Center for Emergency Care Policy and Research, University of Pennsylvania, Philadelphia, PA, USA; Brigham and Women's Hospital, Boston, MA, USA.
Center for Emergency Care Policy and Research, University of Pennsylvania, Philadelphia, PA, USA; Urban Health Lab at the Penn Medicine Center for Health Justice, Perelman School of Medicine at the University of Pennsylvania, USA; Department of Emergency Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA.
Am J Emerg Med. 2023 Dec;74:84-89. doi: 10.1016/j.ajem.2023.09.016. Epub 2023 Sep 20.
Narratives are effective tools for communicating with patients about opioid prescribing for acute pain and improving patient satisfaction with pain management. It remains unclear, however, whether specific narrative elements may be particularly effective at influencing patient perspectives.
This study was a secondary analysis of data collected for Life STORRIED, a multicenter RCT. Participants included 433 patients between 18 and 70 years-old presenting to the emergency department (ED) with renal colic or musculoskeletal back pain. Participants were instructed to view one or more narrative videos during their ED visit in which a patient storyteller discussed their experiences with opioids. We examined associations between exposure to individual narrative features and patients' 1) preference for opioids, 2) recall of opioid-related risks and 3) perspectives about the care they received.
Participants were more likely to watch videos featuring storytellers who shared their race or gender. We found that participants who watched videos that contained specific narrative elements, for example mention of prescribed opioids, were more likely to recall having received information about pain treatment options on the day after discharge (86.3% versus 72.9%, p = 0.02). Participants who watched a video that discussed family history of addiction reported more participation in their treatment decision than those who did not (7.6 versus 6.8 on a ten-point scale, p = 0.04).
Participants preferentially view narratives featuring storytellers who share their race or gender. Narrative elements were not meaningfully associated with patient-centered outcomes. These findings have implications for the design of narrative communication tools.
叙事是与患者就急性疼痛的阿片类药物处方进行沟通并提高患者对疼痛管理满意度的有效工具。然而，尚不清楚特定的叙事元素是否特别有效地影响患者的观点。
本研究是对 Life STORRIED 的多中心 RCT 数据的二次分析。参与者包括 433 名年龄在 18 至 70 岁之间的患者，他们因肾绞痛或肌肉骨骼背痛而到急诊室就诊。参与者被指示在 ED 就诊期间观看一个或多个叙事视频，其中一个患者讲述者讨论了他们使用阿片类药物的经历。我们检查了暴露于个别叙事特征与患者的 1）对阿片类药物的偏好，2）对阿片类药物相关风险的回忆和 3）对所接受护理的看法之间的关联。
参与者更有可能观看讲述者分享自己种族或性别的视频。我们发现，观看包含特定叙事元素的视频的参与者，例如提到处方阿片类药物，更有可能在出院后一天回忆起有关疼痛治疗选择的信息（86.3%比 72.9%，p=0.02）。观看讨论家族成瘾史的视频的参与者比未观看的参与者更有可能参与他们的治疗决策（十分制上分别为 7.6 分和 6.8 分，p=0.04）。
参与者更倾向于观看讲述者分享自己种族或性别的叙事。叙事元素与以患者为中心的结果没有明显关联。这些发现对叙事沟通工具的设计具有启示意义。
