Best Practices

Using Life Stories to Connect Veterans and Providers

Fed Pract. 2015 June;32(6):8-14

References

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Patients were recruited from 2 inpatient units and 1 long-term rehabilitative care unit. Interviewers introduced themselves to the veterans, described the project, and gave each one a project brochure. Veterans were given the opportunity to be interviewed immediately, schedule a future interview, decide later, or not participate.

The majority of veterans who participated chose to be interviewed immediately. Scheduling interviews around procedures and discharges on busy inpatient units proved difficult. Overall participation rate was high: 60% of veterans who were told about the project eventually told their story.

Interview Process

Veterans signed a consent form before the interview, and the interviews were recorded on a digital audio recorder. They were informed they could choose to talk—or not talk—about any part of their life, the interviewer would write a draft of the story based on the interview and bring it back for their review, and the story would not be added to their patient record until they gave their approval. Spouses/partners were invited to participate if they desired.

Interviewers were encouraged to follow the lead of the veteran. Those who were clinicians were encouraged to “take off their clinician hat” during the interview. Unless guided otherwise by the veteran, the interview was semichronological and included the following subjects: birth and childhood, family, schooling, military service, relationships and/or marriage, children, career and employment, general health, and current hospital stay and presenting problem.

Interviews lasted about an hour, and 182 interviews were conducted. Interviews were frequently interrupted by HCPs who checked vitals, administering medications, rounding with residents, and so forth. If the HCP indicated that the patient could keep talking, the interview continued. If the patient had to leave the room for a procedure or medical appointment, the interviewer paused the recording and scheduled a time to come back and complete the interview.

After the interview, veterans were told that they could expect to see the first written draft of their story within 2 days. Veterans who were to be discharged the day of the interview or the following day were told that the story would be sent to them in the mail to review at home.

Personal Health Inventory

Interviewers introduced the PHI to veterans as an opportunity to identify their wellness goals and share these with the PACT. Veterans with late-stage cancer or in hospice care were given the option to skip the PHI. Of the 103 veterans who completed the PHI, 96 chose to have the interviewer read the questions and record their answers; only 7 chose to complete the PHI on their own.

One hundred eighty-two veterans completed personal narratives, and 103 completed the PHI. Incomplete PHIs occurred for the following reasons: hospice or end of life, 12; declined, 20; could not complete, 21; discharged, 19; lost to follow-up, 7.

Writing

The quality of the written stories was critical to the success of the project. Creativity was encouraged to produce stories that captured and brought to life the voice and spirit of the interview subject. The team identified the following features of a good story: (1) written in the first person; (2) nonjudgmental; (3) captures the voice of the veteran; (4) accurately reflects the content of the interview; and (5) nondiagnostic (not labeling).

A short story format was used to increase the likelihood that busy providers would read the narratives. Writers were encouraged to limit the length of the stories to 1 to 2 printed pages (650-1,300 words). Completed stories ranged from 95 words to 2,345 words with an average length of 1,053 words. Veterans wrote 3 and the interviewers wrote 178 narratives; 1 narrative was written by a team member who was not present during the interview but listened to the audio recording.

Editing Process

The first draft of the story was printed and given to the veteran to make any desired changes. Veterans reviewed and updated their stories in different ways. Some wrote their changes on the printed copy and had the writer return at a later time to pick it up. Others read through the story with the writer present and wrote their changes on the printed copy. Some had the writer read the story aloud and alerted the writer when an item needed changing.

Drafts were mailed to already discharged veterans, including a postage-paid return envelope to allow them to mail their changes to the team. After incorporating the veteran’s changes, the team member brought back a second draft of the story for the veteran to review. This process was repeated until the veteran gave final approval. Veterans could then approve whether to share their story with their PACT via the Computerized Patient Record System (CPRS).