University of Pikeville Kentucky College of Osteopathic Medicine Harold, Kentucky
Background and Hypothesis: The population of Appalachia suffers from chronic health conditions at among the highest rates in the general US population. These disparities are particularly evident in high morbidity conditions like Type 2 Diabetes and hypertension. Chronic conditions such as these require a higher degree of ongoing, patient-provider relationships to ensure positive care outcomes. This study hypothesized that chronic health conditions are partially impacted by elements of the patient-provider relationship.
Methods: Employing narrative medicine interviewing techniques, the researchers conducted single, 60-90 minute sessions with participants (n=13), generating over 200,000 words of narrative transcripts. These narratives were “close read,” coded, and sorted into 5 thematic categories [health education, continuity of care, patient-provider communication, socio-economic background, and health systems/insurance], spanning each participant’s diagnosis to present. Each category was also sorted further by narrative elements such as tone, language choice, and specific sub-themes. Additionally, participants provided an oral 24 hour dietary recall. The narrative medicine format of an open-ended, participant-guided interview also allowed for participants to engage with medical narrative creation as a part of knowledge of their bodies and minds. Participants were recruited from the free OMT clinic at the University of Pikeville, Kentucky College of Osteopathic Medicine and were included if they had a diagnosed chronic illness.
Results: Out of the themes identified, the study found the most narrative elements within the category of patient-provider communication. Sub-themes identified in this category were physician empathy and humanistic approach, involvement of physician in health education, establishment of rapport, physician understanding of the bio-social elements of patient care, patient agency and self-advocacy, patient trust in the primary care physicians over specialists, the impact of physician retirement, longevity of the patient-provider relationship, and improved communication with increased patient involvement in decision making.
Conclusion: The study’s findings can help inform direction for further investigation in patient-provider communication in rural Appalachia. Specifically, it points to a need for increased involvement of different health agencies in patient education, and improvement of primary care physicians’ skills in patient-centered communication and care. The study is osteopathically relevant in that, as the union of body, mind, and spirit as a interrelated functional unit, it theorized that patient-provider communication, mostly aspects of the mind and spirit, can have impacts on the chronic health of the body.
Acknowledgement of Research Study Sponsors and IRB: This study was supported by a grant from the Summer Research Fellowship at University of Pikeville Kentucky College of Osteopathic Medicine. The IRB was reviewed and determined to be approved.
