Kleinman's 8 questions

Illness Narrative Assignment guidelines Due Sunday April 12, 2015

11:59pm Background: Illness Narrative Arthur Kleinman is a doctor and anthropologist who has created a set of questions to help guide patient interviews as a way to “understand beliefs the patient holds about his illness, the personal and social meaning he attaches to his disorder, his expectations about what will happen to him and what the doctor will do, and his own therapeutic goals.” Conducting this type of interview aims to help guide the doctor in working with the patient to ensure that the care is beneficial and effective. Below this assignment I have attached a summary PDF article about Kleinman’s explanatory model. Here are the 8 questions suggested by Kleinman, use them to frame your interview with someone with a chronic condition. 1. What do you think caused your problem? (For all questions substitute “problem”

and “it” and “sickness” with “diabetes” or “cancer” etc. ) 2. Why do you think it started when it did? 3. What do you think your sickness does to you? 4. How severe is your sickness? Do you think it will last a long time,

or will it be better soon in your opinion? 5. What are the chief problems your sickness has caused for you? 6. What do you fear most about your sickness? 7. What kind of treatment do you think you should receive? 8. What are the most important results you hope to get from

treatment? A final question I encourage you ask is how this “illness” has impacted their families and friends—especially if they didn’t bring this up during their narrative.

  I have included an article briefly describing Kleinman’s model under our “readings section” please read it as an important background piece to this assignment. Please review these website for examples of how providers and other health professionals use illness narratives to understand how people understand and explain their illness. 1. Diabetes Spectrum http://spectrum.diabetesjournals.org/content/17/4/219.full Check out how they modified Kleiman’s questions to focus on diabetes. 2. Check the Kandula article on Canvas below this assignment.

Your assignment For this assignment you will need to identify someone you know with a chronic illness to conduct a brief interview with and write up a summary and analysis of the interview. I encourage you to identify someone very soon as you will need time to prepare your interview questions and schedule the interview. Talking to someone with a chronic health condition will you understand how someone with a chronic illness is impacted over the course of his or her life. An illness narrative can help you understand the larger issues outside of the medical setting that impact the experience a person has with a chronic conditions such as diabetes, cancer, Alzheimer’s, multiple sclerosis, fibromyalgia, or HIV. You should use and modify Kleinman’s 8 questions to help guide your interview. Feel free to add questions, but don’t get too specific, remember these questions are meant to very open ended to allow the respondent to share their story. Feel free to build off your respondent’s answers to ask follow up questions. For example, if your respondent states that their fibromyalgia began after the moved to a new city, you could ask some follow up questions on why that move may have impacted the condition, how did it impact their mental health, exercise, etc. If they think their disease was caused by their genetic makeup ask them why they think that. DO NOT judge, CORRECT or EDUCATE at any point, as it may come off as OFFENSIVE or JUDGEMENTAL. Try not to help diagnose, provide recommendations, or guide what you think they should do. I know that you are nurses, and you want to help, but the purpose of the activity is to learn and get their perspective. You are there to listen, to get their STORY. Also, the purpose of the interview is not to ask about a particular therapy or treatment and how it’s used, AGAIN it is to let them tell their story. Let their story guide your interview. Use Kleinman’s questions to let them do so. I encourage you to audio record the interview and take detailed notes to help you remember their responses. An interview should last about an hour and should take place in a private and comfortable location for the respondent. After the interview you should take time to reflect on the experience and summarize your experience in your paper. Feel free to get creative, for example you can present the paper as a “letter” to this person’s doctor about how they view their illness, its course and what kind of treatment they would like to get. Assignment Guidelines 3-­‐4 pages, 1” margins, 12point font. Double spaced. Here is an outline of how to write your paper:

  Introduction—Who did you interview and why? Include a thesis statement* and make some conclusive observations about the main theme(s) of the interview. Please use a pseudonym (fake name) when writing this section. You should let the person you interview know that the interview is anonymous; that you will not be using their real name or providing any other details that could compromise their identity (address, phone number etc.)

Narrative—Describe their “narrative” or story related to this illness. Review all the questions you asked and summarize their responses. You should NOT write a transcript of your interview, instead you should summarize the story here and analyze their responses. You MAY use direct quotes in this section, but the majority of the content should be in your own words. Did they focus only on the physical issues or did they emphasize how it has impacted their social, family or economic life? Etc. Use examples from the interview. Reflection—How did the 8 questions help you gain a perspective on how this individual? What benefit did they/you gain in sharing/writing this story? Conclusion—Summarize your paper. What role should narratives play in our study of health/illness?

  * Important: Please research what a THESIS STATEMENT is and what it should do for your paper, failure to have a thesis statement will result in an automatic 5 point deduction. READ THE ATTACHED PDF describing the Explanatory Model further.

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APPENDIX 2

Kleinman’s Explanatory Model of Illness

Kleinman and associates (1978) in their seminal paper further dis- cuss the importance of the explanatory model: “Eliciting the patient’s (explanatory) model gives the physician knowledge of the beliefs the patient holds about his illness, the personal and social meaning he attaches to his disorder, his expectations about what will happen to him and what the doctor will do, and his own therapeutic goals. Comparison of patient model with the doctor’s model enables the clinician to identify major discrepancies that may cause problems for clinical management. Such comparisons also help the clinician know which aspects of his explanatory model need clearer exposition to patients (and families), and what sort of patient education is most appropriate. And they clarify conflicts not related to different levels of knowledge but different values and interests. Part of the clinical process involves negotiations between these explanatory models, once they have been made explicit.”

Eliciting the Patient’s Explanatory Model of illness through a set of targeted questions shown below is an important tool for facilitat- ing cross-cultural communication, ensuring patient understanding, and identifying areas of conflict that will need to be negotiated. The wording and number of questions used will vary depending on the characteristics of the patient, the problem, and the setting.! What do you think has caused your problem?! Why do you think it started when it did?! What do you think your sickness does to you? How does it work?! How severe is your sickness? Will it have a short or long course?! What kind of treatment do you think you should receive?

217

Achieving Cultural Competency: A Case-Based Approach to Training Health Professionals

Edited by L. Hark, H. DeLisser © 2009 Blackwell Publishing Ltd. ISBN: 978-1-405-18072-6

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218 Appendix 2

! What are the most important results you hope to receive from this treatment?! What are the chief problems your sickness has caused for you?! What do you fear most about your sickness?

Adapted from, Kleinman A., Eisenberg L., Good B. Culture, illness, and care: clinical lessons from anthropological and cross-cultural research. Ann Intern Med 1978;88:251–88.

Illness Narrative Assignment guidelines

Kleinman¹s Explanatory Model of Illness

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