Psycho-emotional content of illness narrative master plots for people with chronic illness: Implications for assessment

Healthcare professionals' involvement in breaking bad news to newly diagnosed patients with motor neurodegenerative conditions: a qualitative study

PURPOSE

Research on breaking bad news (BBN) in healthcare has mostly focused on the doctor-patient interaction during a single consultation. However, it has been increasingly recognised that BBN is a wider process that also involves other healthcare professionals. This qualitative study explored non-medical¹ healthcare professionals' involvement in BBN to newly diagnosed patients with motor neurodegenerative conditions in the UK.

MATERIALS AND METHODS

19 healthcare professionals working with people with motor neurone disease, multiple sclerosis, Parkinson's disease or Huntington's disease took part in individual, semi-structured interviews which were analysed using thematic analysis.

RESULTS

Four themes were constructed: dealing with the diagnostic aftermath, unpacking the diagnosis, breaking bad news as a balancing act and empowering patients to regain control over their health and lives. Participants reported being broadly involved in BBN by supporting patients with negative diagnostic experiences, re-iterating diagnostic information and helping patients understand the impact of their condition. The challenges of effectively breaking bad news and how these difficult conversations could help empower patients were also emphasised.

CONCLUSIONS

BBN was a critical and challenging aspect of healthcare professionals' clinical work with newly diagnosed patients with motor neurodegenerative conditions. Besides providing information, BBN was perceived as a way to educate patients, encourage them to make decisions and prepare for the future.Implications for rehabilitationBreaking bad news is a potentially under-recognised but significant aspect in the neurorehabilitation of neurodegenerative conditions.Listening to patients' stories about a long and occasionally unsatisfactory diagnostic journey and allowing them to express their frustration can be critical in regaining patients' trust and building a relationship with them.Newly diagnosed patients have not always received adequate information about their condition at diagnosis or they might have not understood or retained that information. It is, therefore, essential that patients' understanding of their condition is assessed, misconceptions are cleared and appropriate information about the nature and impact of the diagnosis is provided.Irrespective of the length of experience, breaking bad news was perceived as a multi-faceted, challenging, stressful and emotionally demanding task.Formal support and specialised training on breaking the bad news that addresses the incurable, unpredictable and progressive nature of motor neurodegenerative conditions could help professionals with this challenging task.

E-learning communication skills training for physiotherapy students: A two phased sequential mixed methods study

OBJECTIVE

Test whether a single e-learning session can improve empathy and communication across pre-registration and postgraduate physiotherapy students.

METHODS

Design: Two-phase sequential mixed methods study. Phase 1: Pilot randomised control trial. Phase 2: Qualitative study using interpretive phenomenological analysis.

SAMPLING

A purposive sample for both phases.

OUTCOME MEASURES

Phase 1: At baseline, post and 6-week follow up. Demographics.

PRIMARY OUTCOME

Inter-personal Reactivity Index (IRI). Phase 2: Demographics and interview schedule.

INTERVENTION

An e-learning (E) narrative intervention group or active control condition.

ANALYSIS

Phase 1: Descriptive statistics and confidence intervals. Mann-Whitney U test to compare across group change. Phase 2: Thematic analysis.

RESULTS

Thirty-nine participants took part in the mixed methods study (Phase 1 n = 25; Phase 2 n = 14). Phase 1: No significant differences between groups were identified. Potentially importance changes across time were found for the intervention group and control group. Phase 2 results identified 5 themes and 12 sub-themes.

CONCLUSION

The e-learning groups identified an increase in the perceived ability to handle distressing communication. Other important findings from the e-learning are discussed. Further research is warranted. Practical Implications Novel e-learning intervention may have an important role in curriculum development and clinical practice to promote therapeutic communication.

PRACTICAL IMPLICATIONS

Novel e-learning intervention may have an important role in curriculum development and clinical practice to promote therapeutic communication.

Using a Narrative Practice Approach to Understand In-Depth Experiences of Individuals Coping with Chronic Pain

OBJECTIVE

Current psychological interventions to enhance management of chronic pain report small to moderate effects. There is a need to explore the experiences and coping of individuals with chronic pain in depth and expand beyond current knowledge paradigms to enhance psychological interventions. The current literature recommends narrative practice as a qualitative approach in a group to facilitate sharing of knowledge on coping with chronic pain. Therefore, we conducted group sessions incorporating narrative practice to explore the experiences of individuals coping with chronic pain.

DESIGN

We explored the experiences of 11 individuals coping with chronic pain from two group sessions that incorporated narrative practice. Themes emerging from participants' sharing were triangulated from interview transcripts, field notes, and participants' response worksheets. Data analysis adopted thematic analysis and narrative practice approaches.

RESULTS

Themes on coping found include "refocusing," "distraction," "inspiration and perspective taking," and "acknowledgement of skills, knowledge, and attitude." "Distraction" and "refocusing" complimented one another. This provided a new perspective, in contrast to current research that views both as mutually exclusive. Social environmental factors were found to help participants share existing coping methods of "connection," "deepen perspective," "inspiration and perspective taking," and "acknowledgement of skill, knowledge and attitude." The possible relationships between the themes also provided support to the theoretical foundations of Acceptance and Commitment Therapy. Results suggest that adopting a narrative practice sequence helped individuals to acknowledge chronic pain experiences and facilitated their identification of ways to cope.

CONCLUSIONS

Narrative practice identified themes of coping that can inform clinical practice. Narrative practice is indicated as a feasible and acceptable research and clinical approach for individuals with chronic pain.

Screening and supporting the mental health of student physiotherapists during the COVID-19 pandemic

Background/Aims

The purpose of this study was to use the Model of Emotions, Adaptation and Hope as a way to screen and support physiotherapy students and understand the impact of the COVID-19 pandemic on their health by focusing on the stories (narrative) they tell.

Methods

This pilot mixed methods study included a convenience sample of BSc and MSc level student physiotherapists. A single screening online interview was conducted via Zoom or Skype. Students' narratives underwent qualitative analysis and quantitative analysis using the Model of Emotions, Adaptation and Hope.

Results

A total of 19 students took part in this study. Students identified four master plot narratives as a response to the interview: future control; lost productivity; isolation; and opportunity. Significant pre-interview to follow-up change was found in acceptance, pleasantness and energy.

Conclusions

It is possible to support the mental health of physiotherapy students by screening for difficulties and listening to and exploring their responses.

The effects of storytelling in the promotion of physical activity for chronically ill patients: an integrative review

Background/Aims

Physical activity is regarded as an essential component of self-management for people with chronic illness. Storytelling is an approach that successfully uses a group environment to influence change in physical activity intentions and behaviours. The aim of this study was to develop an understanding of what a storytelling intervention entails, its main effects and how this leads to the promotion of physical activity in chronically ill patients.

Methods

An integrative review was undertaken in three stages: search, appraisal and synthesis. Studies were included if they represented participants with a chronic illness, used a storytelling approach for the intervention and had physical activity as a component of the intervention.

Results

A total of 14 articles were identified that included a total of 818 participants (191 male, 348 female, 279 unknown). No articles were identified as flawed and all were included in the synthesis. Four themes were identified: ideal processes within interventions; psychosocial factors that influenced storytelling; perceived outcomes relating to storytelling; and perceived benefits of physical activity.

Conclusions

This review develops a deeper understanding of the required processes, associated factors and outcomes of storytelling interventions for people with chronic illness. It provides evidence of how storytelling can be used to promote physical activity. Further research into storytelling interventions is required.

A Qualitative Study Examining the Illness Narrative Master Plots of People with Head and Neck Cancer

Background: There is a need to understand the common plots (master plots) of illness narratives for people who are treated for cancer. Improved insight would enhance therapeutic relationships and help reduce stress for health care professionals (HCPs). Aim: Identify and refine the most supported narrative master plots, which convey meaning for the tellers' lived experience from diagnosis to a year post-treatment for a group of Head and Neck Cancer (H&NC) patients. Method: A purposive sample of individuals with H&NC using a single qualitative interview was undertaken. A narrative analysis was used. Results: Eighteen people (57.8 years, six female and 12 male) with H&NC participated. The average time since treatment began was 10 months. Five master plots were identified: (1) The responsive and reflective narrative, (2) The frail narrative, (3) The recovery narrative, (4) The survive or die narrative and (5) The personal project narrative. Discussion: The identification of narrative master plots of people with H&NC enables HCPs to understand and prepare for the different stories and reactions presented to them. This is important to prevent people's reactions being labelled in restrictive ways. The implications of recognising the different experiences are discussed further within the manuscript. Research is needed to build on these findings to promote better patient-centred care in practice.

A Qualitative Study on the Impact of First Steps-A Peer-led Educational Intervention for People Newly Diagnosed with Parkinson's Disease

Aim: The dual aim of this research was to consider the impact of providing the First Steps program on the stories of people with Parkinson's Disease (PD) and to investigate the psychosocial and emotional mechanisms which may explain this impact. Methods: A qualitative study using a subtle realist paradigm and hermeneutic phenomenological methodology was undertaken. A single semi-structured interview was used to consider the impact and experiences of people with PD who completed either the intervention (2-day peer-led behavior intervention using storytelling 6-8 weeks apart) or received telephone support calls as part of the active control group. Descriptive statistics and a narrative analysis were undertaken on the results. Results: Forty-two participants were invited to participate, forty of whom completed the interview. This included 18 from the intervention group and 22 from the active control group. The intervention group identified the value of the program as worth-while, demonstrating improved exercise behavior and coping mechanisms following the intervention. Three major stories (the affirmed, the validated and the transformed story) identified the impact of the intervention. Three internal mechanisms (perceived control, hope and action, and the individual's mind set) alongside three social mechanisms (social comparison, social control and the first opportunity to share with peers) appeared to explain this impact. Conclusion: This study provides exciting and novel evidence of the impact of a peer-led psycho-educational intervention for people newly diagnosed with PD. Further research is needed to consider the impact of stories-based approaches on participants and consider a critical evaluation of the mechanisms which may explain changes in stories and self-reported behaviour.