Emotional Disclosure Through Patient Narrative May Improve Pain and Well-Being: Results of a Randomized Controlled Trial in Patients with Cancer Pain

Abstract

Narrative medicine is based upon physicians' awareness of patients' narration of their suffering, their hopes, and how illness has affected them. It offers a model for improving health outcomes. To determine whether incorporating a narrative approach in patients with cancer decreases pain intensity and improves their global sense of well-being, we performed a randomized, single-blind controlled trial in adult patients with cancer and average pain intensity levels of at least 5/10. Two hundred thirty-four patients were randomized into three groups: (1) narrative (n=79), in which patients wrote a story about how cancer affected their lives for at least 20 minutes once a week for three weeks; (2) questionnaire (n=77), in which patients filled out the McGill Pain Questionnaire; and (3) control (n=78), in which patients came weekly to medical visits during which they received usual customary care. Patients rated their pain on a 0-10 scale and their well-being on a seven-point Likert scale weekly for eight weeks. Two raters independently evaluated the emotional content of the narratives. Pain intensity and sense of well-being were similar in all groups before and after treatment. Subgroup analyses showed that patients whose narratives had high emotional disclosure had significantly less pain and reported higher well-being scores than patients whose narratives were less emotional. Further study is needed to demonstrate whether the implementation of narrative medicine is associated with health benefits in this and other contexts.

Does therapeutic writing help people with long-term conditions? Systematic review, realist synthesis and economic considerations

“…Of the 64 included studies, 9,51-58,66-119 59 9,51,[54][55][56][57][58][66][67][68][71][72][73][74][75][76][77][79][80][81][82][83][84][85][86]88,89,91, were RCTs, and four 52,78,87,92 were non-randomised studies. The remaining study 53 was a matched case-control study.…”

“…Among those, numerical results were derived from graphs in nine studies. 51,53,56,70,85,103,110,114,121 Several studies under-reported the numerical data (e.g. reporting the mean with no measure of variability, such as the SD) or used different statistics [such as the median, together with confidence intervals (CIs) and/or ranges or the mean together with the SE] to report the results.…”

“…The study by Rickett et al 66 is reported in the Facilitated TW section. Here, the studies by Cepeda et al 85 and Rini et al 86 are described. A summary of main characteristics is presented in Table 17.…”

“…Three studies 66,85,86 evaluated EW in participants with various types of cancer. The study by Rickett et al 66 is reported in the Facilitated TW section.…”

The History and Physical in Cancer Care: A Primer for the Oncology Advanced Practitioner

“…These qualities should be integrated into the interaction and are more important to patient outcomes than the actual verbiage of the discussion (Coulehan & Block, 2006). With an empathetic listener, the retelling of a medical trauma can itself be therapeutic (Cepeda et al, 2008). This exchange also provides the AP obtaining the history with an opportunity to establish a bond with a new patient and his or her family members and to assess the patient's emotional response to the cancer diagnostic process.…”