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Healing Tool Series: Narrative Medicine

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A patient-centered, collaborative storytelling process to deliver respectful, empathic, and effective medical care for serious illness

“Healing Tools” summaries are a collection of evidence-based resources to help providers and patients use integrative health approaches to improve health and wellbeing.

This tool is for: Providers

This tool was created by: Robert B. Slocum, DMin, PhD, The University of Kentucky Markey Cancer Center

SUMMARY

What is this tool for?

This tool helps providers learn to understand, acknowledge and act on the experiences and suffering of their patients.

Respectful, Empathic and Effective Medical Care

Narrative medicine is a patient-centered and collaborative process in which providers guide patients in telling or writing their stories of illness. The process enables providers to offer respectful, empathic and effective medical care that helps patients cope with serious illness and improve their quality of life.

Providers use narrative medicine to help patients:

  • Stay engaged throughout treatment
  • Identify sources of strength and hope
  • Clarify goals and actions for the future

The Narrative Medicine Program at The University of Kentucky Markey Cancer Center

During a narrative medicine session at The University of Kentucky Markey Cancer Center, a provider guides the patient in sharing his/her story. The sessions are based on four core questions developed by Narrative Medicine Program Coordinator Robert B. Slocum, D Min, PhD:

  • What brings you here?
  • What helps you the most?
  • Do you see anything differently?
  • What comes next?

The patient can share as much or as little of his/her story as desired, in conversation or in writing, such as a journal. The story can cover the patient’s daily experiences or emotional journey. The provider teases out important details and insights so the patient can use the story as a way to cope and recover mentally.

The Narrative Medicine Program has been primarily used with oncology and cardiology patients. It is part of the UK Integrative Medicine & Health program.

Webinar: Narrative Medicine: Encouraging Patient Resilience and Hope

1 hour, 3 minutes

Members of the Academic Consortium for Integrative Medicine & Health can view Dr. Slocum’s webinar on narrative medicine, which covered:

  • Overview of narrative medicine
  • The Narrative Medicine Program at The University of Kentucky Markey Cancer Center
  • Studies of narrative medicine

How does this contribute to an integrative approach?

Combining conventional medicine, self-care, and complementary and alternative medicine can help patients achieve optimal healing and health. Narrative medicine redefines the relationship between the provider and the patient by focusing on the whole person. It facilitates self-awareness within patients and helps keep them engaged throughout treatment.

What does the evidence say about this tool?

Evidence about the effectiveness of narrative medicine includes:

Studies

  • Cancer patients who wrote narratives with high emotional disclosure had significantly less pain and higher wellbeing scores than patients whose narratives were less emotional. In the study, 234 adult patients with cancer and average pain intensity levels of at least 5/10 were randomized into 3 groups:
    1. Narrative (n=79): Patients wrote a story about how cancer affected their lives for at least 20 minutes once a week for 3 weeks
    2. Questionnaire (n=77): Patients filled out the McGill Pain Questionnaire
    3. Control (n=78): Patients had weekly medical visits with usual care
  • Patients with renal cell carcinoma who wrote expressively about their cancer reported more vigor and significantly less sleep disturbance, better sleep quality and duration, and less daytime dysfunction than patients in the neutral writing group.

In the study, 277 patients with stage I to IV with renal cell carcinoma were randomly assigned to 2 groups:

Expressive writing (n=138): Patients wrote about their deepest thoughts and feelings about their cancer

    1. Expressive writing (n=138): Patients wrote about their deepest thoughts and feelings about their cancer
    2. Neutral writing (n=139): Patients wrote about neutral topics

Both groups wrote four times.

  • Women with early-stage breast cancer who expressed their emotions through writing reported significantly fewer negative physical symptoms and had fewer medical appointments for cancer-related morbidities than women who wrote about the facts of their breast cancer experience.
  •  Women who expressed their emotions through writing and women who wrote positive thoughts and feelings about breast cancer had significantly fewer medical appointments for cancer-related morbidities.

In the study, 60 patients with breast cancer were randomly assigned to 4 writing sessions in 1 of 3 groups:

    1. Emotional writing (n=21): Patients wrote their deepest thoughts and feelings about breast cancer
    2. Positive writing (n=21): Patients wrote positive thoughts and feelings about breast cancer
    3. Control group (n=18): Patients wrote the facts of their breast cancer experience

Columbia University Programs:

Columbia University offers a Master of Science in Narrative Medicine and a Narrative Medicine Certification of Professional Achievement program. Rita Charon, MD, PhD, executive director of the programs, is widely recognized as the originator of the narrative medicine field.

What are the drawbacks to using this tool?

Narrative medicine requires rigorous training, and the process takes more time than standard medical care. Reimbursement is often a challenge, especially outside of cancer.

Who created these tools?

The University of Kentucky Markey Cancer Center is Kentucky’s only NCI-designated cancer center.

Dr. Slocum is the narrative medicine program coordinator at UK HealthCare, and an assistant professor (voluntary) in the University of Kentucky College of Medicine.

Websites:

Learn More About Narrative Medicine

Slocum RB, Howard TA, Villano JL. “Narrative Medicine perspectives on patient identity and integrative care in neuro-oncology,” Journal of Neuro-Oncology, September 2017, 134(2):417–421.

Case-based histories of narrative medicine in the care of patients with brain tumors at The University of Kentucky Markey Cancer Center.

Charon R. “Narrative Medicine: A Model for Empathy, Reflection, Profession, and Trust,” JAMA. 2001;286(15):1897-1902 (doi:10.1001/jama.286.15.1897).

Overview of narrative medicine as a model for humane and effective medical care.

Charon R, DasGupta S, Hermann N, et al. The Principles and Practice of Narrative Medicine, 1st Edition

Goals, methods and standards for narrative medicine, based on more than a decade of education and research.

Columbia University

Master of Science in Narrative Medicine

Full- or part-time multidisciplinary program

Curriculum includes:

  • Core courses in narrative understanding, the illness experience, close reading and writing
  • Focused courses on narrative in fields such as genetics, social justice advocacy and palliative care
  • Electives in a discipline the student chooses
  • Fieldwork

Certification of Professional Achievement in Narrative Medicine

Part-time program

  • Five online courses
  • One workshop in-person or virtually

ABOUT THESE INTEGRATIVE HEALTH TOOLS

At Healing Works Foundation, we believe that achieving optimal health and wellbeing requires an integrative health approach—one that combines and coordinates conventional medicine, self-care, and complementary and alternative medicine.

Translating Evidence into Action

The goal of these summaries is to help providers and patients learn about and access evidence-based integrative health tools.

Disclosures:

Healing Works Foundation is a nonprofit organization and does not profit from any of the tools featured in these summaries.

Patients: Contact your provider before starting any new health program.  Show him/her these resources.

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