Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
Centre for Person-Centred Care (GPCC), University of Gothenburg, Gothenburg, Sweden.
Health Expect. 2022 Jun;25(3):971-983. doi: 10.1111/hex.13440. Epub 2022 Feb 11.
Narratives play a central part in person-centred care (PCC) as a communicative means of attending to patients' experiences. The present study sets out to explore what activities are performed and what challenges participants face in the interactive process of narrative elicitation, carried through in patient-professional communication in a remote intervention based on PCC.
Data were gathered from a randomized controlled trial (RCT) in a Swedish city where health care professionals (HCPs) conducted remote PCC for patients on sick leave due to common mental disorders. A sample of eleven audio-recorded phone conversations between HCPs and patients enroled in the RCT were collected and subjected to conversation analysis.
Three interactive patterns in narrative elicitation were identified: Completed narrative sequences driven by the patient, question-driven narrative sequences guided by the HCP, and narrative sequences driven as a collaborative project between the patient and the HCP. In the question-driven narrative sequences, communication was problematic for both participants and they did not accomplish a narrative. In the other two patterns, narratives were accomplished but through various collaborative processes.
This study provides insight into what challenges narrative elicitation may bring in the context of a remote PCC intervention and what interactive work patients and HCP need to engage in. Importantly, it also highlights tensions in the ethics of PCC and its operationalization, if the pursuit of a narrative is not properly balanced against the respect for patients' integrity and personal preferences. Our findings also show that narrative elicitation may represent an interactive process in PCC in which illness narratives are jointly produced, negotiated and transformed.
Stakeholders, including patient representatives, were involved in the design of the main study (the RCT). They have been involved in discussions on research questions and dissemination throughout the study period. They have not been involved in conducting the present study.
叙事在以患者为中心的护理（PCC）中起着核心作用，是关注患者体验的一种交流手段。本研究旨在探讨在基于 PCC 的远程干预中，患者与专业人员之间的医患沟通中，参与者在进行叙事挖掘的互动过程中执行哪些活动，以及面临哪些挑战。
本研究的数据来自瑞典某市的一项随机对照试验（RCT），医疗保健专业人员（HCP）对因常见精神障碍而请病假的患者进行远程 PCC。从 RCT 中招募的 11 名 HCP 与患者进行的电话交谈的音频记录中收集了样本，并对其进行了会话分析。
确定了三种叙事挖掘的互动模式：由患者驱动的完整叙事序列、由 HCP 引导的问题驱动的叙事序列以及患者和 HCP 共同驱动的叙事序列。在问题驱动的叙事序列中，医患双方的沟通都存在问题，他们未能完成一个叙事。而在其他两种模式中，叙事得以完成，但通过不同的协作过程。
本研究深入了解了远程 PCC 干预背景下叙事挖掘可能带来的挑战，以及患者和 HCP 需要进行哪些互动工作。重要的是，它还突出了 PCC 的伦理及其运作的紧张关系，如果对叙事的追求没有与对患者完整性和个人偏好的尊重适当平衡。我们的研究结果还表明，叙事挖掘可能代表了 PCC 中的一种互动过程，在这个过程中，疾病叙事被共同生成、协商和转变。
利益相关者，包括患者代表，参与了主要研究（RCT）的设计。他们一直参与研究问题的讨论和整个研究期间的研究结果的传播。他们没有参与本研究的开展。
