 2011: 534060.
10. Sahlsten MJ, Larsson IE, Sjöström B, Plos KA. Nurse strategies for optimising patient participation in nursing care. Scand J Caring Sci 2009, 23(3): 490-497.
11. Hamilton W, Russell D, Stabb C, Seamark D, Campion-Smith C, Britten N. The effect of patient self-completion agenda forms on prescribing and adherence in general practice: a randomized controlled trial. Fam Pract 2007, 24(1):77-83.
12. Barry CA, Stevenson FA, Britten N, Barber N, Bradley CP. Giving voice to the lifeworld. More humane, more effective medical care? A qualitative study of doctor–patient communication in general practice. Soc Sci Med 2001, 53(4); 487-505.
13. Moja EA, Vegni E. La visita medica centrata sul paziente [The patient-centered medical examination]. Milano: Raffaello Cortina Editore, 2000.
14. Artioli G, Foà C, Sarli L. Editorial: a focus on Post-Graduate specializations. Acta Biomed 2018, 90(4-S): 5-7.
15. Gale NK, Heath G, Cameron E, Rashid S, Redwood S. Using the framework method for the analysis of qualitative data in multi-disciplinary health research. BMC Med Res Methodol 2013, (13):117.
16. Artioli G, Copelli P, Foà C, La Sala R. Valutazione infermieristica della persona assistita-approccio integrato [Nursing assessment of the person – integrated approach]. Milano: Poletto Editore, 2016.
17. Barry CA, Bradley CP, Britten N, Stevenson FA, Barber N. Patients' unvoiced agendas in general practice consultations: qualitative study. BMJ 2000, 320(7244): 1246-1250.
18. Artioli G, Foà C, Cosentino C, Sollami A, Taffurelli C. Integrated narrative assessment exemplification: a leukaemia case history. Acta Bio Med 2017, 88(3-S):13-21.
19. Artioli G, Cosentino C, Taffurelli C, Ferri P, Foà C. The narrative interview for the assessment of the assisted person: structure, method and data analysis. Acta Bio Med 2019, 90(6-S): 7-16.
20. Cecil P, Glass N. An exploration of emotional protection and regulation in nurse–patient interactions: The role of the professional face and the emotional mirror. Collegian 2015, 22(4): 377-385.
21. Kruijver IP, Kerkstra A, Bensing JM, Van De Wiel HB. Communication skills of nurses during interactions with simulated cancer patients. J Adv Nurs 2001, 34(6): 772-779.
22. Banerjee SC, Manna R, Coyle N, Shen MJ, Pehrson C, Zaider T, Hammonds S, Krueger CA, Parker PA, Bylund CL. Oncology nurses' communication challenges with patients and families: a qualitative study. Nurse Educ Pract 2016,16(1): 193-201.
23. Perino F. L'approccio centrato sulla persona in ambito sanitario. [The person-centered approach in healthcare]. Da Persona a Persona-Rivista di Studi Rogersiani 2002, novembre.
24. Artioli G, Foà C, Taffurelli C. An integrated narrative nursing model: towards a new healthcare paradigm. Acta Bio Med 2016; 87(4-S):13-22.
25. Artioli G, Foà C, Cosentino C, Taffurelli C. Integrated narrative nursing: a new perspective for an advanced assessment. Acta BioMed 2017, 88(1-S): 7-17.
26. Marvel MK, Epstein RM, Flowers K, Beckman HB. Soliciting the patient's agenda: have we improved? Jama 1999, 281(3): 283-287.
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