Expert consensus on narrative medicine in China (2023)

The concept and values of NM

Recommendation 1: Rita Charon’s definition in The Principles and Practice of Narrative Medicine is recommended as the baseline definition: NM is “a rigorous intellectual and clinical discipline to fortify healthcare with the capacity to skillfully receive the accounts persons give of themselves – to recognize, absorb, interpret, and be moved to action by the stories of others” [3].

Recommendation 2: The “Basic Concepts of Narrative Medicine 22334 Red Flower Model” (China Copyright Registration Certificate-2023-F-00069644) should be used to explain and elucidate the fundamental tenets of NM. This model reflects the “two tools” of cultivating narrative competency – close reading and writing; the “two tools” of NM practice – the self and the presence of healthcare providers; the “three focuses” of NM – empathy, relationality, and emotion; the “three elements” – attention, representation, and affiliation, as well as the “four relationships” – the composite trust relationships of healthcare providers with patients, with themselves, with colleagues, and with society.

Recommendation 3: The concept of “developmental NM” should be adopted in both practice and research settings, which aims to broaden the horizons of NM by expanding its scope, beneficiaries, tools, and application areas.

Recommendation 4: NM has practical attributes as a comprehensive framework that encapsulates the clinical behaviors of exemplary medical practitioners with a blend of humanistic competency and medical expertise. Therefore, NM not only explains and elucidates clinical medical humanities, but also serves as a tool for humanistic care.

Recommendation 5: NM is of significance to patients. There is an interactive relationship between healthcare professionals and patients. On the one hand, healthcare professionals provide care and support for patients, address patients’ physical and psychological needs, and provide life and death education, so that patients may objectively and rationally face the limits of medicine, understand the meaning of human life, and obtain informed diagnosis and treatment through shared decision-making. On the other hand, the reciprocal nature of patient feedback serves as a testament to the quality of care provided, which greatly enhances the sense of professional achievement and motivate healthcare professionals to improve their services for patients.

Recommendation 6: NM is of significance to healthcare professionals. NM may improve the relationships of healthcare professionals with patients, with themselves, with colleagues, and with society by enhancing their narrative competency. NM not only promotes communication and mutual trust, but also allows healthcare professionals to acquire a sense of respect and achievement, thereby mitigating workplace burnout.

Recommendation 7: NM is of significance to hospitals. NM may enhance the health humanities competency of healthcare professionals, improve patient experience at healthcare institutions, increase their adherence to these institutions and reduce doctor-patient conflicts, as well as promote the development of medical humanities and hospital management.

Recommendation 8: NM is of significance to medicine and healthcare as a whole. The combination of NM with evidence-based medicine and precision medicine is beneficial for the practice of the bio-psycho-social model. On the one hand, NM can be used as a tool for the improvement of evidence-based medicine. On the other hand, precision medicine is the individualization of medical technology at the biomedical level, while NM is the individualization of health humanities at the psychological-social level. NM, evidence-based medicine, and precision medicine complement each other.

Recommendation 9: NM has significant social values. NM brings medicine back to its essence – medicine is not about “the disease” but “the person.” Meanwhile, the harmonious doctor-patient relationship fostered by NM contributes to the advancement of social harmony.

The practice of NM

Recommendation 10: Narrative nursing, rooted in NM and narrative therapy, represents a vital branch of NM and its practical application in the nursing domain.

Recommendation 11: Medical institutions at all levels should incorporate NM into clinic practice. Healthcare providers are encouraged to actively engage in listening to patients’ narratives in their encounter with patients. It is important for healthcare providers to cultivate professional habits of self-reflection, embrace empathy, and promote shared decision-making, in order to foster a collaborative partnership of mutual trust with patients.

Recommendation 12: Medical institutions at all levels should use NM as a foundation to establish humanistic departments, humanistic nursing units, and humanistic hospitals. The concept of NM should be integrated into various aspects of healthcare, including health promotion, hospital management, research and teaching, and doctor-patient dispute resolution.

Recommendation 13: Medical institutions at all levels should organize continuing medical education related to NM. Doctor-patient stories should be disseminated through various media platforms to inspire and motivate healthcare providers to practice NM consistently.

Recommendation 14: Medical schools should provide NM-related courses to medical students to fully demonstrate the educational value of NM. Medical schools are encouraged to explore the construction of a series of NM courses, including basic theories of NM, illness narratives, narrative texts, narrative and doctor-patient communication, and NM and traditional culture.

The research of NM

Recommendation 15: To promote the localization and development of NM in China, it is recommended that in-depth theoretical and practical research be carried out on NM, so as to establish NM with Chinese characteristics, and effectively articulate Chinese voices and tell Chinese stories to the international community.

Recommendation 16: Medical schools/colleges and medical institutions of all levels should conduct empirical research on the clinical application of NM, including qualitative, quantitative, and mixed-method research. In addition to patients, the subjects of NM research should include family members, clinical doctors, and medical students, nurses, clinical pharmacists, and other healthcare providers who interact with patients. The establishment of doctor-patient communities, nurse-patient communities, and medical care communities should also be included in the research.

Recommendation 17: Research on NM education and teaching needs to be strengthened. Such research may include textbook development, curriculum design, teaching contents design, pedagogies, and evaluation models.

Recommendation 18: Research on NM practitioners needs to be strengthened. The research objectives include enhancing narrative competency, empathy, professional resilience, and professionalism of healthcare providers. The goals of such research include promoting self-reflection, reducing occupational burnout, and enhancing professional identity.

Recommendation 19: Research on the effect of NM practice on patients needs to be strengthened. The research objectives include improving patient experience and satisfaction, and improving clinical outcomes, patient outcomes, patient-reported outcomes, and their overall health and well-being.

Recommendation 20: Standardization of intervention methods should be explored, including close reading, parallel chart writing, narrative nursing practice, Balint group activities, and artistic intervention in the empirical research of NM.

Recommendation 21: Quantitative empirical research on the effectiveness of NM should have a series of standardized measurement indicators. It is recommended that the following validated scales for measurement be used, including but not limited to: Patient Satisfaction Scale, Quality of Life Scale (QLS), Self-rating Anxiety Scale (SAS), Self-rating Depression Scale (SDS), Narrative Competence Scale, Caring Ability Scale (CAS), Jefferson Scale of Empathy (JSE), Maslach Burnout Inventory (MBI), Personal Growth Initiative Scale (PGIS), and Career Resilience Scale.