Integration of Person-Centered Narratives Into the Electronic Health Record.
Heather Coats, Nadia Shive, Bonnie Adrian and 2 others
PMID 37582297WHAT IT FOUND
In hospitalized patients with heart failure or end-stage renal disease, a patient-approved story added to the health record improved reported communication quality soon after upload, with a smaller effect later; anxiety and depression did not clearly change.
Key findings
01Patients in the narrative group reported better quality of communication with their health care provider at the first follow-up, with a moderate difference that became smaller at the next time point.
02Secondary measures of anxiety, depression, and psychosocial illness impact showed small or null effects.
03The narrative process was feasible despite pandemic disruptions, and no adverse events were reported.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
The study was a small proof-of-concept trial with 51 enrolled participants, so it was not designed to prove effectiveness. It was done at one academic hospital and only included adults who could read and speak English, so results may not apply to other settings or language groups. Participants, care teams, and outcome collectors were not blinded, and nurses may have changed communication because they knew about the study. The narrative was collected by research team members, not nurses, so this does not show that nurses can create the narrative themselves. Recruitment was disrupted by COVID-19, and missing data were 17.6% overall, with more loss at later time points. The feeling heard and understood outcome was added after the study started and was analyzed in 40 participants, so it is exploratory. The effect on communication was weaker at the second follow-up, so durability beyond the next day is not established.
Declared interests
The authors reported no conflicts of interest. The article is listed as supported by NIH extramural research.
The easy way to misread this
Do not conclude that adding patient narratives to the health record reliably improves communication or mood. This was a small, unblinded proof-of-concept trial; the communication effect weakened by the next time point, anxiety and depression were small or null, and the feeling heard result was added mid-study and was exploratory.