Victoria Shaffer, PhD, describes the the pros and cons of narratives and then explains her work to develop a system of classification for narratives as part of the solution. Victoria provides an overview of the narrative taxonomies she and her colleague have developed. This presentation was part of a Shared Decision Making Month webinar -- The Power of Narratives: How They Shape the Way Patients Make Medical Decisions.

1. All Stories Are Not Alike:
A Taxonomy of Patient
Narratives
Victoria A. Shaffer, PhD
University of Missouri
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2. The Problem
• Narratives are good
• Vivid and engaging
• Inherent credibility
• More powerful than traditional information formats
• Narratives are bad
• Change healthcare decisions
• Bias decisions by changing how people perceive risk
• Make rare outcomes appear equally likely as common
ones
Bekker et al., 2012 IPDAS; Winterbottom et al., 2008
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3. Are patient stories
harmful or helpful?
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4. The Solution
• Prior work treated narratives as if they
were identical
• Narratives are multidimensional
• Must develop a system for classifying and
defining narratives
• Identify associated outcome measures
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5. Taxonomy Overview
1. The purpose of the narrative
2. The content of the narrative
3. The evaluative valence of the narrative
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6. Narrative Purpose
1. Provide information
2. Make healthcare materials more engaging
3. Model targeted behaviors
4. Persuade people to engage in healthy
behaviors or cease unhealthy behaviors
5. Provide comfort to patients and families
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7. Narrative Purpose
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8. Narrative Content
1. Outcome narratives
2. Experience narratives
3. Process narratives
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9. Narrative Content
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10. Outcome Narratives
• “I chose to have a lumpectomy and radiation,
and after 10 years, I’m still cancer free”
• Outcome information about local
recurrence
• “I really regret my choice to have a lumpectomy.
I am constantly checking for new lumps and
worrying about whether the cancer will return”
• Psychological outcome information
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11. Narrative Content
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12. Experience Narratives
• “The surgery part was pretty much what I had
expected. I was in some pain when I woke up from the
surgery, but the pain medications made it tolerable.”
• Information about discomfort after surgery
• “I went to radiation therapy 5 days a week for 6
weeks. This caused me to miss a number of important
events with my family.”
• Information about the time and energy
associated with the treatment
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13. Narrative Content
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14. Process Narratives
• “After I spoke with my doctor, I also talked to
other breast cancer survivors and looked for
information about the two surgeries on the web”
• Strategies for information acquisition
• “I knew I needed to consider my appearance and
how that would make me feel and how worried I
would be about the cancer coming back”
• Identification of important decision
dimensions
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15. Narrative Content
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16. Evaluative Valence
• Overall tone of the message
• Positive
• Negative
• Mixed
• Continuum ranging from extremely positive
to extremely negative
• Negative narratives will have a stronger effect
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17. Relationships Between
Dimensions
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18. What now?
• Research is needed to test the validity of
the taxonomy
• The taxonomy will necessarily evolve
• Patient narratives are NOT
homogeneous
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19. Conclusions so far...
• “Stories” can be harmful or helpful
• Depends upon:
• their content
• their emotional valence
• your purpose
• Patient narratives are a powerful tool that can and should
be used to accomplish a variety of health communication
goals
• However, they should be used intentionally and carefully
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20. Acknowledgements
• Collaborators:
• Brian J. Zikmund-Fisher, University of
Michigan
• Sara Tomek, University of Alabama
• Work funded by the Informed Medical Decisions
Foundation
• Grant 0772-1
• Email: shafferv@health.missouri.edu
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