Assessing Attitudes Towards Narrative Medicine among Palliative Care Patients and Providers in Rural Kenya (GP107)

Outcomes1. Describe the impact of storytelling in the context of palliative care and evaluate whether it has particular utility in non-Western, resource-variable contexts.2. Discuss how stigma, including spiritual stigma, plays a major role in patient narratives and its impact on the valuing and seeking of palliative care in Kenya.Key MessageThis project investigated the utility of storytelling and narrative medicine among palliative care patients and providers in Kenya. Do patients share stories about their illness? If so, to whom? If not, what barriers do they face? How can we better hear stories of palliative patients, especially those from underserved communities?ImportanceNarrative medicine supports that storytelling is an effective tool for training clinicians in empathy while also allowing patients to make meaning of suffering and gain agency.1–4 However, narrative medicine has largely been established in the West, and the translatability of narrative medicine to non-Western settings is relatively unknown.5Objective(s)This hypothesis-generating project aimed to understand 1) patient and provider attitudes in Kenya towards sharing personal stories in a medical context, 2) imagined benefits or barriers to storytelling, and 3) how Kenyan culture/spirituality impacts a patient's willingness to share their story.Scientific Methods UtilizedSemi-structured interviews were conducted in English and Swahili with patients and providers recruited from a rural, outpatient palliative care clinic in Kenya. Interviews were transcribed, translated, and analysed following grounded theory of qualitative analysis.6Results9 patients (56% female, median age 56) and 5 providers (80% female, median age 32) completed interviews, with 11 done in English and 3 in Swahili. Both patients and providers supported sharing stories as a means to receive/provide comprehensive medical care. Patients reflected on storytelling as a medium to manifest healing through positivity or spirituality. Barriers to patient storytelling included stigmas surrounding palliative care and cancer and desire for privacy. Providers further identified stigma, financial burdens, and gendered expectations as potential barriers. Lastly, interviews revealed how belief in divine healing carried its own stigma as palliative patients contended with not being healed by God.Conclusion(s)Patients and providers perceived benefit in patients sharing stories of their illness experience within medical contexts. However, stigma, spiritual concerns, and financial strains may limit willingness to share freely.ImpactThis work highlights how pervasive stigma surrounding cancer and palliative care in Kenya may impact patient storytelling and subsequent health-seeking behaviors. We may consider future interventions utilizing patient narratives to reduce stigma, increase uptake of care, and improve patient experience.