Using a narrative approach to enhance clinical care for patients with asthma

Background: There are currently over 230 million people in the world with asthma, and asthma attacks result in the hospitalisation of a sufferer every 7 minutes. The National Heart, Lung, and Blood Institute outlines four components of clinical practice guidelines for the diagnosis and management of asthma which tends to take a biomedical focus: (i) measures of assessment and monitoring, obtained by objective tests, physical examination, patient history and patient report, to diagnose and assess the characteristics and severity of asthma and to monitor whether asthma control is achieved and maintained; (ii) education for a partnership in asthma care; (iii) control of environmental factors and comorbid conditions that affect asthma; (iv) pharmacologic therapy. Many national guidelines include providing patients with asthma with: (i) written action plans; (ii) inhaler technique training; (iii) structured annual reviews. The problem: Although current guidelines help improve clinical processes of care for asthma, there is also a need to improve self-care of asthma by empowering individuals to take more control of their condition. There is a growing appreciation that a narrative approach with patients with asthma, which focuses on the illness experience and aims to enhance patient-clinician understanding, might improve self-care. Solutions: We explore how a framework for clinicians to listen to patients’ stories, developed from research on individuals with asthma, might enhance communication, improve patient-clinician relationship, and foster better patient self-care. Conclusions: The paper closes with the implications of this approach for clinical practice and future research