AN EXPLORATORY STUDY COMPARING NARRATIVE VERSUS NUMERICAL DISPLAY OF FUNCTIONAL INFORMATION

Purpose: Contextual information consists of functional, social, and financial information about patients. Physicians routinely fail to incorporate contextual information into decision-making despite the emphasis on patient-centered care and functional status. The purpose of this study was to examine the hypothesis that contextual information is best understood and recalled when presented in a narrative form as compared to a numerical form.

Method: The design was a 2-between (presentation form) by 2-within (order of vignettes). Each vignette had two forms for presenting functional information, a narrative “Story-form” format which included patient goals, versus a numerical/tabulated presentation of functional and mental status.

   Thirty volunteer MD residents, nurse practitioners, and staff physicians from an urban, academically affiliated VA Medical Center were asked to read the vignettes and to identify: 1) the top 3 issues for the patient, and 2) the top 3 factors used in considering their plan. Each response was coded as being either "medical" (e.g. diagnosis, lab, medications) or "contextual" (living arrangements, financial, or patient goals) or both by the research team (n=5) through a consensus process. The proportions of total items identified within each category were the dependent variables.

Result: Using within by between subjects ANOVA, the authors found significant differences between the narrative and numerical form of information presentation with those receiving the vignette containing the narrative form for functional information being more likely to list a contextual topic as a top issue (F_1,56 = 5.21; p=0.03; M(narrative group) = 69% and M(numerical group)= 31%). However, there was no difference between the groups for the top most important factor relevant to decision-making. Details regarding identified factors recalled will be presented.

Conclusion: The results of this exploratory study indicate that narrative information may be a better method of communicating functional and goal information. Although these results do not directly deal with the quality of decisions, they do indicate what information was attended to and what was considered important as a function of how it is displayed.

   Narrative may support the abstract processing which is required to ensure that the “gist” of the situation is attended to and addressed, which may be particularly important for contextual information.  Knowing the “big picture” is one of the key components of effective decision-making and effective communication.