Impact of Early Implementation of Narrative Medicine Techniques on Patient Centered Attitudes of Medical Students

Patients to People: Examining the Effects of Early Implementation of Narrative Medicine Techniques on Patient Centered Attitudes in Medical Students. A Qualitative Study

A qualitative study assessing the impact of early narrative medicine practice on Medical Honors Program (MHP) students' attitudes regarding patient-centered interactions, through interviewing patients with chronic or life-limiting illnesses to obtain their illness stories.

MHP students will develop a patient narrative for the patients interviewed. These narratives will be edited by the patient, and, with the permission of the patients, may be published as a collection of stories.

Study Overview

• Status: Withdrawn
• Conditions: Diabetes Mellitus; Hematologic Diseases; Cancer; Chronic Disease; Cystic Fibrosis; Narrative Medicine; Terminal Illness; Rheumatologic Disorder; Oncologic Disorders
• Intervention / Treatment: Behavioral: Patient Provider Orientation Scale; Behavioral: Interview performed by MHP student

Detailed Description

Teach MHP Students about obtaining the illness story and narrative medicine. This will be done during the curriculum of the Medical Humanities class in the fall of 2016.

Recruit patients on units and floors in Shands University of Florida (UF) Health that may potentially have patients that will be good candidates for enrollment in the patient narratives. These may include pediatric hematology and oncology patients, adult hematology and oncology patients, patients with diabetes, organ transplant patients, cystic fibrosis patients, and rheumatologic disorder patients. Investigators will communicate with child life/social workers, as well as faculty medical providers on these inpatient services to help identify appropriate patients for referral and recruitment. These faculty members will obtain authorization from the patient for the investigators to approach the patient regarding recruitment.

Once a patient has been identified, a co-investigator will introduce the project to the patient, review examples of the types of questions to be asked by the MHP student, provide opportunity for questions, obtain informed consent, and provide them with the patient-practitioner orientation scale (PPOS) for completion.

A MHP student will meet with the co-investigator, fill out the PPOS, and then interview the patient. The co-investigator will be present for the interview, but the investigator would like the MHP student to conduct the interview. The interview will be voice recorded with encryption for later transcription.

Following the interview, a co-investigator will lead a discussion to determine patient and student observations/opinions about such conversations. The co-investigator will address differences in PPOS responses from patient vs student, without specifically revealing the personal answers of each, and allow for discussion of how scales can be aligned to better the patient-physician relationship. This discussion will be voice recorded for transcription and qualitative analysis by the investigators

Following the interview, the MHP students will transcribe the patient narrative. During the interview, the student and patient will agree on whether the narrative is written from the first or third person point of view.

The initial informed consent will have a specific series of check boxes to address whether the patient approves of dissemination of their story. This initial consent will specifically state that this narrative will not be published prior to their approval of the final product. The patient will also have the opportunity to declare which patient identifiers, if any, will be changed for the publication. The narrative will be presented to the patient, who will then have the opportunity to make changes and edits. If extensive edits are necessary, a subsequent narrative will be presented to the patient for final approval prior to publication. The investigators will make every effort to get the patient approval in person, however because of the possibility of the patient being discharged before the narrative has been composed, investigators will identify an acceptable method of communication with the patient outside of the hospital (email, phone call) for this purpose. In the case of the patient being discharged and needing to obtain approval, verbal approval over the phone will be obtained by a co-investigator and a witness, and will keep this documentation in a binder locked in the PI's office.

Following the completion of the interviews, the MHP students will meet for a focus group to discuss as a group their observations from their patient encounters. This focus group will be audio recorded and transcribed by the co-investigators for qualitative analysis

After all patient narratives have been completed, narratives may be published in an online or book format, following the consent that the patient provided.

• Study Type: Observational

Contacts and Locations

Study Locations

• United States
  • Florida
    • Gainesville, Florida, United States, 32611
      • University of Florida

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 8 years to 100 years (Child, Adult, Older Adult)
• Accepts Healthy Volunteers: No
• Genders Eligible for Study: All

• Sampling Method: Non-Probability Sample

Study Population

Study population is two-fold. First the MHP students will be recruited and consented. Their participation is voluntary and will not affect their grades. Second, patients will be recruited based on the inclusion and exclusion criteria.

Description

Inclusion Criteria:

• Patient inclusion criteria:

  • Patient of Shands UF Health or Shands Children's hospital
  • Children must be at least 8 years old
  • Patients diagnosed with chronic or potentially life-limiting illnesses
  • Patients must be English speaking

• Student Inclusion criteria

  • UF students enrolled in the Medical Honors Program
  • Medical Honors students must be up to date on HIPAA training and Confidentiality statement agreement
  • Students must take the Medical Humanities course
  • UF college of medicine students

Exclusion Criteria:

• Patient exclusion criteria:

  • Anyone that the medical social worker or Child life specialist feels would be unwilling or unable to participate in the study
  • Patients who at the time of interview are unfit to communicate (ex. Ventilated, comatose)
  • Patients less than eight years old
  • Patients that do not speak English

• Student exclusion criteria:

  • Students not enrolled in the UF College of Medicine
  • Students not enrolled in the Medical Humanities course

Study Plan

How is the study designed?

Design Details

• Observational Models: Cohort
• Time Perspectives: Prospective

Number of groups / cohorts

2

Cohorts and Interventions

Group / Cohort	Intervention / Treatment
Medical Honors Students; The Medical Honors Program students will fill out the Patient Provider Orientation Scale (PPOS). MHP students will then interview a patient with a chronic or life limiting illness.	Behavioral: Patient Provider Orientation Scale; Investigators are interested in the impact that our activity has on the students' patient-centeredness. Investigators will use the Patient-Practitioner Orientation Scale (PPOS), which will be completed by both the student and the patient prior to the encounter. Following the interview, the co-investigators will lead a discussion with the patient and student. Investigators will discuss differences in patient and student PPOS scores, and how each party felt the interview went. Investigators will examine if the patients feel the interview differed from typical interactions with health care providers, and how this made the patient feel. The students will describe what was learned from the patients story as well as try to explore reasons why providers may not always learn the patient's illness story.; Behavioral: Interview performed by MHP student; The MHP students took a course called Medical Humanities in the fall of 2016. MHP students learned patient interviewing skills and the importance of gathering the patients "illness story". The students will conduct an interview with a patient with chronic illness, which will be focused on gather information about how the patients illness affects daily life as well as interactions with the health care system.
Patients with chronic illnesses; The patients will fill out the PPOS scale. The patient will then have an Interview performed by MHP student	Behavioral: Patient Provider Orientation Scale; Investigators are interested in the impact that our activity has on the students' patient-centeredness. Investigators will use the Patient-Practitioner Orientation Scale (PPOS), which will be completed by both the student and the patient prior to the encounter. Following the interview, the co-investigators will lead a discussion with the patient and student. Investigators will discuss differences in patient and student PPOS scores, and how each party felt the interview went. Investigators will examine if the patients feel the interview differed from typical interactions with health care providers, and how this made the patient feel. The students will describe what was learned from the patients story as well as try to explore reasons why providers may not always learn the patient's illness story.; Behavioral: Interview performed by MHP student; The MHP students took a course called Medical Humanities in the fall of 2016. MHP students learned patient interviewing skills and the importance of gathering the patients "illness story". The students will conduct an interview with a patient with chronic illness, which will be focused on gather information about how the patients illness affects daily life as well as interactions with the health care system.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Patient provider orientation scale score (PPOS)	The PPOS is an 18 item questionnaire developed to evaluate patient centered care. The items are rated on a 6 point Likert-type scale. It has two separate parts, sharing and caring, that can be either summed or divided for scoring purposes. Higher scores indicate more patient centeredness.	baseline

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Patient provider orientation scale- "Sharing" portion	Total from the questions related to "sharing" on the PPOS. The sharing portion relates to how open the provider is in sharing power in the patient-physician relationship, or in the case of the patient filling out the form, how much the patient wishes to share the power in the patient-physician relationship.	baseline
Patient provider orientation scale- "Caring" portion	Total from the questions related to "caring" on the PPOS. The caring portion relates to how oriented the provider is in caring for the patient as a person and not just a disease.	baseline
Patient and Student post-interview discussion	qualitative measurement of topics and themes discussed in immediate post-interview discussion between the co-investigator, MHP student, and patient	immediately post-interview, up to 1 day
Medical honors students focus group	qualitative measurement of topics and themes discussed in the focus group held following all MHP students completing their individual interviews	following completion of all MHP/Patient interviews, up to 4 months

Collaborators and Investigators

• Sponsor: University of Florida
• Investigators: Principal Investigator: Robert Lawrence, MD, University of Florida

Publications and helpful links

General Publications

• Batt-Rawden SA, Chisolm MS, Anton B, Flickinger TE. Teaching empathy to medical students: an updated, systematic review. Acad Med. 2013 Aug;88(8):1171-7. doi: 10.1097/ACM.0b013e318299f3e3.
• Hojat M, Vergare MJ, Maxwell K, Brainard G, Herrine SK, Isenberg GA, Veloski J, Gonnella JS. The devil is in the third year: a longitudinal study of erosion of empathy in medical school. Acad Med. 2009 Sep;84(9):1182-91. doi: 10.1097/ACM.0b013e3181b17e55. Erratum In: Acad Med. 2009 Nov;84(11):1616.
• Griffith CH 3rd, Wilson JF. The loss of student idealism in the 3rd-year clinical clerkships. Eval Health Prof. 2001 Mar;24(1):61-71. doi: 10.1177/01632780122034795.
• Haidet P, Dains JE, Paterniti DA, Chang T, Tseng E, Rogers JC. Medical students' attitudes toward patient-centered care and standardized patients' perceptions of humanism: a link between attitudes and outcomes. Acad Med. 2001 Oct;76(10 Suppl):S42-4. doi: 10.1097/00001888-200110001-00015. No abstract available.
• Institute of Medicine (US) Committee on Quality of Health Care in America. Crossing the Quality Chasm: A New Health System for the 21st Century. Washington (DC): National Academies Press (US); 2001. Available from http://www.ncbi.nlm.nih.gov/books/NBK222274/
• Kim SS, Kaplowitz S, Johnston MV. The effects of physician empathy on patient satisfaction and compliance. Eval Health Prof. 2004 Sep;27(3):237-51. doi: 10.1177/0163278704267037.
• Stacy R, Spencer J. Patients as teachers: a qualitative study of patients' views on their role in a community-based undergraduate project. Med Educ. 1999 Sep;33(9):688-94. doi: 10.1046/j.1365-2923.1999.00454.x.
• Krupat E, Bell RA, Kravitz RL, Thom D, Azari R. When physicians and patients think alike: patient-centered beliefs and their impact on satisfaction and trust. J Fam Pract. 2001 Dec;50(12):1057-62.
• Krupat E, Pelletier S, Alexander EK, Hirsh D, Ogur B, Schwartzstein R. Can changes in the principal clinical year prevent the erosion of students' patient-centered beliefs? Acad Med. 2009 May;84(5):582-6. doi: 10.1097/ACM.0b013e31819fa92d.
• Krupat E, Rosenkranz SL, Yeager CM, Barnard K, Putnam SM, Inui TS. The practice orientations of physicians and patients: the effect of doctor-patient congruence on satisfaction. Patient Educ Couns. 2000 Jan;39(1):49-59. doi: 10.1016/s0738-3991(99)00090-7.

Helpful Links

• PPOS scale available here

Study record dates

Study Major Dates

• Study Start (Actual): March 1, 2017
• Primary Completion (Actual): October 18, 2019
• Study Completion (Actual): October 18, 2019

Study Registration Dates

• First Submitted: January 31, 2017
• First Submitted That Met QC Criteria: January 31, 2017
• First Posted (Estimate): February 2, 2017

Study Record Updates

• Last Update Posted (Actual): January 6, 2020
• Last Update Submitted That Met QC Criteria: January 2, 2020
• Last Verified: January 1, 2020

More Information

Terms related to this study

• Additional Relevant MeSH Terms: Digestive System Diseases; Pathologic Processes; Respiratory Tract Diseases; Lung Diseases; Disease Attributes; Infant, Newborn, Diseases; Genetic Diseases, Inborn; Musculoskeletal Diseases; Connective Tissue Diseases; Pancreatic Diseases; Disease; Chronic Disease; Hematologic Diseases; Rheumatic Diseases; Collagen Diseases; Cystic Fibrosis
• Other Study ID Numbers: IRB201601597

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: No

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No
• product manufactured in and exported from the U.S.: No