Communication Studies, Mount Saint Vincent University, Halifax, Nova Scotia, Canada.
Allyn & Betty Taylor Library, Natural Science Centre, Western University, London, Ontario, Canada.
Med Humanit. 2021 Mar;47(1):27-37. doi: 10.1136/medhum-2017-011424. Epub 2019 Feb 8.
Patients and family caregivers tell different stories about their illness and care experiences than their physicians do. Better understanding of the relationships among these narratives could offer insight into intersections and disconnections in patient, caregiver and physician perceptions of illness and care. Such understanding could support enhanced patient-centred care in medical education and practice. Narrative writing is increasingly common among physicians, patients and caregivers and uniquely positioned to reveal matters of concern to these groups. We conducted a scoping review to identify literature in which first-person narratives from more than one group (physicians, patients and/or caregivers) were considered as 'data'. A search strategy involving nine databases located 6337 citations. Two reviewers independently screened titles and abstracts. Full-text screening followed (n=82), along with handsearching of grey literature and bibliographies. Of these, 22 met inclusion criteria. Most pieces analysed narratives by patients and caregivers (n=13), followed by patients, caregivers and physicians (n=7) and patients and physicians (n=2). Only nine pieces compared perspectives among any of these groups. The rest combined narratives for analysis, largely patient and caregiver stories (n=12). Most of the 22 papers used descriptive content analysis to derive themes. Themes of humanity, identity, agency and communication intersect between groups but often manifest in unique ways. What is absent, however, is a more interpretive narrative analysis of structure, orientation and characterisation within these narratives, which may reveal even more than their content. This scoping review offers a cautionary tale of lost potential. Many narratives are gathered and analysed but usually only thematically and rarely comparatively. We call for researchers to explore the potential of comparative analysis and the power of narrative inquiry in the field. Comparative narrative analysis may enrich understanding of how differences between perspectives come to be and what they mean for the experience of illness and care.
患者及其家属所讲述的疾病和护理经历与医生的讲述有所不同。更好地理解这些叙述之间的关系，可以深入了解患者、护理人员和医生对疾病和护理的看法之间的交叉点和不连贯之处。这种理解可以支持在医学教育和实践中加强以患者为中心的护理。叙事写作在医生、患者和护理人员中越来越普遍，并且能够独特地揭示这些群体关注的问题。我们进行了范围界定审查，以确定将来自多个群体（医生、患者和/或护理人员）的第一人称叙述视为“数据”的文献。一个涉及九个数据库的搜索策略共定位了 6337 篇引文。两名审查员独立筛选标题和摘要。然后进行全文筛选（n=82），并进行灰色文献和参考文献的手工搜索。其中，有 22 篇符合纳入标准。大多数研究分析了患者和护理人员的叙述（n=13），其次是患者、护理人员和医生（n=7）以及患者和医生（n=2）。只有 9 篇作品比较了这些群体中的任何观点。其余的作品则主要对叙述进行了综合分析，主要是患者和护理人员的故事（n=12）。这 22 篇论文中的大多数都使用描述性内容分析来得出主题。人性、身份、能动性和沟通等主题在不同群体中相互交叉，但通常以独特的方式表现出来。然而，这些叙述中没有更具解释性的叙事分析结构、方向和特征，这可能揭示的内容比其内容还要多。这项范围界定审查提供了一个潜在风险的警示故事。许多叙述被收集和分析，但通常只是从主题上，很少从比较的角度进行分析。我们呼吁研究人员探索比较分析的潜力和叙事探究在该领域的力量。比较叙事分析可以丰富对观点差异如何产生以及它们对疾病和护理体验意味着什么的理解。
