Strategies and effectiveness of narrative medicine in renal patients: a literature review. Part 1

Abstract

Introduction This paper on narrative-based medicine (NBM) is divided into two articles. The concept of NBM has been developed over the last decades to bring the biomedical aspects of illness and treatment closer to the psychosocial aspects and life experiences related to illness. Purpose To identify and summarize the evidence and concepts of NBM in nephrology. Methods Review of studies based on a literature search in 6 databases. Results Thirty-five papers were included in the review, none of which were quantitative. Discussion The narrative approach applied to a nephrology context seeks to shed light on the life experiences related to kidney disease by collecting, through structured and semistructured interviews, stories from patients, caregivers and health care providers. Some of the main topics emerging in the first article are the lack of a “disease identity” that allows patients to identify with the specific status of kidney disease; uncertainty as a dominant feature of living with an illness characterized by continuous progression and regression; the “unspeakable”, referring to all those aspects for which there is no room for expression in the care relationship, such as living with the risk of dying, experiences that are difficult to put into words, and everything related to mystery, faith and the inexplicable. Conclusions This review shows the importance of exploring the disturbing aspects of life for patients with chronic renal failure. Knowledge of these aspects can help health care providers improve the quality and effectiveness of the therapeutic relationship and ensure that the patient will not feel isolated but at the center of the care process. Narrative medicine, as will be highlighted in the second article, is also aimed at health care providers in order to investigate their experiences, which are often characterized by situations of suffering and discomfort. The narrative approach in nephrology could be supported by further research into the therapeutic abilities of narration in the care relationship.