The Construction Of The Clinical Practice Path Of Narrative Medicine In Traditional Chinese Medicine For Tumor Rehabilitation

BackgroundNarrative medicine has been introduced into China for more than 10 years,and its kernel of calling for the return of humanism to clinical diagnosis and treatment has been widely recognized,and scholars in China have also made positive practical attempts and achieved promising results.In general,the clinical practice of narrative medicine nowadays is mainly focused on training medical students and clinicians with narrative skills,with insufficient attention to the patient side and little integration with the local Chinese context,and most of them outline the advantages of narrative medicine in general,while the specific ways and methods of clinical practice still need to be further enriched.Therefore,we still need to consider how to integrate narrative medicine more widely and deeply into our local medical practice in order to play a greater role.Rooted in traditional Chinese culture,TCM emphasizes the holistic nature of human beings,their uniqueness and their connection with nature,and has characteristic views such as the unity of form and spirit,the unity of nature and man,and discriminatory treatment.Moreover,the clinical practice of TCM for thousands of years has always reflected a strong sense of humanistic care.In terms of theory,many scholars have discussed the natural connection between Chinese medicine and narrative medicine and the large number of techniques in Chinese medicine that can be explored and combined.From the perspective of Chinese medicine,narrative medicine has many elements that can be combined,such as the narrative of treating the untreated diseases,the narrative of chronic diseases,and the narrative of health care,etc.Therefore,we should find the entry point and the way to integrate with Chinese medicine in accordance with Chinese clinical reality,give full play to the characteristics and advantages of Chinese medicine narrative,complement the advantages of Chinese medicine and narrative medicine,incorporate and integrate them,and create a practice path suitable for localization of China.Therefore,this study intends to compile and summarize the characteristic humanistic care treatment methods of TCM,integrate the concept and practical experience of narrative medicine and form a set of specific and rule-based practice paths after rigorous demonstration,in order to provide practical guidance for front-line clinical workers.The research team selected tumor survivors as the target group,integrated the psychological characteristics and needs of patients into the Clinical Practice Path of Narrative Medicine in Traditional Chinese Medicine,formed a Clinical Practice Path of Narrative Medicine in Traditional Chinese Medicine for tumor rehabilitation,and demonstrated its feasibility and clinical replicability in order to serve the clinic better.ObjectiveTo construct a Clinical Practice Path of Narrative Medicine in Traditional Chinese Medicine,and to construct a disease-specific clinical practice pathway for tumor rehabilitation,and to demonstrate its feasibility and clinical generalizability,in order to provide clinical practice guidelines of Narrative Medicine in Traditional Chinese Medicine for the clinical practice.MethodsThis study is divided into three parts:constructing a clinical practice path of Narrative Medicine in Traditional Chinese Medicine,constructing a clinical practice path of Narrative Medicine in Traditional Chinese Medicine for tumor rehabilitation,and assessing the feasibility and generalization of the clinical practice path of Narrative Medicine in Traditional Chinese Medicine for tumor rehabilitation.The first part uses the realistic literature review method and the nominal group method to construct the clinical practice path of TCM narrative medicine and its rules.First,systematically survey and organize practical exercises and cases showing TCM Humanistic Care of ancient Chinese medical texts,famous medical cases,extract the main points and key steps of TCM humanistic care practice.Preliminary construction of theoretical framework as well as formation of keywords for searching modern TCM literature for practices and cases demonstrating humanistic care in TCM in modern TCM literature.Construct a theoretical framework as well as form keywords for searching modern TCM literature,and search modern TCM literature for practices and cases that demonstrate humanistic care in TCM.Then,invite experts in TCM basic theory,TCM clinical,narrative medicine,TCM psychology,and evidence-based methodology to participate in the nominal group method validation meeting,Experts write down their opinions and present their views on the clinical pathways,and discuss the practice pathways one by one.Finally,vote on the resolution to clearly specify the various operational modules and rules of the practice pathway and complete the construction of the clinical practice path of Narrative Medicine in Traditional Chinese Medicine.The second part adopts the face-to-face in-depth interview method and the Meta-integration method integrated with qualitative research to deeply explore the practice experience feelings of front-line oncology clinicians and the consultation experience needs of oncology survivors during the recovery period,and to integrate them to construct a clinical practice path of Narrative Medicine in Traditional Chinese Medicine for oncology recovery.In the third part,the focus group interview method in the qualitative study was used to assess the feasibility and clinical generalizability of the clinical practice pathway of Chinese medicine narrative medicine for oncology rehabilitation.Based on the principle of purposive sampling,front-line clinical doctors in oncology were selected to conduct focus group interviews around the operability and clinical generalizability of the narrative medicine clinical practice pathway for tumor rehabilitation,and the results of the interviews were used to make modifications and improvements to finally form the narrative medicine clinical practice pathway for tumor rehabilitation.Results1 Through the realistic literature review method,integrated the results of data synthesis with the previous theoretical framework,and after expert panel discussion,formed 6 themes of the TCM narrative medicine practice pathway("Treatment opening" "Communication of illness","diagnosis and explanation","joint decision making","end of treatment",and "reflection and summary"),13 preliminary themes("Closing the door," "Medicine is a benevolent art," "Respectful sight and hearing,""See their suffering as if you had it" "Be prudent," "Look into the four difficulties and tell them clearly," "Tell them of their failures," "Tell them of their goodness," "guide with its convenience" "reiterate the urgent need" "open with its suffering" "the doctor’s self-improvement").Through the nominal group method,the final vote of agreement by experts was 92%,and a consensus was reached,which clarified each operation module and details of the practice path and formed the TCM narrative medicine practice path.2 After face-to-face in-depth interviews,4 themes of oncologists’ practice feelings and experiences were obtained through thematic analysis("professional beliefs of essence and sincerity","following the characteristics of Chinese patients","communication and interaction between emotion and reason"),and 8 sub-themes("having a calm and peaceful mind","treating and treating in harmony with mind and body")","Tossing and turning between stress and emotion"),8 sub-themes("having a calm and peaceful mind","treating the body and mind in tune")"Play the role of family members in the bridge between doctors and patients," "Inspire and guide patients,"Fight alongside patients,""Cultivate good medical habits of patients and families("multiple stresses of practice" "emotional response of patients").Extensive screening and reading of domestic and international qualitative studies on medical care experiences and care needs of oncology survivors included 18 domestic and international papers with quality ratings of A and B.A total of 60 themes and 11 categories were finally distilled and further synthesized into 3 integrated findings("Factors of doctor-patient cognitive disagreement""Neglected factors in doctor-patient communication" "Factors to achieve doctor-patient harmony").Based on the clinical practice path of Narrative Medicine in Traditional Chinese Medicine,a clinical practice path of Narrative Medicine in Traditional Chinese Medicine for oncology rehabilitation was constructed.3 A focus group interview was conducted with 6 front-line oncology doctors on the feasibility and clinical replicability of the clinical practice path of Narrative Medicine in Traditional Chinese Medicine for oncology rehabilitation in the actual clinical setting.Based on the feelings and suggestions of the participating physicians,six operational themes,four supporting tools and detailed operational details of the clinical practice path of Narrative Medicine in Traditional Chinese Medicine for oncology rehabilitation were finalized,and the construction of the clinical practice path of Narrative Medicine in Traditional Chinese Medicine for oncology rehabilitation was completed.Conclusion1 This study constructs a clinical practice path of Narrative Medicine in Traditional Chinese Medicine.The pathway integrates the humanistic features of TCM,the key points of NM and the effective communication methods and approaches in TCM psychology and psychology,and provides clinical frontline medical personnel with a process-oriented and flexible guide to the practice of TCM narrative medicine that can be applied in clinical settings.2 This study takes tumour rehabilitation as an example,and constructs a disease-specific clinical practice pathway of TCM narrative medicine for tumour rehabilitation.3 This study evaluates the clinical feasibility and scalability of the clinical practice pathway of TCM narrative medicine for tumour rehabilitation.