Narrative Medicine: Encouraging Patient Resilience and Hope Rob Slocum, D. Min., Ph.D. Narrative Medicine Program Coordinator Markey Cancer Center UKHealthCare

Learning Objectives Describe basic principles and methods of Narrative Medicine  Apply basic principles and methods of Narrative Medicine in interactions with patients Identify appropriate cases for referral to a Narrative Medicine facilitator

Financial Disclosure The presenter has no relevant financial relationships to disclose

Narrative Medicine is… Patient Centered Listen! Respect! See the whole person Interactive & Dynamic Expect the unexpected! Collaborative Share information and insights with treatment team members!

Engaging Patients’ Stories Patients may… Perceive their illness, treatment, & entire lives in terms of stories Recover or rediscover meaning & identity in terms of stories Reframe their self-understanding with a new story Claim the role of central character in their own story

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

Will to Live Patients bring with them (and may change) their own attitudes concerning… Illness Treatment Living

What brings you here? Story Symptoms Diagnosis Getting to treatment “Underdiagnosis”/“Overdiagnosis” Getting to treatment Prognosis Treatment plan

What helps you the most? Observe Identify or discover values Frequent answers Faith Family Friends Personal strength Favorite activities Staff & outstanding facility

Do you see anything differently? Different perspectives? Different priorities? Has anything changed? Frequent answers Don’t take things for granted Thankful attitude Some things that seemed important are not important Give time to things that matter most Don’t put off or defer important things Acknowledge limitations

What comes next? What do you look forward to? What do you want to do with the rest of your life? What will you do first when you get home? Frequent answers Deferred dreams, goals, adventures Family milestones Complete projects, plans Favorite work or recreational activities

Additional Possibilities Follow-up visits Life review Journal writing Journal workshop

Journal Workshop

Overview and Summary of Studies

Narrative Ethics Factual scenarios as stories Characters, conflict, possible resolutions Does the story “make sense” of the facts presented?  Is something “missing”?  Does a different story make better sense of the facts presented?

Narrative & Patient Identity Patient’s essential identity – who the patient is – understood in terms of each patient’s story Patient’s illness has “biographical disruption” Impact of symptoms understood relative to identity Patient may reclaim or rediscover identity during treatment – exploring story to renegotiate identity

Journal Exercise