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Table 4 Factors influencing doctor–patient relationships at the end of the narratives

From: Use of narrative medicine to identify key factors for effective doctor–patient relationships in severe asthma

  Core Narratives Contingent Narratives Moral Narratives
Easy Difficult Evolved Easy Difficult Evolved Easy Difficult Evolved
Emotions at the end (Adult patients) (N = 77) (N = 4) (N = 51) (N = 39) (N = 4) (N = 17) (N = 3) (N = 5) (N = 5)
Fear and sadness 3% 25% 2% 0% 25% 0% 0% 20% 20%
‘Today this person remains on high doses of cortisone and her illness remains uncontrolled. The burden of anxiety and depression on her shoulders worsens the situation’.
Submission 1% 25% 2% 0% 50% 0% 0% 20% 0%
‘Although doctors were giving hope and suggesting possible therapeutic solutions to her, symptoms continued in an increasingly more aggressive way. She could not live or breathe. Any kind of therapy could console her’.
Positive 94% 25% 94% 100% 0% 88% 67% 20% 80%
‘He told me he had written on Facebook, without reference to any person, “My breathing is restored, I can smell perfumes”’. ‘Today, this person is more serene and active. The asthma treatment allowed him to control his life, his actions, and not to put limits on his living because of his illness’.
Hate and anger 0% 0% 0% 0% 25% 0% 0% 40% 0%
‘I haven’t had news about this patient for several months’.
Anticipation 3% 25% 2% 0% 0% 12% 33% 0% 0%
‘Today this person lives with his illness with more courage and dedication, and also tries to live a mostly normal life, being aware that his condition could worsen at any moment’.
Emotions at the end (Paediatric patients) (N = 24) (N = 2) (N = 11) (N = 7) (N = 2) (N = 3) (N = 5) (N = 2) (N = 2)
Fear and sadness 0% 0% 9% 0% 0% 0% 0% 0% 0%
The situation has not gotten better. They told me they would wait before deciding to start a new therapy. They were afraid’.
Submission 0% 0% 0% 14% 50% 0% 0% 0% 0%
‘He was feeling better, but his parents didn’t allow him to do anything’. ‘On that occasion, I had managed to re-establish contact with the patient and gain their esteem and confidence, but actually, I was not totally sure. Indeed, at the first visit after release from the hospital, her father accompanied her punctually, but he never returned for follow-up visits’.
Positive 96% 50% 73% 86% 0% 100% 100% 50% 100%
He was not obligated to use the bronchodilator continuously anymore. He said, “I used to not care about it, but now it is a new and different life for me! Now I can see and feel the difference!”’ ‘She ran towards me and embraced and kissed me. She said that thanks to me she could realise her dream to swim’.
Hatred and anger 0% 50% 9% 0% 50% 0% 0% 50% 0%
‘Her dream was dancing, but she was continuously tired, more often than other girls, and she felt shame because of her problem with her weight’
Anticipation 4% 0% 9% 0% 0% 0% 0% 0% 0%
‘The little girl appeared calm and she seemed to have accepted both the exams and therapies that will follow’
Emotions at the end (RSs in regard to adult patients) (N = 72) (N = 6) (N = 50) (N = 39) (N = 3) (N = 10) (N = 2) (N = 3) (N = 6)
Fear and sadness 4% 33% 2% 0% 0% 0% 0% 0% 0%
‘The therapy for asthma, in her case, was not successful and it didn’t allow her a normal life or the tranquillity to raise her children well’. ‘She usually came back to my center and now has accepted treatment, but I don’t think she has yet to accept the psychological burden of her illness’.
Submission 0% 33% 0% 0% 0% 0% 0% 0% 0%
‘From the relationship I had with this patient, I have learned that acceptance of their illness could be less dramatic than the illness itself’.
Positive 4% 0% 86% 51% 0% 80% 0% 0% 33%
‘And I thought that the therapy would be effective overall!!’ ‘I have reached this goal: the happiness of a man who had met me having past failures ’.
Hate and anger 1% 1% 0% 3% 67% 0% 50% 67% 33%
‘In this case, biological therapy, although efficacious, was not possible due to patient anxiety, probably amplified by the patient’s family situation and by unreliable data found online’. ‘I was not sad knowing she would not return and I thought that anyone could be nice to everyone in this world, and this was one of those kinds of cases’.
Anticipation 0% 33% 0% 0% 0% 0% 0% 0% 0%
‘I decided, at the third visit, to accept her in a clinical study for a new therapy (double blind versus placebo), and she accepted despite several kilometres that she has to do each time, and despite she knows she could receive placebo…’
Emotions at the end (RSs in regard to paediatric patients) (N = 23) (N = 3) (N = 11) (N = 5) (N = 3) (N = 3) (N = 5) (N = 2) (N = 2)
Fear and sadness 0% 50% 0% 17% 0% 0% 0% 50% 0%
‘The patient appeared me quite calm, but less than his usual because in that afternoon he would have the examination and the medical visit for having the Suitability to sport. He plays tennis and he loves it’
Submission 0% 0% 0% 0% 33% 0% 0% 0% 0%
‘I thought something could had changed for this child thanks to benefiting of the therapy, but his parents were too overprotective and anxious’
Positive 87% 50% 100% 83% 0% 100% 100% 50% 100%
‘I arranged with her mother to go to the swimming pool to surprise my patient. Immediately she ran to embrace me, doing the “peace sign” with the hands. Her face emanated joy, and I was incredibly touched by seeing her swimming’.
Hate and anger 9% 0% 0% 0% 67% 0% 0% 0% 0%
‘I thought that perhaps what I had been doing would be useless since the patient and his family seemed to be indifferent’. ‘I thought that the boy’s health was more important than anything else, so his mother must better organise her time since the dates for injections had been communicated to them in time!!’
Anticipation 0% 0% 0% 0% 0% 0% 0% 0% 0%
Not Applicable (N/A)