Narrative medicine to investigate the quality of life and emotional impact of inherited retinal disorders through the perspectives of patients, caregivers and clinicians: an Italian multicentre project

Narrative medicine in pediatric medical education and patient care: A scoping review

Narrative medicine is an approach centered on patients' experiences and their illness stories. Its application in pediatric population warrants further research. This study aims to overview (1) the application of narrative medicine in pediatric medical education and (2) the implementation of narrative medicine in pediatric patient care. Searches were conducted in bibliographic databases (Cochrane Library, ClinicalTrials.gov, EBSCOhost, Embase, MedEdPORTAL, Ovid, PubMed, and Web of Science) without date or language restrictions. Researchers independently screened articles, charted data, and performed data synthesis. Educational intervention studies were evaluated with Kirkpatrick Scale, and Mixed Methods Appraisal Tool was used for methodological quality assessment of all studies. Forty-one articles met our criteria: 17 focused on the application of narrative medicine in pediatric medical education and 24 on its implementation in pediatric patient care. Educational interventions indicated general satisfaction, with reported improvements in empathy, reflection, patient understanding, and professional development. In patient care settings, narrative medicine provided a safe space for story sharing, enhancing emotional, relational, and social connections, and promoting patient- and family-centered care. This review highlights the translation of narrative medicine from educational interventions to clinical practice in pediatric settings. Although more robust research is required, existing evidence supports narrative medicine's potential to foster authentic engagement with patients and caregivers and enhance the quality of pediatric care across various conditions and developmental stages.

Lived experiences of patients, families and caregivers affected by inherited retinal diseases: A qualitative systematic review

BACKGROUND

Inherited retinal diseases (IRDs) are a heterogeneous group of genetic disorders, and a leading cause of vision impairment or blindness, affecting millions worldwide. Despite advances in understanding its phenotype, the physical and psychological impacts of IRDs on patients and their families and caregivers remain underexplored.

OBJECTIVE

This review thus aimed to summarize the existing literature in this area.

METHODS

Following PRISMA guidelines and using search terms such as "inherited retinal disease", "psychological impact", "social impact", and "qualitative research", a systematic search was conducted across PubMed Central, EMBASE, Scopus, and PsycINFO databases up to February 29, 2024, for qualitative studies on the impact of IRDs. The findings were then synthesized narratively to provide a cohesive interpretation.

RESULTS

A total of 20 studies involving 474 participants across six countries (Australia, Belgium, Italy, Sweden, the UK, and the US) were included. Key themes included the significant impact on daily living and independence, work and professional life, coping strategies and resilience, and the emotional burden on families and caregivers. Genetic testing and its implications (reproductive decisions and insurance discrimination) also emerged as an area of concern. IRDs profoundly affect patients and their families and caregivers, influencing daily life, well-being, and societal participation.

CONCLUSIONS

Despite the challenges, resilience and adaptability are prominent, and the findings emphasize the need for comprehensive care that includes psychological support, work adjustments and policies that address the needs of this population. Understanding these quality-of-life issues and areas of unmet need is relevant for healthcare providers, policymakers, and researchers globally.

Relationship Between Perceived Organizational Support, Work Well-Being, and Medical Narrative Ability Among Nurses: A Cross-Sectional Multicenter Study

Aims: The purpose of this study was to investigate the relationship between nurses' perceived organizational support, work well-being, and medical narrative ability. Background: With the proposed bio-psycho-social medical model, nurses' medical narrative ability is closely related to patients' health problems and quality of life. Nurses' perceived organizational support and work well-being can improve nurses' empathy and reflection ability to a certain extent and promote patients' rehabilitation. However, the relationship between nurses' perceived organizational support, work well-being, and medical narrative ability is unclear. Methods: A total of 1831 nurses from 8 hospitals in China were surveyed using an online questionnaire that included nurses' sociodemographic, perceived organizational support, work well-being, and medical narrative ability. IBM SPSS 27.0 was used for Pearson's correlation analysis, one-way ANOVA, t-test, and mediation effect analysis using Model 4 in PROCESS (5000 resamples). Results: The total mean score of perceived organizational support (46.68 ± 11.00), work well-being (53.09 ± 10.81), and medical narrative ability (154.48 ± 22.93) among nurses was found to be moderate. The relationship between perceived organizational support, work well-being, and medical narrative ability was significant, with correlation coefficients ranging from 0.348 to 0.685 (p < 0.01). The relationship between perceived organizational support and medical narrative ability is partially mediated by work well-being. The intermediate effect accounted for 52.36% of the total effect. Conclusion: This study found that nurses' work well-being mediated the relationship between perceived organizational support and medical narrative ability. Implications for Nursing Management: This study evaluated nurses' medical narrative ability and explored the relationship between nurses' perceived organizational support, work well-being, and medical narrative ability. The results of this study can help nursing managers and educators to take appropriate measures to intervene nurses' perceived organizational support and work well-being, so as to improve nurses' medical narrative ability and optimize nursing quality.

Utilising Narrative Medicine to Identify Key Factors Affecting Quality of Life in Dry Eye Disease: An Italian Multicentre Study

INTRODUCTION

Despite an improved understanding of its pathogenesis, dry eye disease (DED) remains relatively underestimated and its treatment challenging. A better alignment between the clinical evaluation and the patient self-assessment also requires capturing the whole patient experience of DED. This project aimed to unveil this experience through narrative medicine (NM).

METHODS

The project involved 38 expert centres in Italy and one in San Marino, targeting adult patients with DED, their informal caregivers and their treating ophthalmologists. Written narratives and sociodemographic and quality of life (QoL)-related data were anonymously collected through the project's webpage. Narratives were analysed through MAXQDA (VERBI Software, Berlin, Germany), NM classifications and content analysis.

RESULTS

A total of 171 patients with DED, 37 informal caregivers and 81 ophthalmologists participated in the research. DED was defined as a disabling condition by 19% of patients and 35% of caregivers; 70% of patients reported that a therapeutic alliance is an integral part of DED treatment and 32% hope for more effective therapies. Forty-four per cent of patients assessed their own QoL as good; however, DED emerged as importantly impacting work performance and social events. DED physical, emotional and economic burden and the cruciality of a trusting care relationship represent the main themes that emerged across all narratives, while empathy and effective treatment are among the factors favouring coping with DED.

CONCLUSION

This project marked a pioneering initiative investigating the lived experience of patients with DED through NM, simultaneously involving all viewpoints involved in the care pathway. NM enabled the unveiling of factors favouring the ability to cope with DED and its associated QoL implications and provided valuable insights to improve the therapeutic alliance.

RP1 Dominant p.Ser740* Pathogenic Variant in 20 Knowingly Unrelated Families Affected by Rod-Cone Dystrophy: Potential Founder Effect in Western Sicily

Background and Objectives. Retinitis pigmentosa (RP) is the most common inherited rod-cone dystrophy (RCD), resulting in nyctalopia, progressive visual field, and visual acuity decay in the late stages. The autosomal dominant form (ADRP) accounts for about 20% of RPs. Among the over 30 genes found to date related to ADRP, RP1 pathogenic variants have been identified in 5-10% of cases. In a cohort of RCD patients from the Palermo province on the island of Sicily, we identified a prevalent nonsense variant in RP1, which was associated with ADRP. The objective of our study was to analyse the clinical and molecular data of this patient cohort and to evaluate the potential presence of a founder effect. Materials and Methods. From 2005 to January 2023, 84 probands originating from Western Sicily (Italy) with a diagnosis of RCD or RP and their relatives underwent deep phenotyping, which was performed in various Italian clinical institutions. Molecular characterisation of patients and familial segregation of pathogenic variants were carried out in different laboratories using Sanger and/or next-generation sequencing (NGS). Results. Among 84 probands with RCD/RP, we found 28 heterozygotes for the RP1 variant c.2219C>G, p.Ser740* ((NM_006269.2)*, which was therefore significantly prevalent in this patient cohort. After a careful interview process, we ascertained that some of these patients shared the same pedigree. Therefore, we were ultimately able to define 20 independent family groups with no traceable consanguinity. Lastly, analysis of clinical data showed, in our patients, that the p.Ser740* nonsense variant was often associated with a late-onset and relatively mild phenotype. Conclusions. The high prevalence of the p.Ser740* variant in ADRP patients from Western Sicily suggests the presence of a founder effect, which has useful implications for the molecular diagnosis of RCD in patients coming from this Italian region. This variant can be primarily searched for in RP-affected subjects displaying compatible modes of transmission and phenotypes, with an advantage in terms of the required costs and time for analysis. Moreover, given its high prevalence, the RP1 p.Ser740* variant could represent a potential candidate for the development of therapeutic strategies based on gene editing or translational read-through therapy for suppression of nonsense variants.