Loy Michelle H, Audet Anne-Marie
Department of Medicine, Weill Cornell Medicine, Cornell University, New York, NY, USA (ML, AA).
Department of Pediatrics, Weill Cornell Medicine, Cornell University, New York, NY, USA (ML).
Am J Lifestyle Med. 2024 Oct 15:15598276241291457. doi: 10.1177/15598276241291457.
The aim of this pilot was to assess the feasibility and acceptability of virtual Narrative Healing Circles (NHC), a new form of Shared Medical Appointments (SMA) among mixed diagnosis population within an urban tertiary academic medical center.
Multi-method, voluntary recruitment of eligible patients, included referrals, flyers, hospital events page, and patients who participated in an ongoing 7-week integrative oncology SMA series. Two physicians (lifestyle medicine and chaplaincy specialists), both trained in narrative medicine, co-led one-hour long virtual NHC SMAs held every other week for a total of either 4 or 8 sessions. Sessions included a centering meditation, brief check-in, topic introduction, short writing exercise initiated with a written, musical, or visual prompt, followed by time of sharing and listening. Optional electronic pre and post participant surveys were emailed at enrollment (7-questions, response rate 29%) and after 4-8 NHC SMA sessions (12-questions, RR 34%).
Virtual NHC SMA were offered from 2/23/22-8/30/23 with 62 unique participants, 266 total visits. Average age: 57 years (range: 27-84 years). Gender: 85% Female, 15% Male; Ethnicity: 73% White, 16% African American, 6% Asian, 5 % Hispanic. About half lived in underserved areas (Harlem, Bronx, Queens, Brooklyn). Payor mix included 40% Medicare, 60% Commercial insurance. Session attendance: 6 participants (mean); 1-13 (range). The number of sessions attended ranged between 1-28 sessions. Anxiety or fear (89%), depression (61%) and pain (67%) were the top 3 symptoms reported in the pre-survey. After 4-8 sessions, participants reported improvements in anxiety/fear (43%), sadness/depression/hopelessness (33%), irritability/stress (33%), isolation/loneliness (33%). They reported several positive changes: restarting yoga or meditation practice, greater focus on awe, journaling, increased mindfulness, and feeling better equipped to manage stress. 94% reported goals met, 95% would recommend the series to others. The 2 clinician leaders reported increased empathy, personal well-being, and work satisfaction.
Virtual NHC SMA series among mixed diagnosis population is feasible, positively affects patients' agency and well-being, and acceptable to patients and providers. A more formal study design with broader representation of diverse population and assessment of causality such as an RCT with longer follow-up is recommended.
本试点研究的目的是评估虚拟叙事治疗圈（NHC）的可行性和可接受性，这是城市三级学术医疗中心内混合诊断人群中共享医疗预约（SMA）的一种新形式。
采用多方法、自愿招募符合条件的患者，包括转诊、传单、医院活动页面，以及参加正在进行的为期7周的综合肿瘤SMA系列的患者。两名均接受过叙事医学培训的医生（生活方式医学和牧师关怀专家）共同主持每两周一次、时长一小时的虚拟NHC SMA，共进行4次或8次。课程包括定心冥想、简短签到、主题介绍、以书面、音乐或视觉提示开始的简短写作练习，随后是分享和倾听时间。在入组时（7个问题，回复率29%）和4 - 8次NHC SMA课程结束后（12个问题，回复率34%），通过电子邮件发送可选的电子前后参与者调查问卷。
虚拟NHC SMA于2022年2月23日至2023年8月30日提供，共有62名独特参与者，总计266次就诊。平均年龄：57岁（范围：27 - 84岁）。性别：85%为女性，15%为男性；种族：73%为白人，16%为非裔美国人，6%为亚洲人，5%为西班牙裔。约一半居住在服务不足地区（哈莱姆、布朗克斯、皇后区、布鲁克林）。支付方构成包括40%医疗保险，60%商业保险。课程出席人数：6名参与者（平均）；1 - 13名（范围）。参加的课程次数在1 - 28次之间。焦虑或恐惧（89%）、抑郁（61%）和疼痛（67%）是调查前报告的前三大症状。在4 - 8次课程后，参与者报告焦虑/恐惧（43%）、悲伤/抑郁/绝望（33%）、易怒/压力（33%）、孤立/孤独（33%）有所改善。他们报告了一些积极变化：重新开始瑜伽或冥想练习、更专注于敬畏、写日记、增强正念，以及感觉更有能力应对压力。94%报告目标达成，95%会向他人推荐该系列课程。两位临床负责人报告同理心、个人幸福感和工作满意度有所提高。
混合诊断人群中的虚拟NHC SMA系列是可行的，对患者的能动性和幸福感有积极影响，且患者和提供者均可接受。建议采用更正式的研究设计，纳入更广泛的不同人群代表，并评估因果关系，如进行更长随访期的随机对照试验。
