Integrity in patients' stories: 'Meaning-making' through narrative in supportive cancer care

Introduction'Personal integrity' refers to a 'state of being whole, entire, undiminished'. To help patients preserve a sense of integrity, care needs to be responsive to their individual illness experience. This study explores 'holistic assessment', a consultation in which patients with cancer tell their illness story to a health professional who responds to the integrity of their story and the whole person, in contrast to the reductionist approach taken by specialists treating the disease.MethodologyAn ethnographic study of two UK centres that provide CAM therapies to patients with cancer, using non-participant observation of thirty four holistic assessments with a maximum diversity sample of patients. Sessions were audio-recorded and transcribed. The data were analysed using a narrative approach with the support of Atlas.ti software.ResultsDuring holistic assessment, patients told long stories about their illness experience. A typology of stories emerged: 'factual', 'emotional' and 'moral', with over-arching processes common to all: Loss, uncertainty and conflict, embracing or resisting change. Patients' stories provided a 'window' into their inner experience, in a collaborative activity with the listener. This provided cues and information about supportive care needs and also contributed to a process of personal meaning-making for patients.DiscussionMaking meaning is an important part of adjusting to a life-threatening illness. Holistic assessment allows patients to express and integrate their vulnerable self, alongside the strong image many feel the need to project in everyday life. The need for holistic assessment within mainstream care has recently been recognised in the UK.