Best Practices

Using Life Stories to Connect Veterans and Providers

The My Life, My Story patient-centered program uses veterans’ personal narratives by veterans to create a strong connection between patients and providers.

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

Author(s):

Thor Ringler, MS, MFA

Eileen P. Ahearn, MD, PhD

Meg Wise, PhD

Elliot R. Lee, PhD

Dean Krahn

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References

1. Veterans Health Administration, Office of Patient Centered Care and Cultural Transformation. My Story Personal Health Inventory, Revision 20. U.S. Department of Veterans Affairs Website. http://www .va.gov/patientcenteredcare/docs/va-opcc-personal -health-inventory-final-508.pdf. Revised October 7, 2013. Accessed May 11, 2015.

2. Pennebaker JW. Telling stories: the health benefits of narrative. Lit Med. 2000;19(1):3-18.

3. Greenberg MA, Stone AA. Writing about disclosed versus undisclosed traumas: immediate and long term effects on mood and health. J Pers Soc Psychol. 1992;63:75-84.

4. Pennebaker JW, Beall SK. Confronting a traumatic event: toward an understanding of inhibition and disease. J Abnorm Psychol. 1986;95(3):274-281.

5. Petrie KJ, Booth RJ, Pennebaker JW, Davidson KP, Thomas MG. Disclosure of trauma and immune response to hepatitis B vaccination program. J Consult Clin Psychol. 1995;63(5):787-792.

6. Petrie KJ, Fontanilla I, Thomas MG, Booth RJ, Pennebaker JW. Effect of written emotional expression on immune function in patients with human immunodeficiency virus infection: a randomized trial. Psychosom Med. 2004;66(2):272-275.

7. Smyth JM, Stone AA, Hurewitz A, Kaell A. Effects of writing about stressful experiences on symptom reduction in patients with asthma or rheumatoid arthritis. JAMA. 1999;281(14):1304-1309.

8. Chochinov HM. Dignity-conserving care—a new model for palliative care: helping the patient feel valued. JAMA. 2002;287(17):2253-2260.

9. Chochinov HM, Hack T, Hassard T, Kristjanson LJ, McClement S, Harlos M. Understanding the will to live in patients near death. Psychosom. 2005;46(1):7-10.

10. Chochinov HM, Kristjanson LJ, Breitbart W, et al. Effect of dignity therapy on distress and end-of-life experience in terminally ill patients: a randomised controlled trial. Lancet Oncol. 2011;12(8):753-762.

11. Wise M, Marchand L, Roberts LJ, Chih M. Existential suffering in advanced cancer: the buffering effects of narrative: a randomized control trial. Poster presented at: University of Washington School of Medicine 6th Annual Department Fair; April 8, 2015; Seattle, Washington.

12. Hall S, Goddard C, Opio D, Speck PW, Martin P, Higginson IJ. A novel approach to enhancing hope in patients with advanced cancer: a randomised phase II trial of dignity therapy. BMJ Support Palliat Care. 2011;1(3):315-321.

13. Heiney SP. The healing power of story. Oncol Nurs Forum. 1995;22(6):899-904.

14. Hyden L-C. Illness and narrative. Soc Health Illness. 1997;19(1):48-69.

15. Carlick A, Biley FC. Thoughts on the therapeutic use of narrative in the promotion of coping in cancer care. Eur J Cancer Care (Engl). 2004;13(4):308-317.

16. Niederhoffer KG, Pennebaker JW. Sharing one’s story: on the benefits of writing or talking about emotional experience. In: Snyder CR, Lopez SJ, eds. Handbook of Positive Psychology. New York, NY: Oxford University Press; 2001:573-583.

17. Pennebaker JW, Kiecolt-Glaser JK, Glaser R. Disclosure of traumas and immune function: health implications for psychotherapy. J Consult Clin Psychol. 1988:56(2):239-245.

Anyone involved with the U.S. health care system has heard one or more of the following dispiriting comments. If you are a patient, you have heard or said, “I wish I felt like my provider understood me. He/she just doesn’t have the time.” If you are a provider, you have heard yourself or another provider say, “I wish I had more time to get to know my patients as people. I could do a better job or at least I could remember them without looking at the chart.” This article describes a novel program—My Life, My Story—instituted at the William S. Middleton Memorial Veterans Hospital (WSMMVH) in Madison, Wisconsin. The program uses personal narratives to foster a sense of connection between providers and their veteran patients.

My Life, My Story had its origins in a small performance improvement project aimed at helping psychiatric residents learn about their new outpatients during rotation. The clinic staff wanted residents to get to know their patients as people in addition to understanding the veterans’ medical conditions. The veterans were first offered the opportunity to come to writers’ workshops and create personal narratives that would be shared later with their clinicians. Unfortunately, only a few veterans were willing to take on this task.

A more patient-friendly approach for collecting and sharing the stories was developed and funded by the VHA Office of Patient-Centered Care and Cultural Transformation (OPCC&CT). Veterans who chose to participate worked with an interviewer/writer to create a personal narrative, which was then shared with their patient aligned care team (PACT). Another component of the interview process was the Personal Health Inventory (PHI), a questionnaire developed by the OPCC&CT that helps veterans articulate their goals and motivations for physical, social, psychological, and spiritual well-being.¹ The PHI and personal narrative were paired, to give health care providers (HCPs) a sense of the veteran and their personal health goals.

Background

The health benefits of telling or writing the story of a difficult emotional event have been demonstrated by Pennebaker.² In varied groups, from prisoners to patients with chronic pain, the writing or talking about experiences improved mood and lowered distress. In addition, studies of medically ill patients showed a decline in physician visits in the 2 to 6 months following the narrative process.^3,4Improved immune response was also shown for patients with hepatitis B, HIV, asthma, and rheumatoid arthritis in response to completing a narrative.^5-7

But the writing task is difficult for many people, especially those with advanced illness. Interviewing these patients and writing their stories is a way to give them a voice that otherwise might go unheard.

Dignity therapy with terminally ill patients, a technique developed by Dr. H.M. Chochinov, used an expert to collect the story by bedside interview and to produce a dignity-enhancing life narrative.^8-10 Wise and colleagues modified this process for patients with cancer stages III and IV by using telephone interviews, which showed reduced anger, depression, tension, and an increased sense of peace.¹¹ Personal narratives in which patients tell their story and receive it in written form have been shown to reduce psychological distress, increase hope, and help the patient feel valued.^10,12

Pennebaker hypothesized that several mechanisms account for these improvements in health measures.² First, developing a narrative provides a contextual understanding of stressful events. Creating a personal narrative allows a patient to identify and give meaning to life’s struggles. Through this process, coping is hypothesized to occur.^13-15 Second, storytelling connects the teller with a wider audience.¹⁶

Another study by Pennebaker and colleagues found an improvement in social connectedness in college students in the days following the disclosure of emotional stories.¹⁷ The study speculates that nondisclosure fosters isolation, whereas disclosure connects us with others, helping us to reach out to others and improving a sense of feeling understood.

Methods

Project staff were recruited to conduct the interviews and write the stories. Team members with varied backgrounds and experiences were selected: a nurse at the WSMMVH who served as an army interrogator in Afghanistan; a professional counselor with prior experience working for the VA; and a marriage and family therapist with a poetry MA.

Providers were recruited for participation in the project through (1) presentations to nursing staff on the inpatient units where stories were gathered; (2) compilations of de-identified stories from veterans on those units were distributed; (3) presentations on the project at outpatient clinics, where the narratives of veterans who were patients at those clinics were read aloud; and (4) discussions of the program at monthly hospital-wide meetings.