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Using Visual and Narrative Methods to Achieve Fair Process in Clinical Care

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Published on: February 16, 2011

It Starts With a Story: A Four-Step Narrative-Based Framework for Serious Illness Conversations.

Natalie Lanocha¹, Sara Taub², Jason A Webb^1,3

¹Oregon Health and Science University, Portland, Oregon, USA.

Journal of Palliative Medicine

|July 5, 2024

Summary

This study introduces an identity-centered framework for serious illness conversations in palliative care. The four-step approach (attend, identify, create, promote) helps clinicians align care with patient values and identity.

Keywords:

communication narrative medicine serious illness conversations

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Area of Science:

Palliative Care
Medical Humanities
Bioethics

Background:

Serious illness conversations are crucial for advance care planning and palliative care.
Patient identity and sense of self are critical for effective serious illness conversations.
A conceptual gap exists in understanding the relationship between patient identity, values, goals, and choices.

Purpose of the Study:

To develop a novel conceptual framework for serious illness conversations.
To propose a structured approach for optimizing these conversations in palliative care.

Main Methods:

Philosophical and theoretical analysis conducted by an interdisciplinary team.
Review of literature in psychology, qualitative research, medical ethics, and choice architecture.
Structured conceptual and narrative analysis.

Main Results:

An original identity-centered conceptual framework for serious illness conversations was developed.
A four-step reproducible approach (AICP: attend, identify, create, promote) was explicated.
The framework integrates patient narrative identity, values, goals, and choices.

Conclusions:

The AICP framework provides a structured method for enhancing serious illness conversations.
Clinicians can use this framework to achieve goal-concordant care and build stronger patient relationships.
This approach fosters trust and goodwill in palliative care settings.